DRG

DRG

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  AR-DRG www.thecodingcompany.sa
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  AR-DRG • Australian RefinedDiagnosis Related Group • Patient classification scheme (based on ICD-10-AM codes) • Group the patients treated in a hospital according to clinical characteristics and resource use. www.thecodingcompany.sa
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  • The AR-DRGgrouper applies both “Demographic" and “Clinical" edits. • AR-DRG has 4 alpha-numeric characters. www.thecodingcompany.sa
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  Length of Stay Payment Primary Diagnosis Secondary Diagnosis Operating Procedures Adm. Data Severity Coding Grouper DRG Payment www.thecodingcompany.sa
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  AR-DRG www.thecodingcompany.sa
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  AR-DRG www.thecodingcompany.sa
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  AR-DRG www.thecodingcompany.sa
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  Group of Patients withHomogenous Resources Consumption = DRG Patient Variables Medical & Management Decision Variables gender, age, main diagnosis, other diagnoses, severity www.thecodingcompany.sa mix and intensity of procedures, technologies and human resource use
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  www.thecodingcompany.sa
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  What Impact WillICD-10 Have On AR-DRG Payments? Lack of ‘specificity’ for a certain diagnosis as documented in the record, could have the potential of not capturing the CC/MCC which could result in a lower paying AR-DRG. AR-DRG shifts could occur due to improper training of the coding staff. This incorrect code assignment could also potentially cause changes within the AR-DRGs resulting in payment increases or decreases www.thecodingcompany.sa
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  35 Year-old Malew/ Pancreatitis ( Risk = $1,958) Diagnoses K850 - Idiopathic acute pancreatitis E803 - Defects of Catalase and Perioxidase E162 - Hypoglycemia DRG 439 Disorders of pancreas exc. malignancy w CC $6,144.60 Diagnoses K850 – Idiopathic acute pancreatitis E889 – Metabolic disorder, unspecified E162 – Hypoglycemia DRG 440 Disorders of pancreas exc. malignancy w/o CC/MCC $4,186.20 Revenue Impact www.thecodingcompany.sa