Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, Република Србија МИНИСТАРСТВО ЗДРАВЉА Linda Best Tuesday, 6th December 2011 Coding for AR-DRG analysis and funding

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, Република Србија МИНИСТАРСТВО ЗДРАВЉА What are coded data used for?  Many uses, including: - Casemix, diagnosis related groups (DRGs) - Research - National morbidity statistics - Health services planning and evaluation - Quality assurance activities - Epidemiology

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, Република Србија МИНИСТАРСТВО ЗДРАВЉА The building blocks  ICD-10-AM and ACHI codes are the building blocks of AR-DRGs used in many settings as health care funding mechanisms.  The principal diagnosis, additional diagnoses and interventions, as documented in the clinical record, are converted into ICD-10-AM and ACHI codes. These codes are then used in the grouping process.

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, Република Србија МИНИСТАРСТВО ЗДРАВЉА Calculating an AR-DRG: Data Items Required ICD-10-AM/ACHI Codes -Principal diagnosis -Additional diagnoses, such as complications and comorbidities -Procedure/s ICD-10-AM/ACHI Codes -Principal diagnosis -Additional diagnoses, such as complications and comorbidities -Procedure/s Mode of separation (discharge status) -Includes died, transferred Mode of separation (discharge status) -Includes died, transferred Sex Same-day Status Newborn admission weight -For age 28 days or less, plus older if less than 2500 grams Newborn admission weight -For age 28 days or less, plus older if less than 2500 grams Length Of Stay -Or Admission and Separation Dates Length Of Stay -Or Admission and Separation Dates

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, Република Србија МИНИСТАРСТВО ЗДРАВЉА If it’s not written, it didn’t happen!  The production of quality clinical data is a collaborative effort  Channels of communication between clinicians and clinical coders should be open and frequently used  Quality documentation supports quality coding which results in appropriate AR-DRG allocation

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, Република Србија МИНИСТАРСТВО ЗДРАВЉА Good clinical documentation The most appropriate AR-DRG can only be assigned to an episode of patient care when relevant clinical information is accurately documented in the clinical record

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, Република Србија МИНИСТАРСТВО ЗДРАВЉА Good clinical documentation cont.  Need clear and complete documentation  Important for clinical specialties to understand what information can impact on DRG assignment

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, Република Србија МИНИСТАРСТВО ЗДРАВЉА Dementia – impact on DRG assignment Age 69 years Gender Male Diagnosis Cognitive impairment Principal diagnosis R41.8 Other and unspecified symptoms and signs involving cognitive functions and awareness MDC 23 Factors influencing health status and other contacts with health services DRG Z61A Signs and symptoms AR-DRG cost weight 0.67 ALOS 2.71 days Reimbursement $2,617

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, Република Србија МИНИСТАРСТВО ЗДРАВЉА Dementia – impact on DRG assignment cont. Diagnosis Mild cognitive disorder Principal diagnosis F06.7 Mild cognitive disorder MDC 01 Diseases and disorders of the nervous system DRG B64B Delirium without catastrophic complication and/or comorbidity AR-DRG cost weight 1.40 ALOS 6.03 days Reimbursement $5,452

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, Република Србија МИНИСТАРСТВО ЗДРАВЉА Diagnosis Cognitive change due to dementia Principal diagnosis F03 Unspecified dementia MDC 01 Diseases and disorders of the nervous system DRG B63Z Dementia and other chronic disturbances of cerebral function AR-DRG cost weight 2.70 ALOS days Reimbursement $10,562 Dementia – impact on DRG assignment cont.