Update of Annex D of the Definitions Manual

Reason for updating Annex D

For the SK-DRG-2023 version of the system, CKS plans to update Annex D of the Definition Manual, which describes the process of verifying demographic and clinical data in the process of assigning a hospital case to a DRG group.

Annex D was added to the Definition Manual in the SK-DRG-2019 version. Compared to the G-DRG, the entire Annex was not translated when added - important sections were omitted that clarify the distinction between an unavoidable error (fatal flag) and a warning flag. All clinical variable conflict tables need to be seen in the context of the distinction between flag and fatal flag, so the CKS proposes to update Annex D, Volume 5 of the Definitions Manual, which will modify the SK-DRG 2023 system settings (the updated sections are shown in colour) in the form described below.

Wording of the proposed update

D.1 Introduction

Prior to assigning a case to an MDC category, the Grouper validates the validity of individual variables based on demographic and clinical data. During this verification, a warning flag (flag) may be generated if the program encounters invalid information or inconsistencies. In addition, an unavoidable error (fatal flag) is displayed if the MDC/DRG cannot be assigned due to a problem (e.g., invalid age information). Records with an unavoidable error are assigned to one of the When some major inconsistencies or invalid data are found in the processing process, resulting in the case not being able to be assigned to any MDC/DRG, the assignment results in one of three DRG groups: 960Z, 961Z or 963Z

The following section of this appendix provides more information on each variable.

D.2 Demographic data

(not to be changed)

D.3 Allowable values for clinical variables

The grouper validates all diagnoses and procedures not only in relation to the ICD-10-SK and ICD-DRG codes but also in relation to the age and sex of the patient. Codes that occur more than once are ignored if they relate to diagnoses, but not if they relate to medical procedures. In addition, the principal diagnosis  is verified , in order to ensure an acceptable principal diagnosis, that it is not a manifestation code, i.e. a code with an asterisk, or a code describing an external cause of injury or poisoning (see groups V, W, X and Y of the ICD-10-SK), or a code with an exclamation mark, to see if the diagnosis is allowed as a principal diagnosis (see coding rules in the DRG system).

The validity of combinations of obstetric diagnosis and medical procedure codes is also checked. If a caesarean section was included in the diagnosis but no procedure code was recorded, the case will be assigned to DRG 962Z Unacceptable coding for caesarean section.

D.4 Warning signs and unavoidable errors

As previously mentioned, both warning flags (flags) and fatal flags (flags) may be generated during the verification of demographic and clinical characteristics. In principle, the following applies:

1. All inadmissible principal diagnoses (Table D.7) are fatal flags and cause the inpatient case to be assigned to error DRG 961Z Inadmissible principal diagnosis.
2. Most of the codes in the Infant Age Conflict Table (Table D.4a) are fatal flags if they are reported as a principal diagnosis and
   1. the patient is between 28 and 364/5 days of age and has an admission weight greater than 2,500 grams; or
   2. the patient is 1 year of age or older. Hospitalization cases for treatment of infants with such a defect are included in DRG 963Z Neonatal diagnosis incompatible with age or weight.
   Hospitalization cases of infants treated with this defect are classified in DRG 963Z Newborn diagnosis incompatible with age or weight.
3. Some of the diagnosis codes in the two gender conflict tables (Tables D.5a and D.7c) may also represent fatal flags if the hospitalisation case is assigned to an MDC for which the selection depends on the gender of the hospitalisation case (MDC 12 Diseases of the male genital organs, MDC 13 Diseases of the female genital organs, MDC 14 Pregnancy, childbirth and sextuplets). Hospitalization cases for which the gender conflict represents an unavoidable error are assigned to an MDC that is determined by the principal diagnosis, but are assigned to DRG 960Z Unclassifiable Groups.
4. All other clinical symptoms - code for external cause, conflict with age and conflict with gender (except for diagnoses that only relate to MDC 12, MDC 13 or MDC 14) - are flagged as a warning flag but are not an unavoidable error (fatal flag).

D.6 Grouper status

At the end of the inpatient case assignment, a grouper status (hereafter GST) is assigned to each inpatient case to indicate successful completion of the assignment process. If the grouper encounters missing or invalid information when attempting DRG assignment, the record is assigned to DRG 960Z Unclassifiable groupers with a non-zero grouper status error type. If the case cannot be assigned to a DRG grouper based on missing or invalid information, the inpatient case is assigned to DRG 960Z Unclassifiable groupers. More details on the individual GST values are provided in the following table.

With the exception of the Age field, demographic data marked with a warning flag ("flag") does not result in grouper status with a non-zero grouping number unless a corresponding classification variable is required for inclusion. For example, gender is not used as a classification variable for DRGs in MDC 01 Diseases and Disorders of the Nervous System, so an invalid entry in the Gender field would not affect the DRG assignment and the resulting GST would be "00". However, if an inpatient case with an invalid gender field was assigned to MDC 14 Pregnancy, Birth and Postpartum, it would not be eligible for DRG assignment and would receive a GST of "05".