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Back  RFI # 2191: Severity of Illness DRG Codes

Formal vs. Informal Help Informal Formal

Submitter

Hacker Michael

Description

This is not a request for interpretation, but a question about the Severity of Illness DRG codes for a Payer's requirements. The Payer is requesting the Severity of Illness codes (1-4) be added to the claims, but I do not see any loop or segment in the 5010 837 Inst guidelines for this information. Will this be added to the 5010 guidelines, or dealt with in a newer version?

Response

Within the 005010X223A2 5010 837 Institutional TR3, the 2300 HI - DIAGNOSIS RELATED GROUP (DRG) INFORMATION, HI01-02 data element has size attributes of a minimum of 1 and maximum of 30. This allows for the severity of illness code of the DRG to be included.

Recommendation

Please see RFI #936 for more discussion on the Severity of Illness component of DRG's.
Submission 1/24/2017
Status Date 5/5/2017
Status F - Final
Primary References
Document 005010X223
Section2300 HI
Page218