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Back  RFI # 936: 2300:HI01-2 (HI01-1 = DR)

Formal vs. Informal Help Informal Formal

Submitter

Mike Reinsmith

Description

Several providers in New York and Massachusetts have expressed a need to append the 1-digit Severity of Illness (SOI) indicator and 1-digit Rate of Mortality (ROM) indicator to the DRG in loop/segment 2300:HI01-2 (HI01-1 = DR) for Medicaid HMO payers. Would this be considered an acceptable use of this segment or is the intended use strictly the DRG number? As an HIS vendor we don't want to set a precedent for improper use of a HIPAA standard transaction segment, so we are seeking approval or guidance as to the proper method of reporting this information on the 4010 as well as the 5010 837 transaction in a location that will be standard for all payers.

Submitter Assigned Keywords

Rate of Mortality ROM Severity of Illness SOI APR DRG

Response

The length of the DRG code is dependent upon the DRG grouper being utilized. It can be up to 5 digits in length at this time.

If the DRG grouper software requirements use the Severity of Illness (which would represent the 4th digit of a DRG Code) or the Rate of Mortality (which would represent the 5th digit of a DRG Code) then it would be appropriate to utilize the 2300 DRG HI Segment when submitting a DRG code that include a 4th or 5th digit.
Submission 1/5/2010
Status Date 2/26/2010
Status F - Final
Primary References
Document 004010X096A1
Section3.1
Page230
Set IDHI
Loop2300
Segment Position231
Segment IDHI
Element Position01
Component Position-2
Industry NameDiagnostic Related Group (DRG) Code
External Code ListCode Source 229
Code ValueDRG