Stream: patient administration WG
Topic: DRG
Josh Barber (Apr 14 2020 at 02:24):
I am trying to understand how FHIR defines DRGs (diagnosis-related group) if there is not a claim. Perhaps I am misunderstanding, but it appears that DRGs are only related to a Claim resource (https://www.hl7.org/fhir/claim.html). However, the coding of a DRG can occur prior to the billing process beginning and in some systems this DRG is associated to an individual clinical encounter (visit) rather than a specific claim.
Am I misunderstanding how FHIR defines DRGs and the relationship to the Claim resource?
Keith Boone (Apr 17 2020 at 05:59):
DRG is a code classifying diagnosis by putting it into a category based on certain rules for coding for claims. In the context of a claim, it has a particular meaning for classification. Outside of a claim, it's still a code classifying a particular diagnosis. Thus, one might include the classification in Condition.category using the DRG codes, along with http://terminology.hl7.org/CodeSystem/condition-category#encounter-diagnosis.
René Spronk (Apr 17 2020 at 07:58):
Hmm. Never mix claim data with clinical data, as especially claim data may state 'different things' than the "true" clinical data (ever heard of upcoding?). As such, depending on context, regarding a DRG-related diagnosis as a Condition may be misleading from a pure clinical perspective.
Keith Boone (Apr 19 2020 at 02:37):
Claim data comes from clinical data, the mix can happen in another system, but it started off as clinical data. I wouldn't say never mix, but do make sure you know which set of mixing bowls you are using if doing so.
Simone Heckmann (Apr 22 2020 at 08:50):
I'd suggest to use ChargeItem for DRGs
Drew Torres (Aug 12 2020 at 19:45):
Is there a mapping available for how to map DRG to ChargeItem?
Matt Rouhana (Jul 02 2021 at 16:34):
Resurrecting this thread - it would be helpful to have a way to represent a DRG on the Encounter resource rather than Claim. In our use case, we're not particularly interested in financial/billing minutae, but regularly need to reference the DRG associated with a particular Encounter. Has there been any development on this front, in terms of extensions or otherwise?
Cooper Thompson (Jul 02 2021 at 16:46):
Would it be on the Encounter or Account?
Simone Heckmann (Jul 02 2021 at 16:48):
Both actually. Systems can use ChargeItem.context to indicate that an item belongs to an Encounter, whereas billing systems can additionally link the ChargeItem.account to the account which is applicable for the item.
Simone Heckmann (Jul 02 2021 at 16:54):
What else would we need but a VS Binding for ChargeItem.code to make it usable for DRGs?
Suggested Profile:
status = planned|billable|billed may be useful (required)
code = the DRG (required)
enteredDate (optional)
context = reference to Encounter (required)
account = reference to Account (optional)
forget about the rest, unless you need it...
@Udo Siefker @Bettina Lieske
Matt Rouhana (Jul 02 2021 at 21:51):
Simone Heckmann said:
Both actually. Systems can use ChargeItem.context to indicate that an item belongs to an Encounter, whereas billing systems can additionally link the ChargeItem.account to the account which is applicable for the item.
It would be useful to not need to introduce another resource and just extend encounter. Is there a standard way to do so?
Last updated: Apr 12 2022 at 19:14 UTC
