Stream: CARIN IG for Blue Button®
Topic: EOB Inpatient - DRG Code
Joel Hansen (Aetna) (Aug 04 2020 at 16:48):
Hi All,
Looking at the CARIN Inpatient IG and also the CARIN spreadsheet, we are working to map our DRG codes in to a supportinginfo slice for Inpatient. A couple of questions:
- In the IG, I see the code system is CMS-DRG, so we are assuming CARIN just wants the CMS/MS DRG codes and not the AP DRG codes which are a different set. Can you verify this assumption?
- We also have multiple MS-DRG codes, we have a Submitted DRG code which is the one sent in by the provider and an Adjudicated DRG code that could be a corrected DRG code from the adjudication process. We are assuming CARIN wants the Adjudicated DRG code. Can you verify this assumption?
Thank you,
Joel
Jason Teeple (Aug 04 2020 at 18:52):
+1 on Joel's question.
It looks like there was an update removing the MS-DRG fixed value.
Joel Hansen (Aetna) (Aug 10 2020 at 16:51):
Hi All, just checking if CARIN or other folks have any further input on this.
Thanks
Joel
Ryan Howells (Aug 13 2020 at 02:51):
Hey @Saul Kravitz @Amol Vyas @Pat Taylor @Igor Sirkovich. Your thoughts?
Pat Taylor (Aug 13 2020 at 11:51):
Hi Joel,
1: We would want the applicable DRG code; either CMS / MS DRG or the AP DRG, depending on the line of business.
2: Yes, we would want the Adjudicated DRG.
Thanks, Pat
Joel Hansen (Aetna) (Aug 13 2020 at 17:32):
@Pat Taylor @Jason Teeple
If/when the binding to MS-DRG is relaxed; we could have 3 code sets AP-DRG, ARP-DRG, MS-DRG. Should we plan for that now or just go with the MS-DRG binding in the CARIN stable IG?
Joel
Jason Teeple (Sep 22 2020 at 11:35):
Joel Hansen (Aetna) said:
Pat Taylor Jason Teeple
If/when the binding to MS-DRG is relaxed; we could have 3 code sets AP-DRG, ARP-DRG, MS-DRG. Should we plan for that now or just go with the MS-DRG binding in the CARIN stable IG?
Joel
@Pat Taylor do we have an answer for this question?
Pat Taylor (Sep 23 2020 at 11:36):
@Jason Teeple @Joel Hansen (Aetna) I'm defining the Value Set / Code System for the three DRGs as we speak so I would plan on moving forward with all three.
Jason Teeple (Sep 23 2020 at 14:52):
Thanks @Pat Taylor that is the direction I gave our team, just wanted to confirm.
Pat Taylor (Sep 30 2020 at 11:50):
@Jason Teeple @Joel Hansen (Aetna) We defined MS-DRG and APR-DRG. My understanding is that AP-DRG isn't used anymore. @Amol Vyas
Last updated: Apr 12 2022 at 19:14 UTC
