Update of Annex D of the Definitions Manual

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 has been added to the Definitions Manual in the SK-DRG-2019 version. Compared to the G-DRG, the whole annex has not been translated - important parts have been omitted, which specify the distinction between an unavoidable error ( fatal flag) and a warning flag ( flag). All tables of clinical variable conflicts 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.

Before assigning a case to an MDC category, the Grouper validates the validity of each variable 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 annex provides more information on each variable.

(no need to change)

Grouper verifies the validity of all diagnoses and procedures not only in relation to the ICD-10-SK and ZZV-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 obstetric diagnosis combinations 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.

As mentioned above, both warning flags and fatal flags can be generated during the verification of demographic and clinical characteristics. In principle, the following applies:

At the end of the inpatient case assignment, each inpatient case is assigned a grouper status (hereafter GST), which indicates the 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 with a non-zero grouper status error type. If the case cannot be assigned to a DRG group 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".