Transcript Slide 1

HRG4
Background
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HRG4 (1)
• Moving from A01 (Chapter, Number) to
AA01A (Chapter, Sub Chapter, Number, Split e.g. <19)
• Supported by OPC4.3 (>2000 new codes >25% more)
with 1400 groups under HRG4 vs 650 under HRG vn3.5
• Greater setting independance
• This is more about Inpatients then anything else
although A&E has 8 categories rather than current 3
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HRG4 (2)
• Technically Outpatients are identified by one single
HRG4 group
• But then Treatment Function Code used by PbR for
billing purposes
• So no real change from a practical point of view
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HRG4 (3)
• 3 levels of complications / co morbidities (none,
intermediate, major) vs current 2 (with or without)
• Separate Paediatrics, new age split and splits on LoS
• So to summarise the average tariff under HRGvn3.5
splits out into the simple and complex tariff under HRG4
in a more refined way
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HRG4 (4)
• HRG4 covers more services
• Chemotherapy
• Critical Care
• Diagnostic Imaging
• Emergency & Urgent Care
• Rehabilitation
• Radiotherapy
• Specialist Palliative Care
But this does not mean PbR covers more services
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HRG4 (5)
• It accommodates multiple procedures i.e.
• Not global, chapter specific
• Takes account of bilaterals
• Applies escalator logic & considers all coding not just
dominant FCE
• FCE ANGIOGRAPHY EA41Z Cardiac Catheterisation
• + FCE CORONARY BYPASS EA14Z
• = SPELL EA15Z- Coronary Artery Bypass Graft with Cardiac
Catheterisation
• If first FCE has >1 trauma diagnosis then multiple
trauma HRG
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HRG4 (6)
• HRGvn3.5
D39 Chronic Obstructive Pulmonary Disease or Bronchitis with CC
D40 Chronic Obstructive Pulmonary Disease or Bronchitis without CC
• HRG4
DZ21A Chronic Obstructive Pulmonary Disease or Bronchitis with length of stay 1 day or less discharged home
DZ21B Chronic Obstructive Pulmonary Disease or Bronchitis with Intubation with Major CC
DZ21C Chronic Obstructive Pulmonary Disease or Bronchitis with Intubation with CC
DZ21D Chronic Obstructive Pulmonary Disease or Bronchitis with Intubation without CC
DZ21E Chronic Obstructive Pulmonary Disease or Bronchitis with NIV without Intubation with Major CC
DZ21F Chronic Obstructive Pulmonary Disease or Bronchitis with NIV without Intubation with CC
DZ21G Chronic Obstructive Pulmonary Disease or Bronchitis with NIV without Intubation without CC
DZ21H Chronic Obstructive Pulmonary Disease or Bronchitis without NIV without Intubation with Major CC
DZ21J Chronic Obstructive Pulmonary Disease or Bronchitis without NIV without Intubation with CC
DZ21K Chronic Obstructive Pulmonary Disease or Bronchitis without NIV without Intubation without CC
• Improved granularity in terms of complications
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HRG4 (7)
• HRGvn3.5
C35 Major Maxillo-facial/ENT Procedures
• HRG4
CZ18R Major Maxillo-facial Procedures 19 years and over
CZ18U Major Maxillo-facial Procedures 18 years and under
• Improved granularity re age split
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HRG4 (8)
• HRGvn3.5
E15 Percutaneous Coronary Intervention
• HRG4
EA31Z
EA32Z
EA33Z
EA34Z
Percutaneous Coronary Intervention (0-2 Stents)
Percutaneous Coronary Intervention (0-2 stents) and Catheterisation
Percutaneous Coronary Interventions with 3 or more Stents
Percutaneous Coronary Interventions with 3 or more Stents and Catheterisation
• Improved granularity re defining the type of care given
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HRG4 (9)
• HRGvn3.5
S24 Respite Care
• HRG4
WA15K Respite care length of stay 9 days or more with Major CC
WA15L Respite care length of stay 9 days or more with Intermediate CC
WA15M Respite care length of stay 9 days or more without CC
WA15N Respite care length of stay between 5 and 8 days with Major CC
WA15O Respite care length of stay between 5 and 8 days with Intermediate CC
WA15P Respite care length of stay between 5 and 8 days without CC
WA15S Respite care length of stay 4 days or less with Major CC
WA15T Respite care length of stay 4 days or less with Intermediate CC
WA15U Respite care length of stay 4 days or less without CC
• Improved granularity re LoS
But this does not mean PbR covers more services just that
they are in more detail
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HRG4 (10)
• One spell can now have multiple HRGs e.g. Procedure
HRG + Critical Care HRGs.
• HRG4 identifies services that could be unbundled:
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Renal Dialysis (chapter LC)
Diagnostic Imaging (RA)
Chemotherapy (SB)
Radiotherapy (SC)
Specialist Palliative Care (SD)
Rehabilitation (VC)
Critical Care (XA to XC)
High Cost Drugs (XD)
HRG4 can unbundle doesn’t mean PbR does
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HRG4 (11)
• Chemotherapy split between Drug Procurement (for
each drug cycle or regimen: SB01Z to SB10Z) and
Delivery (attendance for treatment: SB11Z to SB15Z)
• Only get Delivery Chemo HRGs for Outpatients or Day
Case i.e. Not Inpatients > 1 day length of stay
• Chemotherapy excluded so drugs used as part of the
service also excluded.
• However the drug might also be excluded in its own right
(e.g. Rituximab) regardless of the service
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HRG4 (12)
• High Cost Drugs: XD01Z through to XD38Z
• To see full list of XD descriptions go to down load the code to group zip file
at www.ic.nhs.uk/services/casemix/hrg4/prepare-for-hrg4 towards the
bottom under the heading “Code to Group Table (Updated Jan 08)”. Sheet
6 row 1352 downwards has the full list e.g. XD01Z Primary Pulmonary
Hypertension drugs band 1
• To see how it is coded in the same file go to sheet 10, in cell BA1 select
XD01 from the drop down and you see that OPCS code X821 Primary
pulmonary hypertension drugs Band 1 is how this HRG4 group is identified
• NB XD35 Other specified HCD and XD36 Unspecified
HCD
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HRG4 (13)
• Chemotherapy split between Drug Procurement (for
each drug cycle or regimen) and Delivery (attendance
for treatment)
• Only get Delivery Chemo HRGs for Outpatients or Day
Case i.e. Not Inpatients > 1 day length of stay
• Chemotherapy excluded so drugs used as part of the
service also excluded.
• However the drug might also be excluded in its own right
(e.g. Rituximab) regardless of the service
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HRG4 (14)
• Uncoded activity now has a more detailed error report
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UZ01
UZ02
UZ03
UZ04
UZ05
UZ06
UZ11
UZ12
Invalid Primary Diagnosis
Poorly Coded Primary Diagnosis
Age Conflicting with Diagnosis
Diagnosis Conflicting with Anatomical Sites
Invalid Primary Procedures
Poorly Coded Primary Procedures
NCC Failed to Group (Neonatal Critical Care)
PCC Failed to Group (Paediatric Critical Care)
So should be able to reduce the level of uncoded activity
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