Transcript Klasifikasi, Kodifikasi Penyakit 9 Pertemuan 10

6b
DRGs-CASE-MIX
Disusun oleh:
Dr Mayang Anggraini Naga
Revisi 2012
1
DESKRIPSI
Campuran dari tipe-tipe pasien-pasien
yang diterapi rumah sakit atau fasilitas
asuhan kesehatan perlu disusun melalui
suatu sistem pengelompokkan agar bisa
digunakan sebagai dasar pembaiyaan
asuhan medis pelayanan kesehatan
secara nasional.
2
SAP
Penjelasan tentang
CASEMIX sebagai Instrumen Informasi
yang melibatkan penggunaan metode
ilmiah untuk pengembangan dan
pendayagunaan klasifikasi episodeepisode asuhan pasien.
3
KOMPETENSI
Mampu:
Menjelaskan dasar penyusunan
Sistem Pembiayaan Asuhan Medis
berbasis diagnosis
Berperan aktif dalam pengembangan
sistem pembiayan asuhan medis
4
PENGENALAN
CASMIX *
(* Petikan dari Kathy Eagar, A Short Introduction to Casemix, 1994)
Disusun oleh dr. Mayang Anggraini Naga
CASEMIX
Information tool involving the use of
scientific methods to build and make
use of:
classifications of patient care episodes.
( = the mix of types of patients treated by
hospital or other health care facility)
5
PENGENALAN
CASMIX *
(* Petikan dari Kathy Eagar, A Short Introduction to Casemix, 1994)
Disusun oleh dr. Mayang Anggraini Naga
CASEMIX
Instrumen Informasi yang melibatkan
penggunaan metode ilmiah
untuk
mengembangkan dan pendayagunaan
klasifikasi episode-episode asuhan pasien.
( = campuran dari tipe-tipe pasien-pasien yang
diterapi rumah sakit atau fasilitas asuhan kesehatan)
6
CASEMIX-ADJUSTED
=
Statistics where the effects
of variations in casemix have
been taken into account.
(=
Pemaparan statistik yang
memperhitungkan variasi
efek dalam casemix)
7
CASEMIX-ADJUSTED COST
PER INPATIENT
= The total cost of provision of inpatient
care, divided by total inpatients treated;
and adjusted to take account of the
actual mix of patients treated and
differences in the mean costs of
casemix classes
8
CASEMIX-ADJUSTED COST
PER INPATIENT
= Jumlah biaya provisi asuhan pasien
rawat inap, dibagi oleh jumlah total
pasien rawat-inap yang diterapi; dan di
sesuaikan dengan mengingat mix-pasien
rawat yang nyata dan perbedaan rata-rata
biaya klas case-mix
9
CASEMIX-BASED FUNDING
= A method of funding similar
(and in some circumstances identical)
to output-based funding.
Involves funding of the health care
products of health care delivery units,
where the products are categorized
using CASEMIX CLASSIFICATION.
10
CASEMIX-BASED FUNDING
= Suatu metode pembiayaan yang similar
(dan pada kondisi lingkungan yang identik)
terhadap output-based funding (pembiayaan
berbasis keluaran). melibatkan pembiayaan
asuhan kesehatan produk penyelenggaraan
unit asuhan kesehatan, yang produknya
dikategorikan sesuai KLASIFIKASI CASEMIX
11
TASK WHERE PATIENT CLASSIFCATION
CAN HELP
• Deciding whether re-admission rates are
abnormally high
(Penentuan apakah laju re-admisi abnormal
tinggi)
• Deciding whether too many or too few
pathology tests are being ordered
(Penentuan apakah test-test patologis yang
diperintahkan terlalu banyak atau terlalu sedikit)
12
TASK WHERE PATIENT CLASSIFCATION CAN HELP (Cont.-1)
• Finding and fixing problems of poor outcome
for rehabilitation patients
(Temuan dan penentuan masalah-masalah
terkait keluaran yang buruk bagi pasien-pasien
rehabilitasi)
• Designing benefits structures in private
insurance
(Mendesain struktur yang menguntungkan pada
asuransi privat)
13
TASK WHERE PATIENT CLASSIFCATION CAN HELP (Cont.-2)
• Deciding how resources should be allocated
between public hospitals
(Memutuskan bagaimana sumber daya harus
dialokasi di antara rumah sakit umum)
• Allocating funds between hospital
departments
(Mengalokasikan anggaran pembiayaan antara
departemen di rumah sakit)
14
TASK WHERE PATIENT CLASSIFCATION CAN HELP (Cont.-3)
• Planning bed and staff numbers for new
hospital
(Perencanaan tempat tidur dan staf bagi rumah
sakit baru)
• Investigating whether the nurse staffing mix
needs to be changed.
(Menginvestigasi apakah nurse staffing needs,
kebutuhan staf perawat perlu diubah)
15
USES OF PATIENT CLASSIFICATION
• Patient classifications are useful because
they help us to find differences in:
outcome,
quality, or
cost of care.
(Klasifikasi pasien berguna untuk membantu
kita untuk bisa menemukan perbedaan pada:
keluaran
kualitas, atau
biaya rawat)
16
USES OF PATIENT CLASSIFICATION (cont.-)
• By understanding the differences, health care
professional find opportunities to make health
care more effective.
(Dengan mengetahui perbedaan, maka
profesional asuhan kesehatan memperoleh
kesempatan untuk lebih efektif mengupayakan
asuhannya)
17
USES OF PATIENT CLASSIFICATION (cont.-)
• Casemix seeks to improve classification of
patients care episodes and put them to better
use.
(Tatanan case-mix dimaksud untuk
meningkatkan klasifikasi episode asuhan
pasien dan pemanfaatan yang lebih baik)
18
3 (three) FEATURES OF CASEMIX
(1) Clinical meaning (patients in the same class
should have clinical similarities)
The episodes in a class should involve
similar kinds of presenting problems,
treatment methods and outcomes.
It is not sufficient merely to ensure that
each class contains episodes which are
similar in cost.
Casemix is designed to ensure every
class makes sense to clinicians.
19
3 Gambaran CASEMIX
(1) Arti Klinis (pasien di dalam kelas yang sama
hendaknya memiliki kesamaan, kemiripan
keadaan)
Episode dalam satu kelas yang sama harus meliputi:
- jenis masalah,
- metode pengobatan yang sama dan
- outcome yang sama atau mirip.
Tidaklah cukup hanya memastikan bahwa masing
kelas meliputi episode rawat yang hanya sama dalam
jumlah biaya rawat.
Casemix didisain untuk memastikan bahwa
masing-masing kelas masuk akal bagi para
klinikus.
20
(2) CLASS
A class defined as “patients who were in
hospital for over 20 days” might contain
episodes which are similar in terms of
resource used, but it has little clinical
meaning, because there are many different
reasons for long stays (major trauma,
need for rehabilitation, social problems
which delay discharge)
21
(2) KELAS
Satu kelas didefinisikan sebagai:
“ kelompok pasien yang dirawat lebih dari 20 hari”
akan memilik episode-episode rawat dengan
penyerapan sumber daya sama (similar), namun
ini secara klinis tidak terlalu berarti, karena banyak
alasan yang menyebabkan pasien perlu hari
perawatan lama, sebagai contoh:
major trauma (trauma beart)
need for rehabilitation (perlu rehabilitasi)
social problems (penyandang masalah sosial)
which delay discharge (yang menghambat
pemulangannya).
22
FEATURES OF CASEMIX (CONT.-1)
Resource use homogeneity (patients in
the same class should cost roughly the
same treat) Classes is designed in such
a way that episodes which required similar
levels of resource are assigned to the
same class.
(Is defining classes by surgical and medical
is better than forming them by age?)
23
FEATURES OF CASEMIX (CONT.-1)
Sumber daya yang diserap homogen
(pasien dalam kelas yang sama hendaknya
memperoleh perawatan sama yang berbiaya sama)
Desian kelas sedemikian rupa bahwa episodes
rawat yang memerlukan peringkat sumber daya
sama (mirip) akan terkelompok ke dalam satu kelas
yang sama.
Pertanyaan yang perlu kajian adalah:
Apakah mendefinisikan kelas berdasarkan bedah
(surgical) dan medis (medical) akan lebih baik
daripada membedakan kelas berdasarkan usia?
24
FEATURES OF CASEMIX (CONT.-2)
In the real world, many more patient care
episodes and many more attributes (such as
diagnoses, functional abilities, and type of
admission) must be considered.
 apply statistical methods to find and evaluate
all the options
 Finding rules which define the classes in
such a way that episodes in the same class
are similar in terms of resource use.
25
FEATURES OF CASEMIX (CONT.-2)
Dalam dunia nyata, banyak lagi episode rawat
dan banyak lagi atribut ( di antaranya
diagnoses, functional abilities, and type of
admission) harus menjadi pertimbangan.
 apilkasikan metode statistik untuk mencari
dan mengevaluasi semua opsi.
 Mencari rules yang mampu mendefinisikan kelas-kelas sedemikian rupa sehingga
episode dalam kelompok kelas yang sama
akan memiliki kemiripan sumber daya yang
harus/akan terserap.
26
FEATURES OF CASEMIX (Cont.-3)
(3) The right number of classes (neither too few
or too many) (optimal numbers of classes)
It is difficult to know how many classes of
patient care episodes there should be. Too
many classes will have too few observations to
allow conclusions to be drawn. Then it would
be impossible to know whether a hospital is
really different, or whether analyses are merely
showing the kind of variability which is normal
in small samples.
27
FEATURES OF CASEMIX (Cont.-3)
(3) Jumlah kelas yang tepat (tidak terlalu sedikit
atau terlalu banyak) (jumlah kelas yang
optimal)
Adalah sulit untk mengetahui berapa kelas
episode rawat pasien yang harus ada.
Apabila terlalu banyak akan menimbulkan
observasi yang terlalu sedikit untuk bisa
diambil kesimpulan. Oleh karenanya akan
tidak mungkin mengethaui apakah suatu
rumah sakit betul berbeda, atau apakah
analisis hanya memaparkan jenis variabel
yang ada pada sampel yang normal.
28
FEATURES OF CASEMIX (Cont.-4)
On the other hand there should not be too few
classes.
If large numbers of dissimilar cases are
placed in the same class, real differences
between doctors, nurses, hospitals and so
on will be concealed and clinical meaning
will be lost.  a compromise is needed. 
A statistical method is needed.
29
FEATURES OF CASEMIX (Cont.-4)
Pada sisi lain hendaknya jumlah kelas tidak
terlalu sedikit.
Apabila jumlah kelas yang tidak mirip (sama)
dikelompokkan ke dalam satu kelas sama, maka
perbedaan antara dokter, perawat, rumah sakit
dst, akan terselubung sehingga arti klinisnya
hilang  maka harus/perlu diadakan kompromi
 Diperlukan suatu metode statistis
30
CASEMIX - DRGs
The size of database depends on the
number of patients care episodes
which are to be analyzed using the
classification.
(Besar data-base bergantung pada jumlah
episode rawat pasien yang telah dianalisis
dengan menggunakan klasifikasi)
31
CASMIX-DRGs (Lanjutan-1)
The extended use: a classification with
few classes might be ideal for some
strategic management purposes,
but less so for a private hospital
which is dependent for its financial
survival on very precise description
of it casemix.
32
CASMIX-DRGs (Lanjutan-1)
Perluasan penggunaannya: suatu klasifikasi
dengan kelas yang sedikit akan bisa ideal
bagi kepentingan manajemen strategik,
namun kurang bisa untuk rumah sakit
privat/swasta yang sangat depend kepada
survival finansialnya yang harus tergambar
jelas pada casemix
33
CASMIX-DRGs (Lanjutan-2)
• Many assumed there is only one casemix
classification.
DRGs is the most used casemix classification
in the last decade  the use of DRGs for
resource allocation deserves special attention.
 trend is towards a wider range of uses
of many more casemix classifications
34
CASMIX-DRGs (Lanjutan-2)
• Banyak yang mengasumsi bahwa hanya ada
satu jenis klasifkais case-mix.
DRGs memang adalah yang merupakan
klasifikasi case-mix yang paling banyak
digunakan dalam dekade ini  kegunaan
DRGs untuk alokasi sumber daya memerlukan
perhatian khusus.
 ada kecederungan penggunaan klasifikasi –
klasifikasi case-mix lain-lain.
35
A MORE PRECISE STATEMENT ABOUT
CASEMIX
• CASEMIX IS part of a science approach to
producing good information about health
care
• IT FOCUSES ON building useful classifications
of patients care episodes
AND making good use of patient care
classifications to manage health care.
36
A MORE PRECISE STATEMENT ABOUT CASEMIX (Lanjutan)
Casemix has to be complicated if it is to
help resolve real problems.
There would be little sense in simplifying
casemix ideas and tools so much that
they would no longer be relevant to the
real world.
Their complexity merely reflects the nature
of health care, and if used properly they
make the world less, not more, confusing.
37
DRGs
DRGs are designed to catagorise
acute inpatient episodes, but
CASEMIX classifications have
been developed for other kinds of
episodes:
outpatients,
nursing home care.
38
DRGs (Lanjutan-1)
(1) The first step involves looking at the principle
diagnosis
= the diagnosis or condition established
after study to be chiefly responsible for
the patient’s admission to hospital.
(2) The significant procedure performed and
check the kind of procedure.
39
DRGs (Lanjutan-2)
(3) Taking account on the patient’s age
(children or old)
(4) COMPLICATIONS or COMORBIDITIES
(5) Types of discharge.
40
DIAGNOSIS
Account must taken of accuracy of the
data being analyzed, changes in clinical
practice, social as well as medical
factors, and so on.
 the task is far from easy.
41
DIAGNOSIS
AMA Encyclopedia of Medicine (1989):
DIAGNOSIS
The determination by a physician of the cause
of a person’s problem. Usually this entails
identifying both the disease process and the
agent responsible. (in ICD-10  ! & * codes)
Diagnosis is part science and part art; an
experienced physician relies not only on his/her
scientific knowledge and experience, but also on
intuition to recognize the pattern of an illness
and establish a diagnosis.
42
DIAGNOSIS  DIAGNOSES
• AHIMA, Basic Healthcare Statistic for Health
Information Management Professionals:
Diagnoses = all diagnoses that affect the
current hospital stay.
Diagnosis = A word or phrase used by a
physician to identify a disease from
which an individual patient suffers
or a condition for which the patient
needs, seeks, or receives medical
care.
43
DIAGNOSIS … (Lanjutan-1)
• The Australian Casemix Dictionary
(Department of Human Services and Health):
Diagnoses clusters:
A classification system developed
in the early 1970s. Which only made
use of diagnoses.
(AVGs = Ambulatory Visit Groups)
44
AHIMA & AN-DRG
Diagnosis chiefly responsible for services
provided (out patient) =
The diagnosis, condition, problem, or reason
for encounter/visit that is chiefly responsible
for the services provided.
If a definitive diagnosis has not been established
at the end of the visit/encounter, the condition s
hould be recorded to the highest documented
level of specificity (such as symptoms, signs,
abnormal test results, or other reason for visit).
45
AHIMA & AN-DRG (Lanjutan-1)
•
•
•
•
•
•
The main variables which influence AN-DRG
assigment include:
Principal diagnosis (ICD-CM code)
Procedure codes (ICD-CM code)
Secondary diagnoses (ICD-CM code)
Age and gender
Birth weight (neonatus only)
Dischage status
46
AN-DRG
1.
PDX is used to assign the episode of care to one of
23 Major Diagnostic Categories (MDCs) MDCs
correspond generally to the main organ systems of the
body.
The following specific variables are exceptions:
- Age less than 29 days
- Principal diagnosis which is a specific neonatal
disorders
- Principal or secondary diagnosis of HIV
- Liver transplant
- Bone marrow transplant
- Principal diagnosis of multiple trauma
- Tracheostomy procedure.
47
AN – DRGs (Lanjutan-1)
2. Medical or surgical partition according to
whether a significant operating room (OR)
procedure has been performed. It is to be
noted that not all procedures are considered
significant OR procedures.
2. Sub grouping based on the precise surgical
procedure performed or, for medical patients,
the precise condition designated as the
principal diagnosis.
48
AN – DRGs (Lanjutan-2)
2. Final assignment to a DRG is usually made
by age or the existence of a complicating
diagnosis and/or comorbidity (CC)*
•
A substantial complication or comorbidity (CC)
is defined as a condition that because of its
presence with a specific principal diagnosis,
would cause an increased in the length of stay
by at least one day.
49
PRINCIPAL DIAGNOSIS
The diagnosis or condition established
after study to be chiefly responsible for
occasioning the patient’s admission to
hospital.
(AN-standard definition. One of the two most
important variables used to define AN-DRG
classes)
50
SECONDARY DIAGNOSES
Any condition additional to the principal
diagnosis which affects patient care by
requiring clinical evaluation, therapeutic
treatment, diagnostic procedures, extended
LOS, or increased nursing care or
monitoring. Includes complications and
comorbidities.
51
PRINCIPAL PROCEDURE
The procedure performed for definitive
treatment rather than for diagnostic or
exploratory purposes.
In the context of assignment to an AN-DRG
class, selection of one procedures as principal
is not necessary.
PROCEDURE
A therapeutic intervention.
Procedures are coded using ICD-9-CM.
One of the two most important variables
used to define DRG classes.
52
PROCEDURE HIERARCHIES
•
List of procedures in order of their relative costliness.
Assignment to an AN-DRG is on the basis of the
highest ranking procedure only, where two or more
were undertaken. Ranking is determined by the
computer software (the Grouper).
PROCEDURE REVIEW
A type of utilization review which involves assessing
the patient’s need for diagnostic and therapeutic
procedures.
53
PROSPECTIVE PAYMENT SYSTEM PPS
A type of output-based funding formula, whereby
health care providers (usually hospitals) receive
predetermined payments for each episode of care
defined by casemix classes. (Usually DRGs)
The term was first used for US Medicare’s DRG-based
payment system for hospitals.
PATIENT CLASSIFICATION SYSTEM (AN)
• (Private Hospital) A simple casemix classification
for inpatient episodes which is used to bill for all
services excepting critical care and operating
rooms.
54
ICD-9-CM
ICD-9-CM
(International Classification of
Diseases 9th Revision
Clinical Modification)
Volume I
(Diseases Tabular List)
- Cl. Of Diseases & Injury
(17 Chapters)(numnerik)
- (2 supplementary Class. E & V
(alfanumerik)
- Appendices A – E
A Morph. Of Neoplasm
B Glossary of Mental Dis.
C Cl. Of Drugs (US formula)
D Cl. Of Industrial AA to A)
E HIV infection class.
>< ICD-10
ICD-10
(International Statistical Classification of Diseases & Related
Health Problems)
Volume 1
(Alfanumerik)
- List of three-character
categories (A – Z, (-) U)
- Tabular list of inclusions and
four-character subcategories
(A-Z (-) U)
- Morph.of Neoplasms (M----/-)
- 4 Special tab. Lists for
Mortality (3 character)
- 1 Tabulation list for Morbid.
(3 character)
- Definitions
55
ICD-9 VOLUME 2 >< ICD-10 VOLUME 3
The Alphabetical Index
• TABLE OF CONTENTS
-
Conventions
-
Section 1
Index to Diseases and Injuries
-
Section 2
Table of Drugs & Chemicals
-
Section 3
Index to External Causes of
Injuries and Poisonings
(E code)
• CONTENTS
- Introduction
General arrangement of the
index
Convention used in the index
- Section I
Alphabetical index to diseases
and nature of injury
-
Section II
External causes of injury
-
Section III
Table of drugs & chemical
-
Corrigenda to Volue 1
56
ICD-10 Volume 2
INTRUCTION MANUAL
•
1.
2.
3.
CONTENTS
Introduction
Description of the ICD-10
How to use the ICD
- How to use Volume 1
- How to use Volume 3
4. Rules and Guidelines for Mortality and Morbidity
Coding
5. Statistical presentation
6. History of the Development of the ICD]
References
Index
57
ICD-9-CM Volume 3
• PROCEDURES TABULAR LIST and
ALPHABETIC INDEX
Introduction
Conventions used in the Procedure Classification
Preface to the Annotated ICD-9-CM
Sybolsw and Annotations in Volume 3
Tabular List
1. Operations on the Nervous System (01.-05.9)
2. Operations on the Endocrine System (06.-07.99)
3. Operations on the Eye (08.-016.99)
4. Operations on the Ear (18.-20.99)
5. Operations on the Nose, Mouth, and Pharynx
(21.-29.99)
58
ICD-9-CM Tabular List (Cont.-)
6. Operations on the Respiratory System (30.-34.99)
7. Operations on the Cardiovascular System
(35.-  39.99)
8. Operations on the Hemic and Lymphatic System
(40.-  41.99)
9. Operations on the Digestive System (42.- 54.99)
10. Operations on the Urinary System (55.-59.99)
11. Operations on the Male Genital Organs (60.-64.99)
12. Operations on the Female Genital Org. (65.-71.9)
13. Obstetrical Procedures (72.-  75.99)
14. Operations on the Musculoskeletal Sys.(76.-84.99)
15. Operations on the Integumentary Sys. (85.- 86.99)
16. Miscellaneous Diagnostic & Therapeutic Procedures
(87.- 99.99)
Alphabetic Index
59
7.
OPERATIONS ON THE
CARDIOVASCULAR SYSTEM (35.-  39.-)
(hal69-92)
35 Op. on Valves & Septa of Heart
Includes: sternotomy (median)(transverse)
thoracotomy
} as operative approach
Code also cardiopulmonary bypass [extracorporal
circulation] [heart-lung machine] (39.61)
35.0 Closed heart valvotomy
Excludes: percutaneous (balloon) valvuloplasty (35.96)
60
35 Operation on Valves and Septa of Heart
35.0 Closed heart valvotomy
Excudes: percutaneous (balloon) (valvuloplasty)(35.96)
35.00
35.01
35.02
35.03
35.04
Closed heart valvotomy, unspecified valve
Closed heart valvotomy aortic valve
Closed heart valvotomy, mitral valve
Closed heart valvotomy, pulmonary valve
Closed heart valvotomy, tricuspid valve
35.1 Open Heart Valvuloplasty without Replacement
Includes: open heart valvotomy
Excludes: percutaneous (balloon) valvuloplasty (35.96)
(cont.- ) 
61
35.1
Open Heart Valvuloplasty without Replacement
Includes: open heart valvotomy
Excludes: percutaneous (balloon) valvuloplasty (35.96)
that associated with repair of:
endocardial cushen defect (35.54, 35.63, 35.73)
valvular defect ass. with atrial & ventricular
septal defect (35.54, 35.63, 35.73)
Code also cardiopulmonary bypass [extracorporal circulation]
[heart –lung machinal] (39.61)
35.10 Open heart valvuloplasty without replacement,
unspecified valve
35.11 Open heart valvuloplasty of aortic valve without replacement
35.12 Open heart valvuloplasty of mitral valve without replacement
35.13 Open heart valvuloplasty of pulm. valve without replacement
35.14 Open heart valvuloplasty of tricus. valve without replacement
35.2 Replacement of Valve
62
SYMBOLS and ANNOTATIONS in VOLUME 3
The use of DRGs to determine prospective payment and
Medicare Code Edits (MCEs) to show inconsistencies in
patient information make certain aspects coding
particularly important.
To make sure you assign the right DRG for each patient,
you must code the PRINCIPAL DIAGNOSIS fully and
correctly; you must also include all SECONDARY
DIAGNOSES and all PROCEDURES.
The DRG grouper assumes all patient information is
correct.
The MCEs alert you to errors, inconsistencies, and
nonspecific information, for resolution before you
group the record.
63
Symbols and Annotations in Volume 3 (CONT.-1)
To keep these factors in front of you and simplify the
coding process, ICD-9-CM have color-coded the
diagnosis and procedure tabular lists. In volume 3.
the annotations are as follows:
_____ A non specific code which should not be used when
more precise information is obtainable
A code considered by MCE to be sex-specific
O To be used only for male patients
o To be used only for female patients
A code for a procedure not normally covered by
Medicare
64
Symbols and Annotations in Volume 3 (Cont.- 2)
-------- A code which is NOT considered by the grouper to
be an operating room procedure. When a code is
boxed and shaded, the box is in black ink to
differentiate it more easily from the green shading.
• Our annotations and other explanatory materials
reflect the latest DRG information available as of
publication date.
• We have taken every precaution to safeguard the
accuracy of this edition, nonetheless, the provider
of service holds the ultimate responsibility for
accurate coding.
65
SYMBOLS & ANNOTATIONS in VOLUME 1
A code which should not usually be used as PRINCIPAL
DIAGNOSIS:
+++ For all codes on page 1-917, indicates nonspecific
code.
=== For codes 7981, 798.2, 789.9, and all codes on
page 918-969, indicates UNACCEPTABLE PRINCIPAL
DIAGNOSIS CODE.
Q ____ Questionable admission (entire book)
(italicized manifestation codes and E-codes are other
codes not to be used as PRINCIPAL DIAGNOSIS)
A Code considered by the MCE to be age-specific.
B To be used only for patients less than one year
66
old
SYMBOLS & ANNOTATIONS in VOLUME 1 (Cont.-1)
B
P
M
A
A Code considered by the MCE to be age-specific.
To be used only for patients less than one year
old
To be used only for patients less than eighteen
year old
To be used only for patients between twelve and
fifty-five years old
To be used only for patients more than fourteen
years old
A code considered by the MCE to be sex-specific
O To be used only for male patients
o To be used only for female patients
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SYMBOLS & ANNOTATIONS in VOLUME 1 (Cont.-2)
----- A code considered by the DRG grouper to be a
complication or comorbidity. When a code is boxed
and shaded, box is in black ink to differentiate it
more easily from the green shading.
____ A code which signals the necessity to be absolutely
certain that all secondary diagnoses and
complications are coded well.
This condition occurs when this code is used as
principal diagnosis for a patient who has no
operating procedure.
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NOTES
• Because of the typography of Volume 1 of ICD-9-CM,
it is not always possible to indicate clearly with color
coding the various types of information to be imparted.
This is especially true in those areas where common
fifth-digits apply to several four digit codes.
In some cases the color coding applies to all relevant
fifth digits (e.g in the classification of tuberculosis, when
one five-digit code is designated as a comorbidity, all
five-digit code in sequence are comorbidities), but in
other cases, some of the fifth-digit codes in the
sequence are classified differently from other fifth-digit
codes in the same sequence (e.g. 250.01 is a
comorbidity, but 250.00 is not). In order to make it easier
to understand, the following table shows those cases
where the various five-digit codes within a sequence are
classified. (Lihat hal.xvii – xix, ICD-9-CM vol. 1)
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CONTOH – ICD-9-CM Volume 1
403 Hypertension renal disease
Includes: arteriolar nephritis
arteriosclerosis of:
kidney
renal arterioles
arteriosclerotic nephritis (chronic)(interstitial)
hypertensive
nephropathy
renal failure’
uremia (chronic)
nephrosclerosis
renal sclerosis with hypertension
any condition classifiable to 585, 586, 0r 587
with any condition classifiable to 401.
Excludes: acute renal failure (584,5 – 584.9)
renal disease stated as not due to hypertension
renovascular hypertension (405.0 – 405.9 with
fifth-digit 1)
70