Calculation of WIES

AN-DRG Modifications

A number of adjustments are to be made to the original AN-DRG3 (version 3.1) grouping by utilising the VIC-DRG3 field, prior to the calculation of WIES7. All of the AN-DRG3 adjustments applied in the 1998-99 WIES6 formula continue to apply, and there are no new VIC-DRG3s, from 1 July 1999.

For 1999-2000 separations will continue be coded in ICD-10-AM and then mapped to ICD-9-CM codes for input to AN-DRG Version 3.1 Grouper. Adjustments have been described using both ICD-10-AM and ICD-9-CM codes. The codes to be used in the derivation of the VIC-DRG3 are clearly indicated.

Adjustment for Peritoneal Dialysis

In recognition of cost differences between peritoneal and haemodialysis, episodes with a principal diagnosis of peritoneal dialysis are to be assigned a VIC-DRG3 of 588. ICD-10-AM code Z49.2 is to be used for assigning the VIC-DRG3. This code maps to ICD-9-CM code V56.8.

Radiotherapy

Victorian Coding Standard 0229 states that non-same day patients receiving radiotherapy should have the malignant condition sequenced first, followed by the radiotherapy code (ICD-10-AM code Z51.0) in contrast to same day radiotherapy admissions where Z51.0 will be the principal diagnosis followed by the malignancy code.

However, because these patient episodes would group to AN-DRG3s related to the malignancy which are generally of lower weight than radiotherapy AN-DRG3s, equity has been maintained by re-grouping non-same day medical episodes that include a radiotherapy diagnosis code as if the radiotherapy code was the principal diagnosis.

ICD-10-AM code Z51.0 maps to ICD-9-CM code V58.0 and the latter is to be used for assigning the VIC-DRG3.

Cerebral Infarction

There is a problem in the AN-DRG Version 3.1 grouper logic in regard to cerebral infarction, which has been rectified in AR-DRG Version 4.

To overcome this anomaly for 1999-2000, any record allocated to AN-DRG3s 067, 068 or 069 which has any mapped ICD-9-CM diagnosis code equal to 433.*1, regardless of the value of the fourth digit (*), are to be assigned a VIC-DRG3 of 037 (as if ICD-9-CM code 434.91 were the principal diagnosis.

The equivalent ICD-10-AM codes are I63.0, I63.1, I63.2 (433.*1) and I63.3, I63.4, I63.5, I63.8, I63.9 (434.91)

Neonates

Circular 17/1995 of 30 June 1995 advised definition and reporting changes in relation to newborns. As outlined in that circular, a number of clinical criteria have been developed to differentiate healthy newborns from those requiring more than basic care.

Episodes that group to AN-DRG3 726 or 727 which meet these clinical criteria are to be allocated VIC-DRG3 746 and 747 respectively.

Episodes that group to AN-DRG3 726 or 727 which do not meet these clinical criteria are to be allocated to VIC-DRG3 748 and 749 respectively.

Newborns are classed as meeting clinical criteria where the episode contains:

1) at least one of the following ICD-10-AM procedure codes:

13306-00, 13706-01, 13706-02, 90677-00, 92044-00, 92060-00, 92072-00, 92184-00, 92186-00, 92187-00, 92193-00; and/or,

2) at least one of the following ICD-10-AM diagnosis codes:

G12.0, G52.1, G52.2, G52.3, G52.7, G52.8, G71.0, G71.2, G83.9, J38.01, J38.02, J38.3, P01.6, P70.0, P70.1, P70.2, P70.3, P70.4, P80.0, P80.8, P80.9, Q10.0, Q10.1, Q10.2, Q10.3, Q10.7, Q11.0, Q11.1, Q11.2, Q11.3, Q12.0, Q12.1, Q12.2, Q12.3, Q12.4, Q12.8, Q12.9, Q13.0, Q13.1, Q13.2, Q13.3, Q13.4, Q13.5, Q13.8, Q14.0, Q14.1, Q14.2, Q14.3, Q14.8, Q15.8, Q16.0, Q16.1, Q16.2, Q16.3, Q16.4, Q16.5, Q16.9, Q33.1, Q33.5, Q33.8, Q35.0, Q35.1, Q35.2, Q35.3, Q35.4, Q35.5, Q35.6, Q35.7, Q35.8, Q35.9, Q36.0, Q36.1, Q36.9, Q37.0, Q37.1, Q37.2, Q37.3, Q37.4, Q37.5, Q37.8, Q37.9, Q39.5, Q39.6, Q39.8, Q40.0, Q40.1, Q43.4, Q43.5, Q43.7, Q43.8, Q43.9, Q61.0, Q61.1, Q61.2, Q61.3, Q61.4, Q61.5, Q61.8, Q61.9, Q62.0, Q62.1, Q62.2, Q62.3, Q64.4, Q64.5, Q64.6, Q64.7, Q65.0, Q65.1, Q65.2, Q65.3, Q65.4, Q65.5, Q65.6, Q67.5, Q68.2, Q71.0, Q71.1, Q71.2, Q71.3, Q71.4, Q71.5, Q71.6, Q72.0, Q72.1, Q72.2, Q72.3, Q72.4, Q72.5, Q72.6, Q72.7, Q76.3, Q76.4, Q82.0, Q89.0, Q89.3, Q96.0, Q96.1, Q96.2, Q96.3, Q96.4, Q96.8, Q96.9, Q97.0, Q97.1, Q97.2, Q97.3, Q97.8, Q97.9, Q98.0, Q98.1, Q98.2, Q98.3, Q98.4, Q98.5, Q98.6, Q98.7, Q98.8, Q98.9, Q99.8, Z02.8, Z65.3, Z74.2, Z76.1, Z76.2

The equivalent ICD-9-CM codes are:

1) procedures:

93.96, 96.35, 99.01, 99.02, 99.03, 99.04, 99.18, 99.21, 99.22, 99.29, 99.83; and/or,

2) diagnoses:

335.0, 344.9, 352.2, 352.3, 352.4, 352.5, 352.6, 359.0, 359.1, 478.31, 478.32, 478.5, 743.0, 743.1, 743.3, 743.4, 743.5, 743.61, 743.62, 743.63, 743.66, 743.69, 743.8, 744.0, 744.24, 747.82, 748.69, 749.0, 749.1, 749.2, 750.11, 750.4, 750.5, 750.6, 751.5, 753.1, 753.2, 753.7, 753.8, 754.2, 754.3, 754.41, 755.21, 755.22, 755.23, 755.24, 755.25, 755.26, 755.27, 755.28, 755.29, 755.31, 755.32, 755.33, 755.34, 755.35, 755.36, 755.37, 755.38, 755.39, 755.55, 755.58, 756.13, 756.14, 756.15, 756.19, 757.0, 758.6, 758.7, 758.8, 759.0, 759.3, 761.6, 775.0, 775.1, 775.6, 778.2, 778.3, V20.0, V20.1, V60.4, V62.5, V68.89

 

Bone Marrow Transplants

In recognition of cost differences between allogenic and autologous bone marrow transplants, AN-DRG3 6 is split into VIC-DRG3 011 and VIC-DRG3 012. Any cases grouped to AN-DRG3 006 with any mapped ICD-9-CM procedure code equal to either 41.02 or 41.03 (allogenic) are allocated to VIC-DRG3 011. All other cases originally grouped into AN-DRG3 006 are allocated to VIC-DRG3 012.

The equivalent ICD-10-AM codes are 13706-06 and 13706-00 respectively.

Transvascular Percutaneous Cardiac Intervention (Stents)

In recognition of the additional cost of episodes involving stents, AN-DRG3 297 is split into cases with stents (VIC-DRG3 298) and cases without stents (VIC-DRG3 299). Cases originally grouped into AN-DRG3 297 with any mapped ICD-9-CM procedure code equal to either 36.06 or 36.07 should be grouped into VIC-DRG3 298. All other cases originally grouped into AN-DRG3 297 are allocated to VIC-DRG3 299.

The equivalent ICD-10-AM codes are 35310-00, 35310-03, 35310-01, 35310-04 (36.06) and 35310-05 and 35310-02 (36.07).

Chemotherapy

In recognition of additional cost of episodes involving HIV/AIDS, AN-DRG3 780 is split into VIC-DRG3 778 Chemotherapy with HIV/AIDS for those patients with a mapped ICD-9-CM diagnosis code 042 and VIC-DRG3 779 Chemotherapy without HIV/AIDS for other patients.

The equivalent ICD-10-AM codes are B20, B21, B22, B23.0, B23.8, B24.