The Demo site for our new HL7 Version 2+ (plus) Standard
visit the hl7 website

Draft Website - For Review Purposes Only

DRG - Diagnosis Related Group Segment

The DRG segment contains diagnoses-related grouping information of various types. The DRG segment is used to send the DRG information, for example, for billing and medical records encoding.

HL7 Attribute Table - DRG - Diagnosis Related Group Segment
Seq# DataElement Description Must Implement Flags Cardinality Length C.LEN Vocabulary DataType
DRG
1 00382 Diagnostic Related Group [0..1] CNE
2 00769 DRG Assigned Date/Time [0..1] DTM
3 00383 DRG Approval Indicator [0..1] ID
4 00384 DRG Grouper Review Code [0..1] CWE
5 00385 Outlier Type [0..1] CWE
6 00386 Outlier Days [0..1] NM
7 00387 Outlier Cost [0..1] CP
8 00770 DRG Payor [0..1] CWE
9 00771 Outlier Reimbursement [0..1] CP
10 00767 Confidential Indicator [0..1] [1..1] ID
11 01500 DRG Transfer Type [0..1] CWE
12 02156 Name of Coder [0..1] XPN
13 02157 Grouper Status [0..1] CWE
14 02158 PCCL Value Code [0..1] CWE
15 02159 Effective Weight # [0..1] 5 NM
16 02160 Monetary Amount [0..1] MO
17 02161 Status Patient [0..1] CWE
18 02162 Grouper Software Name # [0..1] 100 ST
19 02282 Grouper Software Version # [0..1] 100 ST
20 02163 Status Financial Calculation [0..1] CWE
21 02164 Relative Discount/Surcharge [0..1] MO
22 02165 Basic Charge [0..1] MO
23 02166 Total Charge [0..1] MO
24 02167 Discount/Surcharge [0..1] MO
25 02168 Calculated Days = [0..1] 5 NM
26 02169 Status Gender [0..1] CWE
27 02170 Status Age [0..1] CWE
28 02171 Status Length of Stay [0..1] CWE
29 02172 Status Same Day Flag [0..1] CWE
30 02173 Status Separation Mode [0..1] CWE
31 02174 Status Weight at Birth [0..1] CWE
32 02175 Status Respiration Minutes [0..1] CWE
33 02176 Status Admission [0..1] CWE

DRG-1: Diagnostic Related Group (CNE) 00382

(Definition from DG1.8 in Ch. 6)

Attention: DG1-8 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6.

(Definition from DRG.1 in Ch. 6)

Definition: This field contains the DRG for the transaction. Interim DRG's could be determined for an encounter. Refer to Externally-defined Table 0055 – Diagnosis Related Group in Chapter 2C, Code Tables, for suggested values.

(Definition from DMI.1 in Ch. 8)

Definition: This field contains the DRG for the transaction. Interim DRG's could be determined for an encounter. Refer to External Table 0055 – Diagnosis Related Group in Chapter 2C, Code Tables, for suggested values.

DRG-2: DRG Assigned Date/Time (DTM) 00769

Definition: This field contains the time stamp to indicate the date and time that the DRG was assigned.

DRG-3: DRG Approval Indicator (ID) 00383

(Definition from DG1.9 in Ch. 6)

Attention: DG1-9 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6

(Definition from DRG.3 in Ch. 6)

Definition: This field indicates if the DRG has been approved by a reviewing entity. Refer to HL7 Table 0136 - Yes/no Indicator for valid values.

DRG-4: DRG Grouper Review Code (CWE) 00384

(Definition from DG1.10 in Ch. 6)

Attention: DG1-10 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6

(Definition from DRG.4 in Ch. 6)

Definition: This code indicates that the grouper results have been reviewed and approved. Refer to User-defined Table 0056 - DRG Grouper Review Code in Chapter 2C, Code Tables, for suggested values.

DRG-5: Outlier Type (CWE) 00385

(Definition from DG1.11 in Ch. 6)

Attention: DG1-11 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6

(Definition from DRG.5 in Ch. 6)

Definition: Refers to the type of outlier (i.e., period of care beyond DRG-standard stay in facility) that has been paid. Refer to User-defined Table 0083 - Outlier Type in Chapter 2C, code Tables, for suggested values.

DRG-6: Outlier Days (NM) 00386

(Definition from DG1.12 in Ch. 6)

Attention: DG1-12 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6

(Definition from DRG.6 in Ch. 6)

Definition: This field contains the number of days that have been approved as an outlier payment.

DRG-7: Outlier Cost (CP) 00387

(Definition from DG1.13 in Ch. 6)

Attention: DG1-13 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6

(Definition from DRG.7 in Ch. 6)

Definition: This field contains the amount of money that has been approved for an outlier payment.

(Definition from GP1.5 in Ch. 6)

Definition: This field contains the amount that exceeds the outlier limitation as defined by APC regulations. This field is analogous to DRG-7 - Outlier Cost; however, the definition in this field note supersedes the DRG-7 definition.

DRG-8: DRG Payor (CWE) 00770

Definition: This field indicates the associated DRG Payor. Refer to User-defined Table 0229 - DRG Payor in Chapter 2C, Code Tables, for suggested values.

DRG-9: Outlier Reimbursement (CP) 00771

Definition: Where applicable, the outlier reimbursement amount indicates the part of the total reimbursement designated for reimbursement of outlier conditions (day or cost).

DRG-10: Confidential Indicator (ID) 00767

(Definition from DG1.18 in Ch. 6)

Definition: This field indicates whether the diagnosis is confidential. Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, "Code Tables", for valid values.

(Definition from DRG.10 in Ch. 6)

Definition: This field indicates if the DRG contains a confidential diagnosis. Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.

DRG-11: DRG Transfer Type (CWE) 01500

Definition: This field indicates the type of hospital receiving a transfer patient, which affects how a facility is reimbursed under diagnosis related group (DRG's), for example, exempt or non-exempt. Refer to User-defined Table 0415 - DRG Transfer Type in Chapter 2C, code Tables, for suggested values.

DRG-12: Name of Coder (XPN) 02156

Definition: This field holds the name of the person ("coder") who supervised or undertook the determination of the DRG code.

DRG-13: Grouper Status (CWE) 02157

Definition: This field indicates the grouper status in general. Refer to Externally-defined Table 0734 - Grouper Status in Chapter 2C, Code Tables, for suggested values.

DRG-14: PCCL Value Code (CWE) 02158

Definition: This field indicates the PCCL (Patient Clinical Complexity Level) value for the calculated DRG as a single value. This value is calculated based on all individual CCL values calculated so far in relation to the basic DRG. Refer to Externally-defined Table 0728 - CCL Value in Chapter 2C, Code Tables, for suggested values.

DRG-15: Effective Weight (NM) 02159

Definition: This field contains the effective weight as calculated for this DRG. When exceeding the upper or lower trim point the effective weight is lower or higher.

DRG-16: Monetary Amount (MO) 02160

Definition: This field contains the monetary amount as calculated for this DRG, i.e., the sum of money the insurance company will pay.

DRG-17: Status Patient (CWE) 02161

Definition: This field contains the status of the patient concerning the financial aspects. It indicates whether the length of stay is normal or respectively shorter or longer than normal. Refer to User-defined Table 0739 – DRG Status Patient in Chapter 2C, Code Tables, for suggested values.

This field is also used along with DRG-23 and DRG-24 as an indication of whether a surcharge (long length of stay) or a discount (short length of stay) has been determined.

DRG-18: Grouper Software Name (ST) 02162

Definition: This field contains the name of the software used for grouping.

DRG-19: Grouper Software Version (ST) 02282

Definition: This field contains the version information of the software used for grouping.

DRG-20: Status Financial Calculation (CWE) 02163

Definition: This field contains the status of the DRG calculation regarding the financial aspects. Refer to User-defined Table 0742 – DRG Status Financial Calculation in Chapter 2C, Code Tables, for suggested values.

DRG-21: Relative Discount/Surcharge (MO) 02164

Definition: There will be a discount/surcharge for the calculated price due to a very short stay, early referral or a very long stay. This field contains the discount or surcharge that is included in the final price.

DRG-22: Basic Charge (MO) 02165

Definition: The basic charge is calculated as a multiplication of the relative weight with the base rate.

DRG-23: Total Charge (MO) 02166

Definition: This field contains the total charge including surcharges or discounts.

DRG-24: Discount/Surcharge (MO) 02167

Definition: This field contains the discount/surcharge as determined for this DRG. The addition/reduction is indicated by DRG-17 - Status Patient.

DRG-25: Calculated Days (NM) 02168

Definition: This field contains the number of days, for which a surcharge/discount has been determined. The addition/reduction is indicated by DRG-17 - Status Patient.

DRG-26: Status Gender (CWE) 02169

Definition: This field contains the status of the use of the gender information for DRG determination. Refer to User-defined Table 0749 – DRG Grouping Status in Chapter 2C, Code Tables, for suggested values.

DRG-27: Status Age (CWE) 02170

Definition: This field contains the status of the use of the age information for DRG determination. Refer to User-defined Table 0749 – DRG Grouping Status in Chapter 2C, Code Tables, for suggested values.

DRG-28: Status Length of Stay (CWE) 02171

Definition: This field contains the status of the DRG calculation for the length of stay information. Refer to User-defined Table 0749 – DRG Grouping Status in Chapter 2C, Code Tables, for suggested values.

DRG-29: Status Same Day Flag (CWE) 02172

Definition: This field contains the status of the use of the same day information for DRG determination. Refer to User-defined Table 0749 – DRG Grouping Status in Chapter 2C, Code Tables, for suggested values.

DRG-30: Status Separation Mode (CWE) 02173

Definition: This field contains the status of the use of the separation mode information for DRG determination. Refer to User-defined Table 0749 – DRG Grouping Status in Chapter 2C, Code Tables, for suggested values.

DRG-31: Status Weight at Birth (CWE) 02174

Definition: This field contains the status of the use of the weight at birth information for DRG determination. Refer to User-defined Table 0755 – DRG Status Weight At Birth in Chapter 2C, Code Tables, for suggested values.

DRG-32: Status Respiration Minutes (CWE) 02175

Definition: This field contains the status of the use of the respiration minutes information for DRG determination. Refer to User-defined Table 0757 – DRG Status Respiration Minutes in Chapter 2C, Code Tables, for suggested values.

DRG-33: Status Admission (CWE) 02176

Definition: This field contains the admission status for the DRG determination. Refer to User-defined Table 0759 – Status Admission in Chapter 2C, Code Tables, for suggested values.