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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]			0055	CNE
2	00769	DRG Assigned Date/Time			[0..1]				DTM
3	00383	DRG Approval Indicator			[0..1]			0136 Yes/no Indicator	ID
4	00384	DRG Grouper Review Code			[0..1]			0056	CWE
5	00385	Outlier Type			[0..1]			0083 Outlier Type	CWE
6	00386	Outlier Days			[0..1]				NM
7	00387	Outlier Cost			[0..1]				CP
8	00770	DRG Payor			[0..1]			0229 DRG Payor	CWE
9	00771	Outlier Reimbursement			[0..1]				CP
10	00767	Confidential Indicator			[0..1]	[1..1]		0136 Yes/no Indicator	ID
11	01500	DRG Transfer Type			[0..1]			0415 Transfer Type	CWE
12	02156	Name of Coder			[0..1]				XPN
13	02157	Grouper Status			[0..1]			0734 Grouper Status	CWE
14	02158	PCCL Value Code			[0..1]			0728 CCL Value	CWE
15	02159	Effective Weight		#	[0..1]		5		NM
16	02160	Monetary Amount			[0..1]				MO
17	02161	Status Patient			[0..1]			0739 DRG Status Patient	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]			0742 DRG Status Financial Calculation	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]			0749 DRG Grouping Status	CWE
27	02170	Status Age			[0..1]			0749 DRG Grouping Status	CWE
28	02171	Status Length of Stay			[0..1]			0749 DRG Grouping Status	CWE
29	02172	Status Same Day Flag			[0..1]			0749 DRG Grouping Status	CWE
30	02173	Status Separation Mode			[0..1]			0749 DRG Grouping Status	CWE
31	02174	Status Weight at Birth			[0..1]			0755 Status Weight At Birth	CWE
32	02175	Status Respiration Minutes			[0..1]			0757 DRG Status Respiration Minutes	CWE
33	02176	Status Admission			[0..1]			0759 Status Admission	CWE

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Attention: DG1-8 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6.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

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

(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.

• Y    the DRG has been approved by a reviewing entity

• N    the DRG has not been approved

(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.

(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.

(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.

(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.

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

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

(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.

• Y    the diagnosis is a confidential diagnosis

• N    the diagnosis does not contain a confidential diagnosis

(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.

• Y    the DRG contains a confidential diagnosis

• N    the DRG does not contain a confidential diagnosis

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.

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

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.

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.

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.

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

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.

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

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

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.

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.

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

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

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

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.

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.

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.

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.

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.

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.

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.

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.

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.