To use the information in this chapter, you should have: • A working knowledge of IBM Basic Assembler Language
• At least a rudimentary understanding of the underlying logic on which all DRG decisions are based
• Access to the Medicare Severity Diagnosis Related Groups Definitions Manual, which explains the principles on which all decisions are made
The executor essentially makes its decisions by comparing indicators for each DRG within an MDC. Indicators are set by the elements found on the patient record. These sets of indicators are referred to as masks. The content of the masks is listed in the MS-DRG grouper tables (page 27). The tables are represented as hexadecimal constants in the module DT330RT and are present in memory when the grouper is loaded for execution. All table lookups are in-memory binary
searches.
The executor begins its basic task by creating masks that are indicative of the conditions found on the patient record. These are called the record masks.
Once the record masks have been constructed, the corresponding DRG masks for the MDC indicated by the principal diagnosis are compared to them, until a match is found or the DRG masks for the MDC are exhausted.
Because the internal format of the grouper tables is optimized in DT330RT for fast lookups and is therefore difficult to read, the nine principal tables included in DT330RT are provided as flat files on the media. See chapter 2 (page 19) for table layout details.
Construction of the record mask
The following list describes how the executor constructs the record masks. 1. Sex is tested for validity (0-2).
An error indicator is turned on if sex is out of that range.
If not, the appropriate indicator is set in the record mask.2. Discharge status is tested for validity (01-07, 20, 21, 30, 43, 50, 51, 61-66, 69, 70, 81-95)
An error indicator is turned on if discharge status is out of range.
Otherwise, the appropriate indicators are set in the record mask.The MS-DRG grouper executor
Medicare Severity Diagnosis Related Groups (MS-DRG) Software Software Installation Guide for z/OS Batch
Page 52
If no entry is found, the record is assigned DRG 999, RTC 7 and no further processing occurs.
If an entry is found, but the MDC number is 0, the record is assigned DRG 999, RTC 7 and no further processing occurs.
Otherwise, the MDC and DXCAT are saved and the indicators for this diagnosis code are moved to the mask where principal diagnosis indicators are positioned.4. All secondary diagnoses are looked up in the Diagnosis Table and their bit indicators “OR’d” together in the mask reserved for secondary diagnosis indicators. Additionally, if any of the secondaries is a complication or comorbidity, the CC exclusion subroutine is called to determine if the CC flag in the record mask should be set. A complete discussion of the CC exclusion subroutine appears later in this chapter (page 53).
Any secondary diagnosis for which there is no Diagnosis Table entry does not cause an error, but is instead ignored. MDC and DXCAT numbers are of no importance for secondaries. 5. Once all diagnoses have been processed, the indicators for principal and secondary are
“OR’d” together in yet another indicator section mask for ALLDX criteria.
6. All procedure codes are looked up in Procedure Table and their bit indicators “OR’d” together in the mask reserved for procedure indicators. As with secondary diagnoses, invalid
procedure codes do not generate errors, but are ignored.
DRG determination
Once the record masks have been constructed, the executor loops through the DRG masks for the MDC indicated by the principal diagnosis, comparing them with the record masks.
1. The comparison is done by moving the record mask to a work area and ANDing it with the current DRG mask.
2. The result of the ANDed work mask is then compared with the DRG mask.
If the results are identical, the associated DRG number is assigned and the processing to find and return the diagnosis and procedure flags is executed.
Otherwise, looping continues until a match is found or the DRG list is exhausted, at which time DRG 999 is assigned.The rest of this section discusses some special conditions in the grouper logic.
Testing for the ONLY surgery condition
When the DRG mask indicates that ONLY specific surgeries can be present, the executor loops through the saved O.R. surgeries from the record, making decisions as follows:
1. The O.R. portion of the DRG mask is moved to a work area. 2. The work mask is ANDed with the mask of the saved O.R. surgery.
The MS-DRG grouper executor
Medicare Severity Diagnosis Related Groups (MS-DRG) Software Software Installation Guide for z/OS Batch
Page 53
If the result of the ANDing is zero, this indicates that the surgery found on the record is other than the ONLY surgery allowed. The executor ceases looping and gets the next DRG mask.
Otherwise, the process continues until all saved O.R. surgeries have been tested.Testing for the ONLY DX condition
The testing for this condition is virtually identical to that done for the ONLY surgery condition, except that the comparison is done on saved diagnoses against the ALLDX portion of the DRG mask.
Testing for the OWISE condition
This condition exists for DRGs 794, 963-965 and 997. This is essentially the “fall through” DRG for the MDC and is assigned when no other DRG criteria have been met. The “anydx” bit in the DRG mask is turned on, leaving a mask with only that bit on, thereby guaranteeing a match.
Testing for the ANYCOMB condition
This condition exists only for DRG 461-462 in MDC 8. The test is done by comparing all coded O.R. procedures with the procedure portion of the DRG mask and adding one to an accumulator for each procedure that has a matching mask. If the resulting count is less than two, this record does not meet the "anycomb" condition, and the next DRG mask is retrieved.
CC exclusion subroutine
A large subset of the diagnosis codes are flagged as complication/comorbidity codes (CC) or major complication/comorbidity codes (MCC). Many of these codes are not really CC/MCC codes at all times because there are many conditions for which the secondary diagnosis is a natural side effect of the principal diagnosis. The CC/MCC exclusion table is organized to reflect a direct relationship between a principal diagnosis and selected secondaries.
Because the ICD-10-CM codes are non-contiguous and do not lend themselves well to defining ranges of codes, an index number is associated with each diagnosis and the CC/MCC exclusion table is constructed entirely from those index numbers.
To determine whether a secondary should be considered a CC/MCC, the executor accesses the CC/MCC table, using the principal diagnosis CC/MCC exclusion category as the key each time a secondary flagged as CC/MCC is encountered.
• If no entry is found for the exclusion category, that means that there are no exclusions and the secondary is considered a CC/MCC code.
The MS-DRG grouper executor
Medicare Severity Diagnosis Related Groups (MS-DRG) Software Software Installation Guide for z/OS Batch
Page 54
• If an entry is found, then the secondary is excluded as a CC/MCC.
Testing for the OTHOR condition
This test is similar in logic to the test for the ONLY conditions, except that it tests for procedures in addition to the O.R. criteria in the DRG mask. When the DRG mask indicates that other O.R. procedures must be present, the executor loops through the O.R. procedures from the record, making decisions as follows:
1. The O.R. portion of the DRG mask is moved to a work area.
2. The work mask is ANDed with the mask of the saved O.R. procedure.
If the result of the ANDing is zero, this indicates that the procedure is other than the specific procedure required (e.g., T&A) and therefore satisfies the other O.R. criteria. When that occurs, looping ceases and processing continues for the DRG.
Otherwise, the loop continues until a procedure satisfies the other condition. If all saved procedures are exhausted without finding one that satisfies the other condition, then processing for that DRG is ended.Testing for illogical principal diagnosis
When a DRG has been matched, and the DRG number is 999, the cause is an illogical principal diagnosis. To indicate this, the return code is changed to 6.
Testing for multiple significant trauma
The principal diagnosis is tested to see if it is a trauma code. If it is, processing continues to test for multiple significant trauma. Otherwise, no further trauma testing is done.
To qualify as multiple significant trauma, two significant trauma codes from different body sites must be present. The diagnosis mask contains special trauma indicators, with each body site trauma represented by a different flag.
The mask of the first diagnosis (either principal or secondary) that is flagged as a significant trauma is saved. The mask of each subsequent diagnosis that is also flagged is compared with the initial saved mask. If they are not the same, the record is flagged as a multiple significant trauma episode. If they are the same, the next diagnosis is tested until the multiple condition is satisfied or the diagnoses are exhausted.
Finding codes that affect Initial DRG assignment
After the DRG has been determined, the grouper executor analyzes the saved diagnosis and procedure masks, comparing them against the masks which were used to determine MDC and
The MS-DRG grouper executor
Medicare Severity Diagnosis Related Groups (MS-DRG) Software Software Installation Guide for z/OS Batch
Page 55
DRG. Codes which were necessary for the determination of the MDC/DRG are flagged with an "affect flag."
Final DRG
If no Hospital Acquired Conditions (HACs) are found on the record, then the initial DRG becomes the final DRG. Otherwise, the record is re-grouped demoting the HAC secondary diagnosis which may or may not change the DRG assignment based on what DRG it was initially assigned to, and/or the presence of other codes that are CCs or MCCs.
Executor ABEND codes
There is one ABEND (abnormal end of job) code that can be generated by the executor, standard version only.
Table 29. ABEND codes generated by the executor-standard version
Code
Description
108 Not able to GETMAIN a work area of sufficient size The alternate interface does not contain any ABEND macros.
Medicare Severity Diagnosis Related Groups (MS-DRG) Software Software Installation Guide for z/OS Batch
Page 57
Appendix A: Grouping results for the test
database
The following is a partial listing of the output produced by the grouper utility program (DT330UT). The program’s printout is a distribution of record counts by final DRG, MDC, and return code (RTC), respectively. The test database used a POA indicator of Z. There were no POAs assigned to the diagnosis codes. The printout of counts from your test run may differ in appearance from what is shown in the appendix, but the content should be the same if the test is successful. Some editing was done in order to fit the text into this manual.
The test, when performed on an IBM Z12 Model 607 computer, used 192K of virtual storage, and took less than 1 CPU second.
COUNTS BY DRG 1 0 | 51 0 | 101 30 | 151 30 | 201 18 | 251 30 | 301 30 | 351 30 | 2 0 | 52 28 | 102 10 | 152 30 | 202 30 | 252 30 | 302 30 | 352 30 | 3 30 | 53 30 | 103 30 | 153 30 | 203 30 | 253 30 | 303 30 | 353 30 | 4 30 | 54 30 | 104 0 | 154 30 | 204 30 | 254 30 | 304 20 | 354 30 | 5 0 | 55 30 | 105 0 | 155 30 | 205 30 | 255 30 | 305 30 | 355 30 | 6 0 | 56 30 | 106 0 | 156 30 | 206 30 | 256 30 | 306 2 | 356 30 | 7 0 | 57 30 | 107 0 | 157 30 | 207 30 | 257 30 | 307 20 | 357 30 | 8 0 | 58 10 | 108 0 | 158 30 | 208 30 | 258 10 | 308 30 | 358 30 | 9 0 | 59 10 | 109 0 | 159 30 | 209 0 | 259 8 | 309 30 | 359 0 | 10 0 | 60 16 | 110 0 | 160 0 | 210 0 | 260 30 | 310 30 | 360 0 | 11 26 | 61 28 | 111 0 | 161 0 | 211 0 | 261 30 | 311 30 | 361 0 | 12 18 | 62 30 | 112 0 | 162 0 | 212 0 | 262 15 | 312 30 | 362 0 | 13 14 | 63 16 | 113 10 | 163 30 | 213 0 | 263 30 | 313 30 | 363 0 | 14 0 | 64 30 | 114 12 | 164 30 | 214 0 | 264 30 | 314 30 | 364 0 | 15 0 | 65 30 | 115 18 | 165 30 | 215 0 | 265 15 | 315 30 | 365 0 | 16 0 | 66 30 | 116 2 | 166 30 | 216 30 | 266 30 | 316 30 | 366 0 | 17 0 | 67 18 | 117 2 | 167 30 | 217 30 | 267 30 | 317 0 | 367 0 | 18 0 | 68 30 | 118 0 | 168 30 | 218 30 | 268 8 | 318 0 | 368 30 | 19 0 | 69 30 | 119 0 | 169 0 | 219 30 | 269 30 | 319 0 | 369 30 | 20 28 | 70 30 | 120 0 | 170 0 | 220 30 | 270 22 | 320 0 | 370 20 | 21 20 | 71 30 | 121 10 | 171 0 | 221 30 | 271 4 | 321 0 | 371 30 | 22 2 | 72 16 | 122 0 | 172 0 | 222 30 | 272 30 | 322 0 | 372 30 | 23 30 | 73 30 | 123 30 | 173 0 | 223 26 | 273 0 | 323 0 | 373 30 | 24 30 | 74 30 | 124 16 | 174 0 | 224 30 | 274 30 | 324 0 | 374 30 | 25 30 | 75 8 | 125 30 | 175 30 | 225 30 | 275 0 | 325 0 | 375 30 | 26 30 | 76 12 | 126 0 | 176 30 | 226 30 | 276 0 | 326 30 | 376 28 | 27 30 | 77 20 | 127 0 | 177 30 | 227 26 | 277 0 | 327 30 | 377 30 | 28 30 | 78 10 | 128 0 | 178 30 | 228 30 | 278 0 | 328 30 | 378 30 | 29 30 | 79 4 | 129 22 | 179 30 | 229 30 | 279 0 | 329 30 | 379 30 | 30 30 | 80 28 | 130 6 | 180 30 | 230 30 | 280 30 | 330 30 | 380 30 | 31 30 | 81 30 | 131 20 | 181 30 | 231 30 | 281 30 | 331 30 | 381 30 | 32 30 | 82 30 | 132 18 | 182 8 | 232 30 | 282 30 | 332 16 | 382 30 | 33 30 | 83 30 | 133 30 | 183 30 | 233 30 | 283 30 | 333 30 | 383 18 | 34 24 | 84 30 | 134 30 | 184 30 | 234 30 | 284 30 | 334 30 | 384 30 |
Grouping results for the test database
Medicare Severity Diagnosis Related Groups (MS-DRG) Software Software Installation Guide for z/OS Batch Page 58 35 30 | 85 30 | 135 16 | 185 28 | 235 30 | 285 16 | 335 30 | 385 30 | 36 30 | 86 30 | 136 8 | 186 30 | 236 30 | 286 30 | 336 30 | 386 30 | 37 30 | 87 30 | 137 12 | 187 30 | 237 0 | 287 30 | 337 30 | 387 30 | 38 30 | 88 10 | 138 12 | 188 30 | 238 0 | 288 18 | 338 30 | 388 30 | 39 30 | 89 30 | 139 12 | 189 30 | 239 30 | 289 6 | 339 30 | 389 30 | 40 30 | 90 30 | 140 0 | 190 30 | 240 30 | 290 0 | 340 30 | 390 30 | 41 30 | 91 30 | 141 0 | 191 30 | 241 30 | 291 30 | 341 30 | 391 30 | 42 30 | 92 30 | 142 0 | 192 30 | 242 30 | 292 30 | 342 30 | 392 30 | 43 0 | 93 30 | 143 0 | 193 30 | 243 30 | 293 30 | 343 30 | 393 30 | 44 0 | 94 30 | 144 0 | 194 30 | 244 30 | 294 10 | 344 14 | 394 30 | 45 0 | 95 12 | 145 0 | 195 30 | 245 12 | 295 2 | 345 30 | 395 30 | 46 0 | 96 4 | 146 6 | 196 30 | 246 30 | 296 20 | 346 30 | 396 0 | 47 0 | 97 20 | 147 8 | 197 30 | 247 30 | 297 2 | 347 30 | 397 0 | 48 0 | 98 18 | 148 4 | 198 16 | 248 30 | 298 4 | 348 30 | 398 0 | 49 0 | 99 5 | 149 30 | 199 24 | 249 30 | 299 30 | 349 30 | 399 0 | 50 0 | 100 30 | 150 16 | 200 30 | 250 30 | 300 30 | 350 30 | 400 0 | COUNTS BY DRG 401 0 | 451 0 | 501 30 | 551 30 | 601 8 | 651 0 | 701 0 | 751 0 | 402 0 | 452 0 | 502 30 | 552 30 | 602 30 | 652 0 | 702 0 | 752 0 | 403 0 | 453 14 | 503 14 | 553 30 | 603 30 | 653 30 | 703 0 | 753 0 | 404 0 | 454 30 | 504 30 | 554 30 | 604 30 | 654 30 | 704 0 | 754 20 | 405 30 | 455 22 | 505 30 | 555 22 | 605 30 | 655 28 | 705 0 | 755 30 | 406 30 | 456 28 | 506 18 | 556 28 | 606 20 | 656 30 | 706 0 | 756 0 | 407 18 | 457 30 | 507 30 | 557 28 | 607 30 | 657 30 | 707 30 | 757 8 | 408 16 | 458 24 | 508 30 | 558 30 | 608 0 | 658 30 | 708 30 | 758 20 | 409 30 | 459 30 | 509 8 | 559 22 | 609 0 | 659 30 | 709 24 | 759 6 | 410 10 | 460 30 | 510 30 | 560 30 | 610 0 | 660 30 | 710 28 | 760 10 | 411 16 | 461 10 | 511 30 | 561 30 | 611 0 | 661 30 | 711 16 | 761 30 | 412 14 | 462 30 | 512 30 | 562 30 | 612 0 | 662 30 | 712 12 | 762 0 | 413 8 | 463 30 | 513 28 | 563 30 | 613 0 | 663 30 | 713 30 | 763 0 | 414 30 | 464 30 | 514 26 | 564 20 | 614 30 | 664 30 | 714 30 | 764 0 | 415 30 | 465 28 | 515 30 | 565 30 | 615 22 | 665 30 | 715 10 | 765 30 | 416 30 | 466 30 | 516 30 | 566 30 | 616 30 | 666 30 | 716 10 | 766 30 | 417 30 | 467 24 | 517 30 | 567 0 | 617 30 | 667 30 | 717 30 | 767 6 | 418 30 | 468 30 | 518 4 | 568 0 | 618 22 | 668 30 | 718 2 | 768 0 | 419 30 | 469 30 | 519 26 | 569 0 | 619 30 | 669 30 | 719 0 | 769 26 | 420 26 | 470 30 | 520 30 | 570 30 | 620 30 | 670 30 | 720 0 | 770 6 | 421 30 | 471 30 | 521 0 | 571 30 | 621 28 | 671 20 | 721 0 | 771 0 | 422 12 | 472 30 | 522 0 | 572 30 | 622 30 | 672 10 | 722 16 | 772 0 | 423 30 | 473 30 | 523 0 | 573 30 | 623 30 | 673 30 | 723 20 | 773 0 | 424 30 | 474 30 | 524 0 | 574 20 | 624 30 | 674 30 | 724 0 | 774 30 | 425 30 | 475 30 | 525 0 | 575 12 | 625 30 | 675 30 | 725 2 | 775 30 | 426 0 | 476 20 | 526 0 | 576 4 | 626 30 | 676 0 | 726 30 | 776 4 | 427 0 | 477 30 | 527 0 | 577 10 | 627 30 | 677 0 | 727 20 | 777 8 | 428 0 | 478 30 | 528 0 | 578 18 | 628 30 | 678 0 | 728 30 | 778 10 | 429 0 | 479 30 | 529 0 | 579 30 | 629 30 | 679 0 | 729 8 | 779 2 | 430 0 | 480 30 | 530 0 | 580 30 | 630 30 | 680 0 | 730 8 | 780 0 |
Grouping results for the test database
Medicare Severity Diagnosis Related Groups (MS-DRG) Software Software Installation Guide for z/OS Batch Page 59 431 0 | 481 30 | 531 0 | 581 30 | 631 0 | 681 0 | 731 0 | 781 30 | 432 30 | 482 30 | 532 0 | 582 30 | 632 0 | 682 30 | 732 0 | 782 2 | 433 30 | 483 30 | 533 12 | 583 30 | 633 0 | 683 30 | 733 0 | 783 0 | 434 12 | 484 0 | 534 24 | 584 22 | 634 0 | 684 30 | 734 20 | 784 0 | 435 30 | 485 24 | 535 30 | 585 24 | 635 0 | 685 14 | 735 22 | 785 0 | 436 30 | 486 30 | 536 30 | 586 0 | 636 0 | 686 10 | 736 2 | 786 0 | 437 16 | 487 12 | 537 12 | 587 0 | 637 30 | 687 28 | 737 28 | 787 0 | 438 30 | 488 30 | 538 12 | 588 0 | 638 30 | 688 6 | 738 4 | 788 0 | 439 30 | 489 30 | 539 30 | 589 0 | 639 30 | 689 30 | 739 4 | 789 0 | 440 30 | 490 0 | 540 28 | 590 0 | 640 30 | 690 30 | 740 30 | 790 0 | 441 30 | 491 0 | 541 16 | 591 0 | 641 30 | 691 26 | 741 30 | 791 0 | 442 30 | 492 30 | 542 30 | 592 30 | 642 30 | 692 6 | 742 30 | 792 0 | 443 30 | 493 30 | 543 30 | 593 30 | 643 28 | 693 30 | 743 30 | 793 2 | 444 30 | 494 30 | 544 30 | 594 4 | 644 30 | 694 30 | 744 30 | 794 0 | 445 30 | 495 30 | 545 24 | 595 12 | 645 30 | 695 18 | 745 8 | 795 30 | 446 30 | 496 30 | 546 30 | 596 30 | 646 0 | 696 30 | 746 30 | 796 0 | 447 0 | 497 30 | 547 24 | 597 6 | 647 0 | 697 8 | 747 30 | 797 0 | 448 0 | 498 30 | 548 6 | 598 16 | 648 0 | 698 30 | 748 30 | 798 0 | 449 0 | 499 12 | 549 8 | 599 0 | 649 0 | 699 30 | 749 20 | 799 14 | 450 0 | 500 30 | 550 2 | 600 6 | 650 0 | 700 30 | 750 8 | 800 24 | COUNTS BY DRG 801 8 | 826 0 | 851 0 | 876 30 | 901 30 | 926 0 | 951 4 | 976 6 | 802 24 | 827 30 | 852 0 | 877 0 | 902 30 | 927 2 | 952 0 | 977 22 | 803 30 | 828 12 | 853 30 | 878 0 | 903 30 | 928 28 | 953 0 | 978 0 | 804 30 | 829 30 | 854 30 | 879 0 | 904 30 | 929 20 | 954 0 | 979 0 | 805 0 | 830 6 | 855 30 | 880 28 | 905 12 | 930 0 | 955 14 | 980 0 | 806 0 | 831 0 | 856 30 | 881 30 | 906 30 | 931 0 | 956 30 | 981 30 | 807 0 | 832 0 | 857 30 | 882 20 | 907 30 | 932 0 | 957 28 | 982 30 | 808 30 | 833 0 | 858 30 | 883 18 | 908 30 | 933 30 | 958 30 | 983 28 | 809 30 | 834 30 | 859 0 | 884 30 | 909 30 | 934 30 | 959 30 | 984 30 | 810 14 | 835 30 | 860 0 | 885 30 | 910 0 | 935 30 | 960 0 | 985 30 | 811 30 | 836 24 | 861 0 | 886 16 | 911 0 | 936 0 | 961 0 | 986 30 | 812 30 | 837 8 | 862 30 | 887 6 | 912 0 | 937 0 | 962 0 | 987 30 | 813 30 | 838 4 | 863 30 | 888 0 | 913 16 | 938 0 | 963 30 | 988 30 | 814 10 | 839 4 | 864 30 | 889 0 | 914 30 | 939 30 | 964 30 | 989 30 | 815 16 | 840 30 | 865 14 | 890 0 | 915 18 | 940 30 | 965 30 | 990 0 | 816 12 | 841 30 | 866 30 | 891 0 | 916 30 | 941 30 | 966 0 | 991 0 | 817 0 | 842 30 | 867 30 | 892 0 | 917 30 | 942 0 | 967 0 | 992 0 | 818 0 | 843 24 | 868 20 | 893 0 | 918 30 | 943 0 | 968 0 | 993 0 | 819 0 | 844 28 | 869 4 | 894 8 | 919 30 | 944 0 | 969 30 | 994 0 | 820 30 | 845 12 | 870 30 | 895 26 | 920 30 | 945 6 | 970 14 | 995 0 | 821 30 | 846 30 | 871 30 | 896 30 | 921 30 | 946 0 | 971 0 | 996 0 | 822 24 | 847 30 | 872 30 | 897 30 | 922 30 | 947 30 | 972 0 | 997 0 | 823 30 | 848 4 | 873 0 | 898 0 | 923 30 | 948 30 | 973 0 | 998 0 | 824 30 | 849 0 | 874 0 | 899 0 | 924 0 | 949 0 | 974 30 | 999 172 | 825 28 | 850 0 | 875 0 | 900 0 | 925 0 | 950 0 | 975 28 |
Grouping results for the test database
Medicare Severity Diagnosis Related Groups (MS-DRG) Software Software Installation Guide for z/OS Batch Page 60 COUNTS BY MDC 0 172 1 1930 2 130 3 570 4 1206 5 2499 6 1808 7 936 8 2585 9 696 10 785 11 1128 12 386 13 480 14 214 15 32 16 340 17 568 18 460 19 208 20 94 21 566 22 140 23 160 24 222 25 130 COUNTS BY RTC 0 18273 1 2 2 0 3 0 4 4 5 8 6 0 7 30 8 0 9 32 10 56 11 30 12 0 13 0 14 0 15 10
Medicare Severity Diagnosis Related Groups (MS-DRG) Software Software Installation Guide for z/OS Batch Page 61
Index
A
ABEND codes ... 55admission date control statement ... 40
affect flag ... 54 age control statement ... 39 alternate interface... 48 re 57 ancillary buffer ... 17 ANYCOMB condition DRG determination ... 53
B
buffer control statement ... 42C
CC exclusion subroutine DRG determination ... 53COBOL test interface program ... 23
using the grouper with... 45
code descriptions returned by the grouper 13 control statement admission date ... 40 age ... 39 buffer (BUF) ... 42 diagnosis flags (DFL) ... 42 discharge date ... 40 discharge diagnosis ... 38 discharge status ... 40 DRG ... 41 grouper flags ... 41 grouper utility ... 37 MDC ... 41 output ... 41 present on admission ... 40 procedure ... 39 procedure dates ... 40 procedure flags (SFL) ... 42 return code ... 41 sex... 39
D
data format requirements ... 9data formats ... 9
diagnosis ... 49
diagnosis flags control statement ... 42
discharge date control statement ... 40
discharge diagnosis control statement ... 38
discharge status control statement ... 40
DRG control statement ... 41
DRG determination ... 52
ANYCOMB condition ... 53
CC exclusion subroutine ... 53
illogical principal diagnosis ... 54
multiple significant trauma ... 54
ONLY DX condition ... 53
ONLY surgery condition ... 52
OTHOR condition... 54
OWISE condition... 53
E
Executor processing, diagnosis and procedure buffer ... 49Executor, grouper ... 9
F
flags returned by the grouper ... 13folder contents, grouper ... 19
format requirements for data ... 9
G
grouper code descriptions returned ... 41executor ... 9 folder contents ... 19 implementation ... 9 utility program ... 9 version number ... 17 grouper executor ABEND codes ... 55 DRG determination ... 52 record mask ... 51
grouper flags (GFL) control statement ... 41
grouper program ... 23
grouper return code ... 13
grouper subroutines input ... 46
output ... 48
grouper tables loader program ... 23
grouper utility control statement ... 37
interface program ... 23
link-editing ... 37
Index
Medicare Severity Diagnosis Related Groups (MS-DRG) Software Software Installation Guide for z/OS Batch
Page 62
using... 37
H
higher level languages, COBOL ... 45I
ICD-10-CM/PCS grouper CC/MCC exclusions ... 33diagnosis pattern table ... 29
diagnosis table ... 29
grouper logic ... 28
list of attributes ... 27
procedure cluster definitions ... 31
procedure clusters ... 28
procedure pattern table ... 31
procedure table ... 30
ICD-10-CM/PCS grouper attributes diagnosis ... 28
procedure ... 30
ICD-10-CM/PCS grouper tables ... 27
illogical principal diagnosis ... 54
information returned by the grouper ... 11
initial DRG assignment ... 54
interface, alternate... 48
L
link-editing, grouper utility ... 37M
main control program ... 23MDC control statement ... 41
multiple significant trauma, DRG determination ... 54
O
object lib ... 22ONLY DX condition, DRG determination .. 53
ONLY surgery condition, DRG determination ... 52
OTHOR condition, DRG determination ... 54
output control statement ... 41
grouper ... 12
grouper subroutines ... 48
OWISE condition, DRG determination ... 53
P
present on admission control statement ... 40procedure buffer executor processing ... 49
procedure control statement ... 39
procedure dates control statement ... 40
procedure flags (SFL) control statement ... 42
R
record layout DRGDSC3 ... 26 DRGDSC4 ... 26 MDCDSC ... 25 test database ... 24record mask, construction ... 51
return code control statement ... 41
test database ... 57
S
sample JCL creating the grouper utility load module 37 grouping test database ... 43sex ... 39
source library, grouper program ... 23
SYSIN stream... 37