STANDARD DATA DICTIONARY #83.1 -- DRG MDC CATEGORY DRG FILE 3/24/25 PAGE 1
STORED IN ^ICDD(83.1, (863 ENTRIES) SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 18.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
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File contains all Diagnostic Related Groups (DRG) with their related criteria required for DRG calculations. There may be multiple
entries for a single DRG based on the MCC/CC definition and the various codes assigned.
This file should not be modified locally.
DD ACCESS: @
RD ACCESS: @
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
AUDIT ACCESS: @
IDENTIFIED BY: MDC-CAT (#.02)[R], UNIT (#.03)[R]
POINTED TO BY: MDC DRG field (#.01) of the MDC DRG LIST sub-field (#83.1101) of the DRG MDC CATEGORY DRG ORDER File (#83.11)
CROSS
REFERENCED BY: MDC CASE(ACE), DRG(B), MDC-CAT(C)
LAST MODIFIED: DEC 20,2016@15:55:43
83.1,.01 DRG 0;1 POINTER TO DRG FILE (#80.2) (Required)
LAST EDITED: MAY 29, 2016
HELP-PROMPT: Enter a DRG to define its calculation characteristics.
DESCRIPTION: This is a Diagnostic Related Group (DRG) code. Entry will define all the characteristics necessary
for the DRG to calculate.
CROSS-REFERENCE: 83.1^B
1)= S ^ICDD(83.1,"B",$E(X,1,30),DA)=""
2)= K ^ICDD(83.1,"B",$E(X,1,30),DA)
83.1,.02 MDC-CAT 0;2 POINTER TO DRG MDC CATEGORY FILE (#83) (Required)
LAST EDITED: JUL 16, 2016
HELP-PROMPT: Enter the MDC-Category this DRG is assigned to.
DESCRIPTION: The MDC-Category this DRG is assigned to. Each DRG is assigned to one MDC-Category that defines
the related care.
CROSS-REFERENCE: 83.1^C
1)= S ^ICDD(83.1,"C",$E(X,1,30),DA)=""
2)= K ^ICDD(83.1,"C",$E(X,1,30),DA)
Cross reference of MDC-Category of the DRG.
83.1,.03 UNIT 0;3 NUMBER (Required)
INPUT TRANSFORM: K:+X'=X!(X>1000)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: JUL 16, 2016
HELP-PROMPT: Enter the number of this DRG within the MDC-Category subgroup.
DESCRIPTION: This is a simple counter (1:1) of DRG records within a category as there may be more than one entry
per DRG. The Unit combined with the DRG uniquely identifies the DRG record within the category.
83.1,.04 CATEGORY TYPE 0;4 SET
'M' FOR MEDICAL;
'MP' FOR MEDICAL W/OR;
'P' FOR SURGICAL;
LAST EDITED: OCT 26, 2016
HELP-PROMPT: Enter the type of category for this DRG.
DESCRIPTION: Each DRG is defined as either Medical or Surgical based on the level of care being provided. This
generally corresponds to the assignment of Operating Room procedures and DRG hierarchy.
MEDICAL DRGs may not be assigned if Operating Room procedures exist for the event unless
specifically required. MEDICAL W/OR is a special subset of Medical that allows unrelated Operating
Room procedures. SURGICAL may have specifically required and/or unrelated Operating Room
procedures.
83.1,.05 AGE 0;5 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>130)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: OCT 26, 2016
HELP-PROMPT: Enter the Age that affects this DRG, if applicable, a number between 0 and 130.
DESCRIPTION:
If the patient's Age affects the selection of the DRG then enter that Age here.
83.1,.06 SEX 0;6 SET
'M' FOR MALE;
'F' FOR FEMALE;
LAST EDITED: OCT 26, 2016
HELP-PROMPT: Enter the Sex that affects this DRG, if applicable.
DESCRIPTION: If the patient's Sex affects the selection of the DRG then enter that here. Selecting a value for
this field will limit the DRGs selection to patients of that Sex.
83.1,.07 MCC REQUIRED 0;7 SET
'1' FOR MCC REQ;
LAST EDITED: OCT 26, 2016
HELP-PROMPT: Enter MCC REQ if this DRG requires a Diagnosis with an MCC designation.
DESCRIPTION: Identifies if a Secondary Diagnosis defined as a major complication or comorbidity (MCC) is
required for this DRG to be selected. Or the Principal Diagnosis must be an MCC of its Own.
83.1,.08 CC REQUIRED 0;8 SET
'1' FOR CC REQ;
LAST EDITED: OCT 26, 2016
HELP-PROMPT: Enter CC REQ if this DRG requires a Diagnosis with a CC designation.
DESCRIPTION: Identifies if a Secondary Diagnosis defined as a complication or comorbidity (CC) is required for
this DRG to be selected. Or the Principal Diagnosis must be a CC of its Own.
83.1,.09 SPECIAL 0;9 SET
'1' FOR AMA;
'2' FOR ALIVE;
'3' FOR EXPIRED;
'4' FOR TRANSFER ACF;
'5' FOR EXPIRED/TACF;
LAST EDITED: OCT 26, 2016
HELP-PROMPT: Enter the code corresponding to the special conditions relating to the patient that apply to this
DRG, if any.
DESCRIPTION: Special circumstances of the patient stay that are required for the DRG to be selected:
AMA - patient left hospital Against Medical Advice ALIVE - patient did not die during the stay
EXPIRED - patient died during the stay TRANSFER ACF - Patient transferred to an Acute Care Facility
on Discharge EXPIRED/TACF - Patient either died during the stay or transferred to an Acute Care
Facility on Discharge
83.1,.1 CASE/SET NAME 0;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<3) X
LAST EDITED: OCT 26, 2016
HELP-PROMPT: Enter the name associated with the case or set of codes specific to this DRG, 3 to 50 characters.
This should match a Code Set Name.
DESCRIPTION: Identifies DRGs that require a distinct sub-set of codes within the category to be selected. These
are generally in addition to the other codes required for the less specific DRGs within the
category. The Case/Set Name should match or contain at least one of the Code Sets assigned to the
DRGs MDC Case.
TECHNICAL DESCR: Not every Code Set Name needs to be a DRG Case/Set Name. But every DRG Case/Set Name must match or
contain a Code Set Name so the two may be linked when creating the Cases.
83.1,10 MDC CASE 10;0 DATE Multiple #83.1001
LAST EDITED: JUL 05, 2016
DESCRIPTION: The MDC Case identifies the groups of Code Sets that define the DRG and are required for that DRGs
selection. A DRG may have multiple Case's assigned, any one of the Cases will result in the DRG
being selected (OR).
83.1001,.01 EFFECTIVE 0;1 DATE (Required) (Multiply asked)
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUL 16, 2016
HELP-PROMPT: Enter the first date this case applies to the DRG.
DESCRIPTION: A Case may cover a specific date range and will result in the DRG selection only within those
dates. The effective date is the first date the case will apply to the DRG.
CROSS-REFERENCE: 83.1001^B
1)= S ^ICDD(83.1,DA(1),10,"B",$E(X,1,30),DA)=""
2)= K ^ICDD(83.1,DA(1),10,"B",$E(X,1,30),DA)
83.1001,.02 INACTIVE 0;2 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUL 16, 2016
HELP-PROMPT: Enter the last date this case applies to the DRG.
DESCRIPTION: A case may cover a specific date range and will result in the DRG selection only within those
dates. The inactive date is the last date the case will apply to the DRG.
83.1001,.03 MDC CASE 0;3 POINTER TO DRG MDC CATEGORY CASE FILE (#83.2) (Required)
LAST EDITED: JUL 19, 2016
HELP-PROMPT: Enter the Case that defines the DRGs Code Sets.
DESCRIPTION: An MDC Case that contains all the Code Sets required for the DRG selection. If multiple Cases
are assigned, any one of them may result in the DRG selection. Only a single Case is required to
be satisfied for the DRG to be selected (OR).
CROSS-REFERENCE: 83.1^ACE
1)= S ^ICDD(83.1,"ACE",$E(X,1,30),DA(1),DA)=""
2)= K ^ICDD(83.1,"ACE",$E(X,1,30),DA(1),DA)
Cross reference by Case and DRG.
FILES POINTED TO FIELDS
DRG (#80.2) DRG (#.01)
DRG MDC CATEGORY (#83) MDC-CAT (#.02)
DRG MDC CATEGORY CASE (#83.2) MDC CASE:MDC CASE (#.03)
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