DRG-INA-DRG-INA-CBG

7/23/2019 DRG-INA-DRG-INA-CBG

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HOSIZAH

Prodi Manajemen Informasi Kesehatan


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DIAGNOSIS RELATEDGROUPS (DRGs)


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PENGERTIAN

Diagnosis Related Groups (DRGs)

represent an inpatient classificationscheme to categorize patients who

are medically related with respect to

diagnoses and treatment, who arestatistically similar in their lengths of

stay


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DRG assignment is usually performed

by a computer with grouper software,

but may be performed manually

utilizing the decision trees and

listings of OR procedures,complications, and comorbidities
http://drgs%20proses.ppt/http://drgs%20proses.ppt/


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Principal Diagnosis

The principal diagnosis is defined as thecondition which after study, was found to

be chiefly responsible for occasioning thepatients admission to the hospital for care.

Only one DIAGNOSIS may be listed as thePrincipal Diagnosis.


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Secondary Conditions

All conditions should be listed that:

1. existed at the time of patients admission tohospital for which treatment was given, or

2. that arose during the patients stay inhospital, or

3. that affected the patients treatment and/orLOS by greater than one day.


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MAJOR DIAGNOSTIC CATEGORY (MDC) 12Diseases and disorders of the Male Reproductive System

ORProcedure

Major PelvicCC

Yes

No

334

335

DRG

Penis341

Age>69and/or CC

336

337

Transurethal Prostatectomy

Other Male Reproductive System

OR Procedures

PrincipalDiagnosis

Malignancy

344

345

Yes

No

NoNo

Yes

Yes

Yes

Surgical Partitioning

PrincipalDiagnosis

Age>69and/or CC

Age>69and/or CC

346

347

348

349

350

351

Malignancy

Benign Prostatic Hypertrophy

Inflammation

Sterilization

Other Male Reproductive System Diagnoses352

No

No

Yes

Medical Partitioning

CC = Complication and/or Comorbidity


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INDONESIA DIAGNOSIS

RELATED GROUPS(INA-DRGS) INA-CBGS


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INA-DRG

Indonesia-Diagnosis Related Groups

adalah pengklasifikasian setiap tahapanpelayanan kesehatan sejenis ke dalamkelompok yang mempunyai arti relatifsama.

Setiap pasien yang dirawat di RSdiklasifikasikan ke dalam kelompok yangsejenis dengan gejala klinis yang samaserta biaya perawatan yang relatif sama.

(De kes, 2008).


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INA-DRG

INA-DRG terdiri dari 23 Major Diagnostic

Categories (MDC)

sebanyak 1.077 kode INA-DRG beserta tarifnyayang terbagi ke dalam 789 kode rawat inap dan

288 kode rawat jalan.

Kode Diagnosis penyakit (ICD-10) sebanyak18.483 dan

Tindakan (ICD-9-CM) sebanyak 2.945.


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1 Diseases and disorders of the nervous system

2 Disease and disorders of the eye

3 Disease and disorders of the ear, nose, and throat

4 Disease and disorders of the respiratory system

5 Disease and disorders of the circulatory system

6 Disease and disorders of the digestive system

7 Disease and disorders of the hepatobiliary system and pancreas

8 Disease and disorders of the musculoskeletal system and connective tissue

9 Disease and disorders of the skin, subcutaneous tissue, and breast

10 Endocrine, nutritional, and metabolic diseases and disorders

11 Disease and disorders of the kidney and the urinary tract

12 Disease and disorders of the male reproductive

13 Disease and disorders of the female reproductive system

14 Pregnancy, childbirth, and the purperium

15 Newborn and other neonates with conditions originating in the perinatal period

16 Disease and disorders of blood and blood forming organs and immunological disorders

17 Myeloproliferative disease and disorder, and poorly differentiated neoplasm

18 Infectious and parasitic disease (systemic or unspecified sites)

19 Mental diseases and disorders

20 Alcohol/drug use and alcohol/drug- induced organic mental disorders

21 Injuries, poisoning, and toxic effects of drugs

22 Factors influencing health status and other contact with health services23 Medical Outpatient Visits

Major Diagnostic Categories (MDC) 23 MDC


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KEUNTUNGAN INA-DRG

Tarif terstandarisasi dan lebih transparan.

Penghitungan tarif pelayanan lebih objektif

dan berdasarkan kepada biaya yang

sebenarnya.

RS mendapat pembiayaan berdasarkan

kepada beban kerja sebenarnya.

Dapat meningkatkan mutu dan efisiensipelayanan RS.


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14 VARIABEL INA-DRG1. Identitas Pasien

2. Tanggal masuk rumah sakit

3. Tanggal keluar rumah sakit

4. Lama hari rawat

5. Tanggal lahir

6. Umur ketika masuk rumah sakit (dalam satuan tahun)7. Umur ketika masuk rumah sakit (dalam satuan hari)

8. Umur ketika keluar dari rumah sakit (dalam satuan hari)

9. Jenis kelamin

10.Status keluar rumah sakit (discharge disposition)

11.Berat badan baru lahir12.Diagnosis utama

13.Diagnosis sekunder, seperti komplikasi dan komorbiditas

14.Prosedur atau pembedahan utama.


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CUPLIKAN KODE INA-DRGNo INA-

DRGDescription ALOS Tarif

Kls III(Rp.)

TarifKls II(Rp.)

TarifKls I(Rp.)

VIP(Rp.)

VVIP(Rp.)

1 011011 IP IntracranialVascular

Procedures

8,5 7.532.350 10.043.133

15.064.700

20.086.267

25.107.833

2 011012 IP IntracranialVascularProceduresw/CC

14,4 12.749.410

16.999.214

25.498.820

33.998.427

42.498.034

3 011013 IP IntracranialVascularProceduresw/MCC

27,9 24.681.434

32.908.579

49.362.868

65.817.158

82.271.447


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[email protected] CONTOH

0 1 1 0 1 1

MDCSeverity Level 1

IP Intracranial Vascular Procedures

Kode INA-DRG Description

0 1 1 0 1 2

Severity Level 2

IP Intracranial Vascular Procedures w/C


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CONTOH IMPLEMENTASI INA-DRGNo No

RMKode Dx.

UtamaKode Dx.Sekunder

Kode Dx.Tindakan

KodeINA-

DRG

LosRiel

Tarif(standar

bukutarif)

BiayaRiel(jt rp)

AlosBuku

SelisihHarga(jt rp)

01 3220959 D 03.8 Z 34.8M 46.9K 51

Z 30.1

69526976993

131111 3 3,240 1,143 3 2,097

02 3383318 N 20.2 N03.9J18.9K30I25,2D52.9

550456315609904

111203 22 18,421 23,685 24 -5,264

03 3384951 M51.2 G82.5 8102 081073 - 39,721 38,465 19 1,256

04 3372630 O49.0 - 4029 161201 7 9,886 7,910 18 -2,056

05 3378640 C53.9 - 6899964

131201 7 9,547 14,437 8 -4,890

Kuliah Umum Mahasiswa STIKES PanakukkangUEU, Jakarta (27 April 2011)


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Mengapa Penggunaan INA-DRG INA-CBG?Grouper yang digunakan dalam INA-DRG sebelum ini

lisensinya telah berakhir sejak 30 September 2010

Tidak mungkin menggunakan system DRG tanpa

menggunakan grouper karena: Kode Diagnosis ICD-10 sekurang-kurangnya 14,500 kode ICD-9 CM/Procedure sekurang-kurangnya 8,500 kode Untuk melakukan kombinasi berdasarkan algoritma dari

23,000 kode tsb menjadi 1.077 kelompok DRG (Indonesia)

tidak dapat dilakukan manual, tanpa grouper


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Coding & Entry:Dapat dilakukan

(software tdk bermslh)

Tidak ada luaran

kode DRG dan

tarif Klaim &

verif. tertunda

Grouper:Tidak

Berfungsi

Tdk bisa

melakukan

grouping

Apa Yang Terjadi Dengan Berakhirnya

Lisensi Grouper?

Tidak dapat berlangsungnya proses grouping menyebabkan tidak bisa berlangsungnya

klaim karena tidak ada luaran kode DRG dan tarif


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Apa Yang Berbeda? (1)

Case -Mix Main Groups (CMGs) CMGs adalah klasifikasi tingkat pertama Dilabel dengan Alphabet (A s/d Z) Ekivalent dengan Chapters in ICD-10

Berhubungan dengan Body Systems & pembayaranpaket 31 CMGs pada UNU Grouper

22 Acute Care CMGs 2 Ambulatory CMGs 1 Subacute CMGs 1 Chronic CMGs 4 Special CMGs 1 Error CMGs

Total DRGs (CBGs)= 1,220


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[email protected] Apa Yang Berbeda? (2)Pendekatan Body System

IR DRG : MDC (23 Digit Numeric)

NOS. Case-Mix Major Groups (CMG)CMG

Codes

1 Central nervous system Groups G

2 Eye and Adnexa Groups H

3 Ear, nose, mouth & throat Groups U

4 Respiratory system Groups J

5 Cardiovascular system Groups I

6 Digestive system Groups K

7 Hepatobiliary & pancreatic system Groups B

8

Musculoskeletal system & connective

tissue Groups M

9

Skin, subcutaneous tissue & breast

Groups L

10

Endocrine system, nutrition & metabolism

Gropus E

11 Nephro-urinary System Groups N

12 Male reproductive System Groups V

13 Female reproductive system Groups W

14 Deleiveries Groups O15 Newborns & Neonates Groups P

16

Haemopoeitic & immune system

Groups D

17

Myeloproliferative system &

neoplasms Groups C

18

Infectious & parasitic diseases

Groups A

19 Mental Health and Behavioral Groups F

20

Substance abuse & dependence

Groups T

21

Injuries, poisonings & toxic effects of

drugs Groups S

22

Factors influencing health status &

other contacts with health services

Groups Z

23 Medical Ambulatory Groups Q

24 Errors CMGs X

Generic: 31CMG (24 Alphabet+7 Spec Case)


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[email protected] Apa Yang Berbeda? (3)Sistem Coding

1 2 3 4 5 6

MDC Severity

Level

1.077 INA-DRG Codes: 789 Inpatient Codes

288 Outpatient Codes.

A 1 2 3 4

CMG CBG TypeService

LevelSeverity

level

CMGs are the first level of classifications

Labels in Alphabet (A to Z)

Mostly equivalent to Chapters in ICD-10

Correspond to Body Systems24+7 CMGs in Gneric UNUGrouper

IR-DRG: 6 Digit, Numerik Generic: 5 Digit, Alphabet + Numerik

DRG Type


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Tata Prosedur Tidak Berubah

Documents

DRG-INA-DRG-INA-CBG