id
HOSIZAH
Prodi Manajemen Informasi Kesehatan
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DIAGNOSIS RELATED GROUPS (DRGs)
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PENGERTIAN
Diagnosis Related Groups (DRGs) represent an inpatient classification scheme to categorize patients who are medically related with respect to diagnoses and treatment, who are statistically 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
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Principal Diagnosis The principal diagnosis is defined as the condition which after study, was found to be chiefly responsible for occasioning the patients admission to the hospital for care.
Only one DIAGNOSIS may be listed as the Principal Diagnosis.
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Secondary Conditions All conditions should be listed that: 1. existed at the time of patients admission to hospital for which treatment was given, or 2. that arose during the patients stay in hospital, or 3. that affected the patients treatment and/or LOS by greater than one day.
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MAJOR DIAGNOSTIC CATEGORY (MDC) 12 Diseases and disorders of the Male Reproductive System
DRG
Yes 334
Surgical Partitioning
Major Pelvic CC No 335 341 Yes Transurethal Prostatectomy Age>69 and/or CC No Other Male Reproductive System OR Procedures Principal Diagnosis Malignancy Yes No Yes No Yes No 337 344 345 346 347 348 349 350 351 352 336
OR Procedure
Penis Yes
No
Medical Partitioning Principal Diagnosis
Malignancy
Age>69 and/or CC
Benign Prostatic Hypertrophy
Age>69 and/or CC
Inflammation Sterilization Other Male Reproductive System Diagnoses
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 tahapan pelayanan kesehatan sejenis ke dalam kelompok yang mempunyai arti relatif sama. Setiap pasien yang dirawat di RS diklasifikasikan ke dalam kelompok yang sejenis dengan gejala klinis yang sama serta biaya perawatan yang relatif sama. (Depkes, 2008).
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INA-DRG
INA-DRG terdiri dari 23 Major Diagnostic Categories (MDC) sebanyak 1.077 kode INA-DRG beserta tarifnya yang terbagi ke dalam 789 kode rawat inap dan 288 kode rawat jalan. Kode Diagnosis penyakit (ICD-10) sebanyak 18.483 dan Tindakan (ICD-9-CM) sebanyak 2.945.
Major Diagnostic Categories (MDC) 23 MDC
[email protected]1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Diseases and disorders of the nervous system Disease and disorders of the eye Disease and disorders of the ear, nose, and throat Disease and disorders of the respiratory system Disease and disorders of the circulatory system Disease and disorders of the digestive system Disease and disorders of the hepatobiliary system and pancreas Disease and disorders of the musculoskeletal system and connective tissue Disease and disorders of the skin, subcutaneous tissue, and breast Endocrine, nutritional, and metabolic diseases and disorders Disease and disorders of the kidney and the urinary tract Disease and disorders of the male reproductive Disease and disorders of the female reproductive system Pregnancy, childbirth, and the purperium Newborn and other neonates with conditions originating in the perinatal period Disease and disorders of blood and blood forming organs and immunological disorders Myeloproliferative disease and disorder, and poorly differentiated neoplasm Infectious and parasitic disease (systemic or unspecified sites) Mental diseases and disorders Alcohol/drug use and alcohol/drug- induced organic mental disorders Injuries, poisoning, and toxic effects of drugs Factors influencing health status and other contact with health services Medical Outpatient Visits
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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 efisiensi pelayanan RS.
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14 VARIABEL INA-DRG
1. 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 lahir 12. Diagnosis utama 13. Diagnosis sekunder, seperti komplikasi dan komorbiditas 14. Prosedur atau pembedahan utama.
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ALUR PENETAPAN KODE INA-DRG
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Kode Salah Salah Ruang Perawatan
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CUPLIKAN KODE INA-DRG
No INADRG
011011
Description
ALOS
Tarif Kls III (Rp.)
7.532.350
Tarif Kls II (Rp.)
10.043.13 3
Tarif Kls I (Rp.)
15.064.70 0
VIP (Rp.)
20.086.26 7
VVIP (Rp.)
25.107.83 3
IP Intracranial Vascular Procedures IP Intracranial Vascular Procedures w/CC IP Intracranial Vascular Procedures w/MCC
8,5
011012
14,4
12.749.41 0
16.999.21 4
25.498.82 0
33.998.42 7
42.498.03 4
011013
27,9
24.681.43 4
32.908.57 9
49.362.86 8
65.817.15 8
82.271.44 7
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CONTOH
Description IP Intracranial Vascular Procedures
Kode INA-DRG
011011
MDC
Severity Level 1
011012
IP Intracranial Vascular Procedures w/CC
Severity Level 2
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CONTOH IMPLEMENTASI INA-DRG
No No RM Kode Dx. Utama Kode Dx. Sekunder Kode Dx. Tindakan Kode INADRG 131111 Los Riel Tarif (standar buku tarif) 3,240 Biaya Riel (jt rp) 1,143 Alos Buku Selisih Harga (jt rp) 2,097 01 3220959 D 03.8 Z 34.8 M 46.9 K 51 Z 30.1 N03.9 J18.9 K30 I25,2 D52.9 G82.5 6952 697 6993 3 3
02
3383318
N 20.2
5504 5631 560 9904
111203
22
18,421
23,685
24
-5,264
03
3384951
M51.2
8102
081073
39,721
38,465
19
1,256
04
3372630
O49.0
4029
161201
9,886
7,910
18
-2,056
05
3378640
C53.9
689 9964
131201
9,547
14,437
-4,890
Kuliah Umum Mahasiswa STIKES Panakukkang UEU, 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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Apa Yang Terjadi Dengan Berakhirnya Lisensi Grouper?
Coding & Entry: Dapat dilakukan (software tdk bermslh) Grouper: Tidak Berfungsi Tdk bisa melakukan grouping Tidak ada luaran kode DRG dan tarif Klaim & verif. tertunda
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 & pembayaran paket 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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Apa Yang Berbeda? (2)
Generic: 31CMG (24 Alphabet+7 Spec Case)
NOS. 1 2 3 4 5 6 7 8 9 10 11 12 Case-Mix Major Groups (CMG) Central nervous system Groups Eye and Adnexa Groups
14 Deleiveries Groups Respiratory system Groups Newborns & Neonates Groups Haemopoeitic & immune system Digestive system Groups 16 Groups
Pendekatan Body System
IR DRG : MDC (23 Digit Numeric)
CMG Codes G H
W O P D C
Ear, & throat Groups system Groups U 13nose, mouth Female reproductive J I K B M Cardiovascular system Groups
15
Hepatobiliary & pancreatic system Groups Myeloproliferative system &
neoplasms Groups Musculoskeletal system& & parasitic connective Infectious diseases tissue 18 Groups Groups 17
A F T S
Skin, tissue &and breast 19 subcutaneous Mental Health Behavioral Groups Groups L Substance abuse & dependence 20 Groups Endocrine system, nutrition & metabolism Gropus Injuries, poisonings & toxic effects of E
21 drugs Groups Nephro-urinary System Groups Factors influencing health status & Male reproductive Groups other System contacts with health services 22 Groups 23 24 Medical Ambulatory Groups Errors CMGs
N V
Z Q X
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Apa Yang Berbeda? (3)
Sistem Coding
Generic: 5 Digit, Alphabet + Numerik CMGs are the first level of classifications Labels in Alphabet (A to Z) Mostly equivalent to Chapters in ICD-10 Correspond to Body Systems 24+7 CMGs in Gneric UNUGrouper
IR-DRG: 6 Digit, Numerik
1.077 INA-DRG Codes: 789 Inpatient Codes 288 Outpatient Codes.
1 2 3 4 5 6
A 1
MDC
DRG Type
Severity Level
CMG
Service Level
CBG Type Severity
level
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Contoh Hasil Coding
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