Download HRG4+ 2016/17 Engagement Grouper Chapter Summaries

HRG4+ 2016/17 Engagement
Grouper
Chapter Summaries
Published August 2015
HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
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Version:
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Date of publication:
August 2015
Page 2 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Contents
HRG4+ Design Changes Overview
6
AA – Nervous System Procedures and Disorders
7
AB – Pain Management
9
BZ – Eyes and Periorbita Procedures and Disorders
10
CA – Ear, Nose, Mouth, Throat and Neck Procedures
12
CD – Dental and Orthodontic Procedures
16
DZ – Thoracic Procedures and Disorders
18
EA – Cardiac Procedures
21
EB – Cardiac Disorders
23
EC – Congenital Cardiac Surgery
25
FZ – Digestive System Procedures and Disorders
27
GA – Hepatobiliary and Pancreatic System Surgery
30
GB – Hepatobiliary and Pancreatic System Endoscopic and Percutaneous
Procedures
31
GC – Hepatobiliary and Pancreatic System Disorders
33
HA – Orthopaedic Trauma Procedures
35
HB – Orthopaedic Non-Trauma Procedures
35
HC – Spinal Surgery and Disorders
37
HD – Musculoskeletal Disorders
39
HR – Orthopaedic Reconstruction Procedures
40
JA – Breast Procedures and Disorders
41
JB – Burns Procedures and Disorders
44
JC – Skin Surgery
46
JD – Skin Disorders
47
KA – Endocrine System Disorders
49
KB – Diabetic Medicine
50
KC – Metabolic Disorders
51
LA – Renal Procedures and Disorders
53
LB – Urological and Male Reproductive System Procedures and Disorders
56
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
LD – Renal Dialysis for Chronic Kidney Disease
58
LE – Renal Dialysis for Acute Kidney Injury
72
MA – Female Reproductive System Procedures
73
MB – Female Reproductive System Disorders
75
MC – Assisted Reproductive Medicine
77
NZ – Obstetric Medicine
78
PB – Neonatal Disorders
80
PC – Paediatric Ear Nose and Throat Disorders
81
PD – Paediatric Respiratory Disorders
82
PE – Paediatric Cardiology Disorders
83
PF – Paediatric Gastroenterology Disorders
84
PG – Paediatric Hepatobiliary Disorders
85
PH – Paediatric Rheumatology Disorders
86
PJ – Paediatric Dermatology Disorders
87
PK – Paediatric Diabetology, Endocrinology and Metabolic Disorders
88
PL – Paediatric Renal Disorders
89
PM – Paediatric Haematological-Oncology Disorders
90
PN – Paediatric Non-Malignant Haematological Disorders
91
PP – Paediatric Ophthalmic Disorders
92
PR – Paediatric Neurosciences Disorders
93
PT – Mental Health Disorders
94
PV – Paediatric Trauma Medicine
95
PW – Paediatric Infectious Diseases
96
PX – Paediatric Medicine
97
RA – Diagnostic Imaging Procedures
98
RN – Nuclear Medicine Procedures
100
SA –Haematological Procedures and Disorders
102
SB – Chemotherapy
104
SC – Radiotherapy
108
SD – Specialist Palliative Care
111
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
UZ – Undefined Groups
118
VA – Multiple Trauma
120
VB –Emergency Medicine
122
VC – Rehabilitation
129
WA – Immunology, Infectious Diseases, Poisoning, Shock, Special
Examinations, Screening and Other Healthcare Contacts
130
WD – Treatment of Mental Health Patients by Non-Mental Health Service
Providers
132
WF – Non-admitted Consultations
133
XA – Neonatal Critical Care
135
XB – Paediatric Critical Care
141
XC – Adult Critical Care
155
XD – High Cost Drugs
157
YQ – Vascular Open Procedures and Disorders
158
YR – Vascular Imaging Interventions
161
YZ – Other Imaging Interventions
163
The Documentation Suite
165
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
HRG4+ Design Changes Overview
The HRG4+ 2016/17 Engagement Grouper Design necessarily involves several Global
Design Concepts being applied across all relevant and appropriate subchapters within the
Casemix Design. These include the following:

Changes to accommodate OPCS-4.7
Changes to the procedure classification OPCS-4, implemented from 1st April 2014, are
incorporated within the HRG4+ design. Where a new code has been added, Subchapterspecific Expert Working Group advice has been used to determine the most appropriate
HRGs to map to, and confirm whether new codes should be a member of specific lists.

Changes to accommodate ICD-10 4th Edition
Changes to the primary diagnosis classification ICD-10, implemented from 1st April 2012,
are utilised within the HRG4+ design. Where a new code has been added, Expert
Working Group advice has been used to determine the most appropriate HRGs to map
to, and confirm whether new codes should be a member of specific lists, such as
Complication and Comorbidity (CC) lists.
With regard to deletions, the grouper implements the ICD-10 classifications as detailed
by the Clinical Classifications Service at the HSCIC. Therefore ICD-10 codes that are not
present in the updated code set are not valid. If used, these will cause the episode (and
spell) to generate UZ01Z, Data Invalid for Grouping.

Procedure Hierarchy changes
Procedure hierarchies (PH) have been rescaled to more appropriately reflect the
expected resource use of procedures across all subchapters, particularly when
differentiating between low-cost high-volume procedures. A new logarithmic hierarchy
range has been introduced which runs from 3 to 40, with a lower resource difference
expected between the bands at the lower end, than those at the higher.
Procedure hierarchies have also been amended to eliminate overlap between HRG
‘categories’. Where multiple procedures are recorded, the procedure with the first highest
hierarchy value will drive the grouping to the appropriate highest expected resource
HRG.

Diagnosis Hierarchy changes
Diagnosis hierarchies (DH) have also been rescaled to better reflect the expected
resource use of diagnoses across all subchapters. Diagnosis hierarchies are used to
determine the primary diagnosis of a multi-episode spell with multiple primary diagnoses
across episodes. The new logarithmic DH range runs from 5 to 26, with a lower resource
difference expected between the bands at the lower end than those at the higher.
It should be assumed that unless otherwise stated, the following Chapter Summary
changes by default include the HRG4+ Global Design Concepts outlined above.
Full details of all design changes, including those made to code mappings and logics can be
found in the Code to Group Excel document that accompanies each Grouper release. This
can be accessed via http://www.hscic.gov.uk/casemix/payment
Worked examples regarding the use of HRG4+ can also be found in a separate document
on the above site.
Page 6 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
AA – Nervous System Procedures and Disorders
A – Nervous System
Scope and Composition
Composition and Concepts
E16/17
LP
15/16
P14/15
Total HRGs
106
65
65
Total HRG Roots
40
33
33
Procedure-driven HRGs
57
45
45
Diagnosis-driven HRGs
49
20
20
It comprises of:
Age Splits
No
 Intracranial procedures for trauma
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
Subchapter AA covers all-age
procedures and adult diagnoses
relating to the nervous system. It
includes activity undertaken in
inpatient, day case and non-admitted
care settings.
 Intracranial procedures for nontrauma
 Neuropsychology and neurophysiology assessments
 Neurological disorders in adults
All diagnosis-driven activity relating to the treatment of children (aged 18 years and under)
groups to an HRG in Chapter P, Diseases of Childhood and Neonates, in line with the
requirements of the Casemix Design Framework.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
New HRGs have been created and HRGs have been deleted
A number of HRGs have been deleted and replaced by HRGs with interactive CC splits.
There are 91 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design.
Full details of all design changes can be found in the Code to Group Excel document that
accompanies this release.
Nine HRGs specifically identify the care of patients who have had a Stroke; six diagnosisdriven HRGs which include interactive CC splits, and three procedure-driven HRGs,
mirroring the existing Major, Intermediate and Minor Intracranial Procedures logic.
Four new HRGs AA39Z Long Term EEG Monitoring, AA40Z Complex Long Term EEG
Monitoring, AA41Z Sleep Studies and AA42Z Complex Sleep Studies have been created
in order to better differentiate the resource usage of these neurophysiological tests, resulting
Page 7 of 166
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in the deletion of the AA34C Neurophysiological Operations, 19 years and over and
AA34D Neurophysiological Operations, 18 years and under HRG.
Interactive Complications and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determines the HRG derived.
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to
CC lists. Diagnosis codes that should always indicate additional resource have been added
to all CC lists for consistency. To allow the interactive CC logic to be implemented, all major
CC lists have been deleted and all codes now appear on subchapter-specific CC lists. Major
CCs have a value of two and all other CCs have a value of one.
Mapping of code to more appropriately reflect resource
OPCS-4.7 codes L29.6 High-flow interposition extracranial to intracranial bypass from
external carotid artery to middle cerebral artery and L29.7 Bypass of carotid artery by
anastomosis of superficial temporal artery to middle cerebral artery have been mapped
to Chapter AA Nervous System Procedures and Disorders to better reflect the nature of the
clinical care provided.
In addition, three OPCS-4.7 codes have been mapped to HRGs. The three codes are A57.5
Destruction of spinal nerve root NEC, A57.8 Other specified operations on spinal
nerve root and A09.2 Maintenance of neurostimulator in brain. OPCS codes A57.5 and
A57.8 are mapped to AA21*, Minor Intracranial Procedures Except Trauma with Other
Diagnoses and A09.2 is mapped to AA15*, Intermediate Intracranial Procedures Except
Trauma with Other Diagnoses in order to better reflect the resource used where these
procedures are recorded.
ICD-10 diagnosis code G44.2 Tension headache has been mapped to HRG root AA31
Headache, Migraine or Cerebrospinal Fluid Leak in order to more accurately reflect that
the care provided is similar to that for other types of headache.
Other lists have been updated
To appropriately recognise pituitary surgery, primary diagnoses of Acromegaly, Cushing’s
disease and Rathke’s cyst have been added to the diagnosis list Brain Tumours or Cerebral
Cysts used in procedure-driven grouping.
Page 8 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
AB – Pain Management
A – Nervous System
Scope and Composition
Composition and Concepts
Subchapter AB relates to Pain
Management services and covers
activity for all ages. It includes activity
undertaken in inpatient, day case and
some activity undertaken in nonadmitted care settings.
It comprises of:
E16/17
LP
15/16
P14/15
Total HRGs
10
10
10
Total HRG Roots
10
10
10
Procedure-driven HRGs
10
10
10
Diagnosis-driven HRGs
0
0
0
Age Splits
No
 Procedures for the management of Complications and
No
Comorbidities Splits
pain, based on the level of
Intervention Splits
No
complexity
 Pain Radiofrequency Treatments
 Insertion of Neurostimulator or Intrathecal Drug Delivery Device (for management of pain)
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
No changes have been made to this subchapter as part of the HRG4+ implementation.
Changes to other HRGs within the HRG4+ design may impact on the activity that maps to
the HRGs, in this subchapter, in the HRG4+ 2016/17 Engagement design.
Full details of all design changes can be found in the Code to Group Excel document that
accompanies this release.
Page 9 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
BZ – Eyes and Periorbita Procedures and Disorders
B – Eyes and Periorbita
Scope and Composition
Composition and Concepts
Subchapter BZ covers procedures for
patients of all ages and diagnoses for
adults relating to the eyes and
periorbita, delivered in admitted or
non-admitted care settings.
It comprises of:








E16/17
LP
15/16
P14/15
Total HRGs
58
33
33
Total HRG Roots
24
24
24
Procedure-driven HRGs
54
31
31
Diagnosis-driven HRGs
4
2
2
Age Splits
Cataract and lens procedures
Complications and
Oculoplastics procedures
Comorbidities Splits
Orbit and lacrimal procedures
Intervention Splits
Cornea and sclera procedures
Ocular motility procedures
Glaucoma procedures
Vitreous retinal procedures
Diagnosis-driven ophthalmic disorders for adults
Yes
Yes
Yes
All diagnosis-driven activity relating to the treatment of children (aged 18 years and under)
groups to an HRG in Chapter P, Diseases of Childhood and Neonates, in line with the
requirements of the Casemix Design Framework.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
New HRGs have been created and HRGs have been deleted
A number of HRGs have been deleted and replaced by HRGs with interactive CC splits, and
diagnosis-driven HRGs with interactive CC and intervention splits.
There are 46 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design. Interactive CC splits are not employed for surgical HRGs for children, due to low
volumes.
Full details of all design changes can be found in the Code to Group Excel document that
accompanies this release.
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Intervention splits added to Diagnosis-Driven HRGs
Intervention splits have been added to Subchapter BZ. This reflects where, within a
diagnosis-driven HRG, there are ‘minor interventions’ performed which not only means that
they include the cost/resources associated with these procedures, but may indicate that the
patient’s condition was more severe resulting in more resource-intensive treatment.
Interactive Complications and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with Interactive CC splits based
on summed scores, to more appropriately reflect the additional resource use expected when
treating patients with multiple comorbidities. The summed ‘score’ of all secondary diagnoses
from the values assigned to the CC list determines the HRG derived.
The ‘Interventions’ list is only utilised for procedures that map to a base HRG with a
maximum length of stay check.
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to
CC lists. Diagnosis codes that should always indicate additional resource have been added
to all CC lists for consistency. To allow the interactive CC logic to be implemented, all major
CC lists have been deleted and all codes now appear on subchapter-specific CC lists. Major
CCs have a value of two and all other CCs have a value of one.
Other lists have been updated
The list BZ_cataract has been modified with the removal of flags from a number of
procedures to ensure they map to HRGs which better reflect expected resource use.
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CA – Ear, Nose, Mouth, Throat and Neck Procedures
C – Ear, Nose, Mouth, Throat, Neck and Dental
Scope and Composition
Composition and Concepts
Subchapter CA covers ear, nose,
throat and neck procedures for
patients of all ages. It includes activity
undertaken in inpatient, day case and
non-admitted care settings.
This activity is now separate from CD
Dental and Orthodontic Procedures
and CB Ear, Nose, Throat and Neck
Disorders. It is comprised of:





E16/17
LP
15/16
P14/15
Total HRGs
120
N/A
N/A
Total HRG Roots
70
N/A
N/A
Procedure-driven HRGs
120
N/A
N/A
Diagnosis-driven HRGs
0
N/A
N/A
Age Splits
Yes
Complications and
Comorbidities Splits
Yes
Intervention Splits
Neck procedures
Nose procedures
Ear procedures, including audiology
Mouth and throat procedures
Maxillofacial procedures
No
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
This subchapter has been created specific to ear, nose, mouth, throat and neck procedures
that previously sat within subchapter CZ Mouth Head Neck and Ears Procedures and
Disorders, which has been deleted.
The new subchapter contains 120 HRGs which are split into neck, ear, nose, mouth or throat
and maxillofacial procedures. In addition, there are now many HRGs that are specific to
clinically common ENT procedures such as CA33Z Pinnaplasty and CA61Z
Adenotonsillectomy.
The majority of procedures within this subchapter employ multiple procedure logic to take
account of the additional resource usage associated with undertaking multiple procedures,
particularly for reconstructive surgery.
Many HRGs within this subchapter have infant and paediatric age splits to reflect the
different resource usage associated with these patients when compared to adults
undergoing the same procedures.
Page 12 of 166
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Interactive CC splits have been employed in several HRG roots in this subchapter to more
appropriately reflect the additional expected resource use for patients with multiple
comorbidities.
There are 23 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design.
Changes made to logic
Multiple procedure logic has been added to the majority of procedure codes within this
subchapter using a method of summing the score of the procedures undertaken on specific
lists associated with specific HRGs.
For example, where the dominant procedure is a “minor” sinus procedure (e.g. E13.3
Intranasal antrostomy) recorded alone, this would map to CA29Z Minor Sinus
Procedures. When this is recorded with another “minor” sinus procedure (e.g. E14.2
Intranasal ethmoidectomy) then, as both have a value of 2 on the CA_FESS list, and a
summed score from list CA_FESS of 4 is required to “escalate” to the next highest resource
HRG, the HRG derived will be CA28Z Intermediate Sinus Procedures.
All the minor procedure HRGs within this subchapter have had maximum length of stay logic
added to reflect that these procedures are deemed minor for grouping purposes and are
therefore inappropriate to drive HRG grouping where the length of stay is greater than this
maximum. Where the length of stay does exceed this maximum, the HRG will be derived
from the primary diagnosis.
Logic has been added to several excision of lesion OPCS codes to map this activity to a
higher expected resource HRG if the lesion is a specific malignant or vascular tumour,
thereby reflecting the additional resource usage associated with caring for these complex
patients.
Complications and Comorbidity lists updated
A new CC list has been created for this subchapter, which is shared with subchapter CB
Ear, Nose, Mouth, Throat and Neck Disorders. Full details of all CC lists can be found on
the HRG4+ Code to Group workbook ‘CC Lists’ sheet.
Mapping of codes to more appropriately reflect resource
Several procedure codes relating to pre-prosthetic oral surgery have been mapped to the
dental HRGs within subchapter CD Dental and Orthodontic Procedures to reflect that this
is dental surgery.
In order to more appropriately identify neck surgery, new HRGs specific to neck procedures
have been created, which includes constructing several combination codes for soft tissue
procedures that previously mapped to HRGs within other subchapters, where the site code
relates to the neck.
A small number of procedure codes that do not specify the particular organ that has been
operated on have been mapped to WA21Z Other Procedures or Health Care Problems to
reflect the fact that these cannot reliably be identified as ENT procedures.
In addition, several procedures that have been deemed insignificant for grouping, i.e. those
with very low expected resource, have been effectively ignored when grouping, to reflect this
fact.
Page 13 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
CB – Ear, Nose, Mouth, Throat and Neck Disorders
C – Ear, Nose, Mouth, Throat, Neck and Dental
Scope and Composition
Composition and Concepts
Subchapter CB includes all ear, nose,
mouth, throat and neck disorders for
adults only. It includes activity
undertaken in inpatient and day case
settings.
It is comprised of:
 Malignant disorders
 Non-malignant disorders
E16/17
LP
15/16
P14/15
Total HRGs
12
N/A
N/A
Total HRG Roots
2
N/A
N/A
Procedure-driven HRGs
0
N/A
N/A
Diagnosis-driven HRGs
12
N/A
N/A
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
Yes
All diagnosis-driven activity relating to the treatment of children (aged 18 years and under)
groups to an HRG in Chapter P, Diseases of Childhood and Neonates, in line with the
requirements of the Casemix Design Framework.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
This subchapter has been created to better reflect the expected resource use for the care of
ear, nose, mouth, throat and neck disorders that previously sat within subchapter CZ Mouth
Head Neck and Ears Procedures and Disorders, which has been deleted.
The new subchapter contains twelve diagnosis-driven HRGs which are differentiated
between malignant and non-malignant disorders, to reflect the fact that treating malignant
conditions consumes, on average, more resource than treating non-malignant disorders.
Interactive CC splits have been employed in both HRG roots in this subchapter to more
appropriately reflect the additional expected resource usage for patients with multiple
comorbidities.
There are 12 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design.
Intervention splits added to Diagnosis-Driven HRGs
Intervention’ splits have been added to Subchapter CB. This reflects where, within a
diagnosis-driven HRG, there are ‘minor interventions’ performed which not only means that
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they include the cost/resources associated with these procedures, but may indicate that the
patient’s condition was more severe resulting in more resource-intensive treatment.
The ‘Interventions’ list is only utilised for procedures that map to a base HRG with a
maximum length of stay check.
Interactive Complications and Comorbidity splits added to HRGs
Standard CC splits in subchapter CZ have been replaced with new Interactive CC splits
based on summed score to more appropriately reflect the additional resource usage when
treating patients with multiple comorbidities.
Complications and Comorbidity lists updated
A new CC list has been created for this subchapter, which is shared with subchapter CA
Ear, Nose, Mouth, Throat and Neck Procedures. Full details of all CC lists can be found
on the HRG4+ Code to Group workbook ‘CC Lists’ sheet.
Page 15 of 166
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CD – Dental and Orthodontic Procedures
C – Ear, Nose, Mouth, Throat, Neck and Dental
Scope and Composition
Subchapter CD covers dental and
orthodontic procedures for patients of all
ages. It includes activity undertaken in
inpatient, day case and non-admitted care
settings.
Other mouth and throat procedures are
covered alongside ear, nose, and neck
procedures within subchapter CA Ear, Nose,
Mouth, Throat and Neck Procedures. Dental
disorders are covered in subchapter CB Ear,
Nose, Mouth, Throat and Neck Disorders.
It is comprised of:
 Extraction of teeth
 Other dental procedures
 Orthodontic procedures
Composition and
Concepts
E
16/17
LP
15/16
P
14/15
Total HRGs
23
N/A
N/A
Total HRG Roots
12
N/A
N/A
Procedure-driven HRGs
23
N/A
N/A
Diagnosis-driven HRGs
0
N/A
N/A
Age Splits
Yes
Complications and
Comorbidities Splits
No
Intervention Splits
No
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
A new subchapter has been created specific to dental and orthodontic procedures. This
replaces the HRGs that previously sat within subchapter CZ Mouth Head Neck and Ears
Procedures and Disorders, which has been deleted.
HRGs have been merged
As there are too few children undergoing minor dental biopsy to meet minimum design
criteria, a new HRG CD08Z Minor Dental Biopsy, has been created.
Changes made to logic
The length of stay check logic on the dental HRGs has been amended to more appropriately
reflect the expected complexity of the procedures undertaken. It has been kept at 0 to 2 days
for major procedures, amended to 0 to 1 day for procedures of intermediate complexity and
0 days for minor dental and orthodontic procedures.
Page 16 of 166
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Mapping of codes to more appropriately reflect resource
Several procedure codes relating to pre-prosthetic oral surgery have been mapped from
HRGs specific to mouth and throat procedures to the dental HRGs within this subchapter to
reflect that this activity is dental surgery.
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DZ – Thoracic Procedures and Disorders
D – Respiratory System
Scope and Composition
Composition and Concepts
Subchapter DZ covers both adult
respiratory diagnoses and thoracic
and respiratory procedures for
patients of all ages.
The subchapter includes activity
undertaken in inpatient, day case and
non-admitted care settings.
It comprises of:



Thoracic surgery
Ambulatory respiratory
procedures
Respiratory disorders in adults
E16/17
LP
15/16
P14/15
Total HRGs
139
100
99
Total HRG Roots
50
51
50
Procedure-driven HRGs
45
35
34
Diagnosis-driven HRGs
94
65
65
Age Splits
Yes
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
All diagnosis-driven activity relating to the treatment of children (aged 18 years and under)
groups to an HRG in Chapter P, Diseases of Childhood and Neonates, in line with the
requirements of the Casemix Design Framework.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
New HRGs have been created and HRGs have been deleted
A number of HRGs have been deleted and replaced by procedure-driven HRGs with
interactive CC splits, and diagnosis-driven HRGs with interactive CC and intervention splits.
There are 101 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design.
A new HRG DZ54Z Complex Bronchoscopy has been created to identify complex
bronchoscopy activity such as endobronchial valve placements and bronchial thermoplasty.
New HRGs DZ62* Very Complex Thoracic Procedures, DZ63* Major Thoracic
Procedures and DZ64* Intermediate Thoracic Procedures have been created to better
differentiate the resource usage according to the expected complexity of the procedure
undertaken.
Several new ambulatory HRGs have been created, with more clinically relevant labels, to
better reflect current clinical practice and to ensure that the different expected resource
usage associated with these procedures is appropriately captured. The new HRGs are:
Page 18 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0






DZ55Z Bronchodilator Studies
DZ56Z Carbon Monoxide Transfer Factor Test
DZ57Z Oximetry or Blood Gas Studies
DZ58Z Alveolar Carbon Monoxide Measurement or Smoking Cessation
Support
DZ59Z Airflow Studies
DZ60Z Hypoxic (Altitude) or Hyperoxic (Shunt) Assessment
As a result of the creation of the new HRGs for ambulatory procedures the following HRGs
have been deleted:








DZ34Z
DZ35Z
DZ39Z
DZ40Z
DZ41Z
DZ43Z
DZ44Z
DZ48Z
Complex Bronchodilator Studies
Simple Bronchodilator Studies
Complex Gas Exchange Studies
Simple Gas Exchange Studies
Smoking Cessation Support
Complex Airflow Studies
Simple Airflow Studies
Respiratory Drive Studies
Full details of all design changes can be found in the Code to Group Excel document that
accompanies this release.
Changes made to logic
Multiple procedure logic has been added to the procedure codes mapping to the thoracic
open surgery HRGs within this subchapter. For example if the dominant procedure is a
“Major” procedure and another “Major” procedure from a specified list is also recorded in the
patient record, this would “escalate” this activity to the next highest resource “Very Major”
HRG.
The logic employed to generate DZ52Z Full Pulmonary Function Testing has been
amended to capture the appropriate activity when combinations of tests are performed
simultaneously.
The length of stay flag for DZ50Z Respiratory Sleep Study has been changed from 0 days
to 0 to 1 days to more appropriately capture those patients that may require an overnight
stay for this investigation.
The length of stay flag for DZ06* Minor Thoracic Procedures now requires a length of stay
of 0 to 1 days to more appropriately capture those patients that may require an overnight
stay for these procedures.
Interactive Complications and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determines the HRG derived.
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Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to
CC lists. Diagnosis codes that should always indicate additional resource have been added
to all CC lists for consistency. To allow the interactive CC logic to be implemented, all major
CC lists have been deleted and all codes now appear on subchapter-specific CC lists. Major
CCs have a value of two and all other CCs have a value of one.
Mapping of codes to more appropriately reflect resource
Combination codes have been created for various thermoplasty procedures, based on
guidance published by NICE, in order to map to the appropriate HRG in both clinical and
resource terms.
OPCS-4 procedure code E87.4 Diagnostic assessment of circulatory oxygenation using
reduced oxygen air has been mapped to DZ60Z Hypoxic (Altitude) or Hyperoxic (Shunt)
Assessment.
OPCS-4 procedure code E93.3 Body plethysmographic measurement of airways
resistance has been mapped to DZ45Z Lung Volume Studies.
.
Page 20 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
EA – Cardiac Procedures
E – Cardiac Surgery and Primary Cardiac Conditions
Scope and Composition
Composition and Concepts
Subchapter EA covers all cardiac
procedures with the exception of
those for treatment of congenital
conditions which are within
subchapter EC Congenital Cardiac
Surgery.
It includes activity undertaken in
inpatient, day case and non-admitted
care settings, for all ages of patient. It
comprises of:







E16/17
LP
15/16
P14/15
Total HRGs
88
38
36
Total HRG Roots
33
37
35
Procedure-driven HRGs
88
38
36
Diagnosis-driven HRGs
0
0
0
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
Pacemaker procedures
Cardioverter procedures
Coronary Artery Bypass Graft (CABG) procedures
Valve procedures
Implantation of Prosthetic Heart or Ventricular Assist Device
Complex echocardiogram and other diagnostic tests
Percutaneous coronary interventions
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
Subchapter Redesign
The subchapter has been redesigned, with a new Subchapter EC Congenital Cardiac
Surgery created to replace HRGs which have been moved from Subchapter EA.
Five HRGs for Congenital Cardiac Surgery: EA23Z Major Complex Congenital Surgery,
EA24Z Complex Congenital Surgery, EA25Z Intermediate Complex Congenital
Surgery, EA26Z Standard Congenital Surgery and EA36B Catheter, 18 years and
under have been deleted and this activity moved to a new Subchapter EC Congenital
Cardiac Surgery.
New HRGs have been created and HRGs have been deleted
A number of HRGs have been deleted and replaced by HRGs with interactive CC splits.
There are 78 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design.
Page 21 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Two new HRGs, EA58Z Transcatheter Aortic Valve Implantation (TAVI) with
Transfemoral Approach and EA59Z Transcatheter Aortic Valve Implantation (TAVI)
with non-Transfemoral Approach, have been created in order to better differentiate the
resource usage when carrying out TAVI dependent on the surgical approach used. As a
result of the creation of these HRGs EA53Z - TAVI (Transcatheter aortic valve
implantation) has been deleted.
Due to the introduction of the new EC Congenital Cardiac Surgery subchapter activity has
moved out of several HRGs which has meant that due to low volumes of remaining activity,
HRG roots EA09* Percutaneous Interventions: Percutaneous Transluminal ASD, VSD
or PFO Closure and Valve Insertion and EA10* Percutaneous Interventions: Balloon
Valve Intermediate Interventions and Arterial Duct Closure have been merged into a
single new HRG root EA57* Percutaneous Interventions: Percutaneous Transluminal
ASD, VSD or PFO Closure and Valve Insertion or Balloon Valve Intermediate
Interventions and Arterial Duct Closure.
EA44Z Minor Cardiac Procedures has been deleted and the activity has been divided
amongst more appropriate HRG roots in terms of resource utilisation, as follows:



EA20*
EA35*
EA40*
Other Complex Cardiac Surgery and Re-do's
Other Percutaneous Interventions
Other Non-Complex Cardiac Surgery
The OPCS code for fetal echocardiography, which previously mapped to EA45Z Complex
Echocardiogram, including Transoesophageal and Fetal Echocardiography, now maps
to HRG NZ73Z Fetal Ultrasound and other related Fetal Interventions
Changes made to logic
To support the creation of subchapter EC Congenital Cardiac Surgery, some procedures
have had congenital logic added to ensure the HRG derived is appropriate; either if the
patient age is less than 19 years or a congenital cardiac primary diagnosis is present.
Logic has been added to pacemaker procedure codes to map to HRG Root EA07 Pace 3:
Biventricular and all Congenital Pacemaker Procedures; Resynchronisation Therapy
with a primary diagnosis of a congenital cardiac disorder in order to reflect the additional
complexity of treating these patients, particularly in relation to their anaesthetic requirement.
Interactive Complications and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determine the HRG derived.
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to
CC lists. Diagnosis codes that should always indicate additional resource have been added
to all CC lists for consistency. To allow the interactive CC logic to be implemented, all major
CC lists have been deleted and all codes now appear on subchapter-specific CC lists. Major
CCs have a value of two and all other CCs have a value of one.
Page 22 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
EB – Cardiac Disorders
E – Cardiac Surgery and Primary Cardiac Conditions
Scope and Composition
Composition and Concepts
Subchapter EB covers all diagnoses
for adults within the Cardiac
specialty. It includes activity
undertaken in an inpatient and day
case setting. It comprises of disease
or condition-specific HRGs.
E16/17
LP
15/16
P14/15
Total HRGs
48
14
14
Total HRG Roots
13
10
10
Procedure-driven HRGs
0
0
0
Diagnosis-driven HRGs
48
14
14
All diagnosis-driven activity relating to Age Splits
the treatment of children (aged 18
Complications and
years and under) groups to an HRG
Comorbidities Splits
in Chapter P, Diseases of Childhood
Intervention Splits
and Neonates, in line with the
requirements of the Casemix Design Framework.
No
Yes
No
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
New HRGs have been created and HRGs have been deleted
A number of HRGs have been deleted and replaced by HRGs with interactive CC and
intervention splits.
There are 47 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design.
Three new HRG roots that are disease-specific, thereby offering more granular information,
have been created from the contents of the existing HRG EB01Z Non-Interventional
Acquired Cardiac Conditions:
 EB12* Unspecified Chest Pain
 EB13* Angina
 EB14* Other Acquired Cardiac Conditions
As a result, EB01Z Non-Interventional Acquired Cardiac Conditions has been deleted as the
activity has been subsumed into the newly created disease-specific HRGs.
A new HRG root EB15* Primary Pulmonary Hypertension has been created to separately
identify this resource-intensive activity using ICD-10 diagnosis I27.0 Primary pulmonary
hypertension.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Full details of all design changes can be found in the Code to Group Excel document that
accompanies this release.
Interactive Complications and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determines the HRG derived.
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to
CC lists. Diagnosis codes that should always indicate additional resource have been added
to all CC lists for consistency. To allow the interactive CC logic to be implemented, all major
CC lists have been deleted and all codes now appear on subchapter-specific CC lists. Major
CCs have a value of two and all other CCs have a value of one.
Mapping of codes to more appropriately reflect resource
ICD-10 Diagnosis I10.X Essential (primary) hypertension has been mapped from EB03*
Heart Failure or Shock to EB04* Hypertension to reflect the fact that this is a hypertension
diagnosis.
ICD-10 Diagnosis I11.0 Hypertensive heart disease with (congestive) heart failure has
been mapped from EB04* Hypertension to EB03* Heart Failure or Shock to better reflect
that this is a heart failure diagnosis.
Page 24 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
EC – Congenital Cardiac Surgery
E – Cardiac Surgery and Primary Cardiac Conditions
Scope and Composition
Composition and Concepts
E16/17
LP
15/16
P14/15
Subchapter EC covers procedures
Total HRGs
9
N/A
N/A
within cardiac surgery which are
either carried out on patients 18
Total HRG Roots
3
N/A
N/A
years or under or are carried out as a
Procedure-driven HRGs
9
N/A
N/A
result of patients having a congenital
heart condition. All other cardiac
Diagnosis-driven HRGs
0
N/A
N/A
procedures are within subchapter EA
Age Splits
No
Cardiac Procedures.
Complications and
No
It includes activity undertaken in
Comorbidities Splits
inpatient, day case and non-admitted
Intervention Splits
No
care settings, for all ages of patient.
It comprises of HRGs in a matrix grid depending on resource usage based on diagnosis and
procedure scores.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
A new subchapter has been created in order to capture congenital cardiac surgery either for
patients under the age of 18 or that relates to treatment for congenital heart conditions.
This new subchapter contains nine HRGs which are dependent on a patient’s score, which is
calculated using a grid logic based on both their diagnoses and the procedures carried out.
The nine HRGs are as follows:






EC01A Congenital Cardiac Surgery with Intervention Score 58 or less, with
Diagnosis Score 64 or less
EC01B Congenital Cardiac Surgery with Intervention Score 58 or less, with
Diagnosis Score 65-117
EC01C Congenital Cardiac Surgery with Intervention Score 58 or less, with
Diagnosis Score 118 or more
EC02A Congenital Cardiac Surgery with Intervention Score 59-121, with
Diagnosis Score 64 or less
EC02B Congenital Cardiac Surgery with Intervention Score 59-121, with
Diagnosis Score 65-117
EC02C Congenital Cardiac Surgery with Intervention Score 59-121, with
Diagnosis Score 118 or more
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0



EC03A Congenital Cardiac Surgery with Intervention Score 122 or more, with
Diagnosis Score 64 or less
EC03B Congenital Cardiac Surgery with Intervention Score 122 or more, with
Diagnosis Score 65-117
EC03C Congenital Cardiac Surgery with Intervention Score 122 or more, with
Diagnosis Score 118 or more
These activities would have previously generated HRGs within Subchapter EA Cardiac
Procedures and, as a result of the creation of this new subchapter, five existing HRGs within
EA have been deleted, as follows: EA23Z Major Complex Congenital Surgery, EA24Z
Complex Congenital Surgery, EA25Z Intermediate Complex Congenital Surgery,
EA26Z Standard Congenital Surgery and EA36B Catheter, 18 years and under.
Subchapter EC employs grid logic, so takes into account multiple procedures as well as
multiple diagnoses. This accurately reflects the complexity involved in treatment of
congenital cardiac disorders.
Changes made to logic
This subchapter employs grid logic, taking into account multiple procedures as well as
multiple diagnoses. This accurately reflects the complexity involved in treatment of
congenital cardiac disorders. Each procedure and diagnosis is allocated a score which
ranges from 5 to 20 for diagnosis and 5 to 40 for procedures. These scores are then totalled
and the HRG is defined based on the scores. The following grid provides the scoring logic
used and shows which HRG would be produced.
Procedure score =>
<58
58-121
>=122
<=64
EC01A
EC02A
EC03A
65-117
ECO1B
EC02B
EC03B
>=118
ECO1C
ECO2C
EC03C
Diagnoses score
Page 26 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
FZ – Digestive System Procedures and Disorders
F – Digestive System
Scope and Composition
Composition and Concepts
Subchapter FZ covers both
endoscopic and open surgical
digestive system procedures for
patients of all ages, and
gastroenterology medicine for adults,
delivered in inpatient, day case and
non-admitted care settings.
It does not include treatment of
hepatobiliary or pancreatic system
disorders which can be found within
Chapter G Hepatobiliary and
Pancreatic System.
E16/17
LP
15/16
P14/15
Total HRGs
196
158
126
Total HRG Roots
60
67
62
Procedure-driven HRGs
142
112
80
Diagnosis-driven HRGs
54
46
46
Age Splits
Yes
Complications and
Comorbidities Splits
Yes
Intervention Splits
Yes
It comprises of:

Open surgical procedures on the gastrointestinal tract

Endoscopic procedures on the gastrointestinal tract

Gastrointestinal disorders in adults
All diagnosis-driven activity relating to the treatment of children (aged 18 years and under)
groups to an HRG in Chapter P, Diseases of Childhood and Neonates, in line with the
requirements of the Casemix Design Framework.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
New HRGs have been created and HRGs have been deleted
A number of HRGs have been deleted and replaced by procedure-driven HRGs with
interactive CC splits, and diagnosis-driven HRGs with interactive CC and intervention splits.
There are 149 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design.
A new HRG FZ89Z Complex Therapeutic Endoscopic Upper or Lower Gastrointestinal
Tract Procedures has been created to accommodate the high cost specialist therapeutic
gastrointestinal procedures such as radiofrequency ablation, balloon enteroscopy and
cryotherapy.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
A new HRG root FZ90 Abdominal Pain has been created to separately identify this high
volume activity.
Two new HRG roots, FZ91 Non-Malignant Disorders of the Gastrointestinal Tract and
FZ92 Malignant Disorders of the Gastrointestinal Tract, have been created from the
merging of several of the diagnosis-driven HRGs to allow for a greater differentiation of splits
based on interventions and interactive CC splits.
Full details of all design changes can be found in the Code to Group Excel document that
accompanies this release.
Changes made to logic
A combination code has been created to identify stapled transanal rectal resection (STARR)
to ensure that it could be mapped to the most appropriate HRG.
A combination code has been created for Haemorrhoidal Artery Ligation (HALO) based on
guidance published by NICE, in order to map to the appropriate HRG.
Logic has been added to OPCS-4 code T43.9 Unspecified diagnostic endoscopic
examination of peritoneum (which includes gynaecological laparoscopy) which maps to a
base HRG root of FZ13 Minor Therapeutic or Diagnostic General Abdominal
Procedures to map to MA10Z Minor Laparoscopic or Endoscopic, Upper Genital Tract
Procedures where a primary diagnosis of a gynaecological disorder is recorded. This more
appropriately reflects the nature of this procedure.
Intervention splits have been added to HRGs
Intervention splits have been added to all the diagnosis-driven HRGs within this subchapter.
This reflects where, within a diagnosis-driven HRG, there are ‘minor interventions’ performed
which not only means that they include the cost/resources associated with these procedures,
but may indicate that the patient’s condition was more severe resulting in more resourceintensive treatment.
Several of these HRG roots have “with Multiple Interventions” and “with Single Intervention”
splits to more appropriately capture the additional resource usage of patients who have
multiple minor interventions during their episode/spell.
The ‘Interventions’ list is only utilised for procedures that map to a base HRG with a
maximum length of stay check.
Interactive Complication and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determine the HRG derived.
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to
CC lists. Diagnosis codes that should always indicate additional resource have been added
to all CC lists for consistency. To allow the interactive CC logic to be implemented, all major
Page 28 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
CC lists have been deleted and all codes now appear on subchapter-specific CC lists. Major
CCs have a value of two and all other CCs have a value of one.
Mapping of codes to more appropriately reflect resource
ICD-10 code K51.8 Other ulcerative colitis has been mapped to HRG root FZ37
Inflammatory Bowel Disease to reflect the type of condition. ICD-10 code K29.0 Acute
haemorrhagic gastritis and K62.5 Haemorrhage of anus and rectum have been mapped
to HRG root FZ38 Gastrointestinal Bleed to reflect the type of condition. ICD-10 code
A54.6 Gonococcal infection of anus and rectum has been mapped to HRG root FZ36
Gastrointestinal Infections to reflect that this is an infectious condition.
Changes to HRG Labels
HRG root FZ36 Intestinal Infectious Disorders and its associated splits have been
relabelled FZ36 Gastrointestinal Infections, to more appropriately reflect the HRG content.
In addition, where the abbreviation GI was previously used in HRG labels within this
subchapter it has been amended to Gastrointestinal.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
GA – Hepatobiliary and Pancreatic System Surgery
G – Hepatobiliary and Pancreatic Surgery
Scope and Composition
Composition and Concepts
Subchapter GA includes hepatobiliary
and pancreatic system surgery. It
includes activity undertaken in inpatient,
day case and non-admitted care settings
for patients of all ages. It does not
include endoscopic or percutaneous
procedures which are included in
subchapter GB Hepatobiliary and
Pancreatic System Endoscopic and
Percutaneous Procedures. It
comprises of:



E
16/17
LP
15/16
P
14/15
Total HRGs
26
22
21
Total HRG Roots
10
10
10
Procedure-driven HRGs
26
22
21
Diagnosis-driven HRGs
0
0
0
Age Splits
Yes
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
Hepatobiliary and multi-visceral transplants
Open and laparoscopic hepatobiliary and pancreatic procedures, based on complexity
Cholecystectomy
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
New HRGs have been created and HRGs have been deleted
A number of HRGs have been deleted and replaced by HRGs with interactive CC splits.
There are 20 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design.
Interactive Complication and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determines the HRG derived.
Complication and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added.
Diagnosis codes that should always indicate additional resource have been added for
consistency. To allow the interactive CC logic to be implemented, all major CC lists have
been deleted and all codes now appear on subchapter-specific CC lists. Major CCs have a
value of two and all other CCs have a value of one.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
GB – Hepatobiliary and Pancreatic System Endoscopic and
Percutaneous Procedures
G – Hepatobiliary and Pancreatic Surgery
Scope and Composition
Composition and Concepts
E16/17
Subchapter GB covers hepatobiliary
Total HRGs
26
and pancreatic system endoscopic
and percutaneous procedures. It
Total HRG Roots
9
includes activity undertaken in
Procedure-driven HRGs
26
inpatient, day case and non-admitted
care settings for patients of all ages.
Diagnosis-driven HRGs
0
It does not include open surgical
Age Splits
Yes
procedures which are included in
Complications and
subchapter GA Hepatobiliary and
Yes
Comorbidities Splits
Pancreatic Surgery. Some
Intervention Splits
No
percutaneous activity which is done
under radiological control maps to
chapter Y Vascular Procedures and Disorders and Imaging Interventions.
LP
15/16
P14/15
22
16
9
7
22
16
0
0
It comprises of:

Hepatobiliary and pancreatic system endoscopic radiological procedures.

Endoscopic retrograde cholangiopancreatography (ERCP) procedures.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
New HRGs have been created and HRGs have been deleted
A number of HRGs have been deleted and replaced by HRGs with interactive CC splits.
There are 23 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design.
Full details of all design changes can be found in the Code to Group Excel document that
accompanies this release.
Interactive Complication and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determines the HRG derived.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
With the introduction of interactive CCs there is no longer a necessity for length of stay splits
so these have been deleted to be replaced with interactive CC splits which more accurately
reflect the resource usage of patients.
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to
CC lists. Diagnosis codes that should always indicate additional resource have been added
to all CC lists for consistency. To allow the interactive CC logic to be implemented, all major
CC lists have been deleted and all codes now appear on subchapter-specific CC lists. Major
CCs have a value of two and all other CCs have a value of one.
Page 32 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
GC – Hepatobiliary and Pancreatic System Disorders
G – Hepatobiliary and Pancreatic Surgery
Scope and Composition
Composition and Concepts
Subchapter GC covers all adult liver,
biliary and pancreatic system
disorders. It includes activity
undertaken in inpatient and day case
settings.
It comprises of:


Malignant hepatobiliary and
pancreatic disorders
Non-malignant hepatobiliary
and pancreatic disorders
E16/17
LP
15/16
P14/15
Total HRGs
22
12
12
Total HRG Roots
3
4
4
Procedure-driven HRGs
0
0
0
Diagnosis-driven HRGs
22
12
12
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
Yes
 Liver failure
All diagnosis-driven activity relating to the treatment of children (aged 18 years and under)
groups to an HRG in Chapter P, Diseases of Childhood and Neonates, in line with the
requirements of the Casemix Design Framework.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
New HRGs have been created and HRGs have been deleted
All the HRGs within this subchapter have been deleted and replaced by HRGs with
interactive CC and intervention splits.
There are 19 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design.
Full details of all design changes can be found in the Code to Group Excel document that
accompanies this release.
HRG roots GC15 Non-Malignant Liver Disorders and GC16 Non-Malignant Pancreatic
or Biliary Disorders have been merged into a single new HRG root GC17 Non-Malignant
Hepatobiliary or Pancreatic Disorders to allow for a greater differentiation of splits based
on interventions and interactive CC splits.
Intervention splits have been added to HRGs
Intervention’ splits have been added to Subchapter GC. This reflects where, within a
diagnosis-driven HRG, there are ‘minor interventions’ performed which not only means that
Page 33 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
they include the cost/resources associated with these procedures, but may indicate that the
patient’s condition was more severe resulting in more resource-intensive treatment.
This includes “with Multiple Interventions” and “with Single Intervention” splits to more
appropriately capture the additional resource usage of patients who have multiple minor
interventions during their episode/spell.
The ‘Interventions’ list is only utilised for procedures that map to a base HRG with a
maximum length of stay check.
Interactive Complications and Comorbidity splits added to HRGs
The existing CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determines the HRG derived.
With the introduction of interactive CCs there is no longer a need for length of stay splits on
GC12 Malignant Hepatobiliary or Pancreatic Disorders so these have been deleted to be
replaced with interactive CC splits which more accurately reflect the resource use of patient
care.
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to
CC lists. Diagnosis codes that should always indicate additional resource have been added
to all CC lists for consistency. To allow the interactive CC logic to be implemented, all major
CC lists have been deleted and all codes now appear on subchapter-specific CC lists. Major
CCs have a value of two and all other CCs have a value of one.
Changes to HRG Labels
GC12* Malignant Liver or Pancreatic Disorders has been relabelled GC12* Malignant,
Hepatobiliary or Pancreatic Disorders to clarify that it includes cancers of the biliary
system.
Page 34 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
HA – Orthopaedic Trauma Procedures
HB – Orthopaedic Non-Trauma Procedures
H – Musculoskeletal System
Scope and Composition
Composition and Concepts
Subchapters HA and HB cover
trauma and non-trauma orthopaedic
procedures for patients of all ages
and adult diagnoses.
Spinal activity can be found in
Subchapter HC Spinal Procedures
and Disorders.
Musculoskeletal disorders can be
found in Subchapter HD,
Musculoskeletal Disorders.
E16/17
LP
15/16
P14/15
Total HRGs
134
134
125
Total HRG Roots
79
79
68
Procedure-driven HRGs
120
120
108
Diagnosis-driven HRGs
14
14
17
Age Splits
Yes
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
Reconstruction Procedures can be found in Subchapter HR Orthopaedic Reconstruction
Procedures.
These Subchapters include activity undertaken in inpatient, day case and non-admitted care
settings, and include HRGs specific to “minimal intervention” activity.
Subchapter HA comprises of:

Hip procedures for trauma or malignancy

Knee procedures for trauma or malignancy

Foot and ankle procedures for trauma or malignancy

Hand and wrist procedures for trauma or malignancy

Shoulder and upper arm procedures for trauma or malignancy

Elbow and lower arm procedures for trauma or malignancy

Traumatic amputations and other procedures for trauma or malignancy
 Trauma or malignancy diagnoses without procedure for adults
Subchapter HB comprises of:

Hip procedures for non-trauma

Knee procedures for non-trauma

Foot and ankle procedures for non-trauma

Hand and wrist procedures for non-trauma

Shoulder and upper arm procedures for non-trauma

Elbow and lower arm procedures for non-trauma

Other procedures for non-trauma
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
All diagnosis-driven activity relating to the treatment of children (aged 18 years and under)
groups to an HRG in Chapter P, Diseases of Childhood and Neonates, in line with the
requirements of the Casemix Design Framework.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to
CC lists. Diagnosis codes that should always indicate additional resource have been added
to all CC lists for consistency.
Other lists have been updated
The HA_trauma_malig list has been updated to include M90.7-* Fracture of bone in
neoplastic disease as these fractures relate to an underlying malignancy.
Page 36 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
HC – Spinal Surgery and Disorders
H – Musculoskeletal System
Scope and Composition
Composition and Concepts
Subchapter HC includes spinal
surgery for patients of all ages and
treatment for adult spinal disorders,
undertaken as inpatient, day case or
non-admitted activity. It comprises
of:
E16/17
LP
15/16
P14/15
Total HRGs
55
32
33
Total HRG Roots
23
20
20
Procedure-driven HRGs
27
15
17
Diagnosis-driven HRGs
28
17
16

Extradural spinal procedures
Age Splits
No

Intradural spinal procedures
Yes

Complications and
Comorbidities Splits
Spinal reconstruction
procedures
Intervention Splits
No

Spinal disorders in adults
All diagnosis-driven activity relating to the treatment of children (aged 18 years and under)
groups to an HRG in Chapter P, Diseases of Childhood and Neonates, in line with the
requirements of the Casemix Design Framework.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
New HRGs have been created
A number of spinal procedures have been mapped to reconstruction-specific HRGs in
subchapter HC Spinal Surgery and Disorders, from Subchapter HR Orthopaedic
Reconstruction Procedures, to distinctly recognise this complex, resource intensive
reconstructive spinal surgery. The HRGs, listed below, use the same logic as previously
used to reach the Subchapter HR HRGs:

HC40A - Complex Spinal Reconstructive Surgery with CC Score 3+

HC40B - Complex Spinal Reconstructive Surgery with CC Score 0-2

HC41A - Major Spinal Reconstructive Surgery with CC Score 2+

HC41B - Major Spinal Reconstructive Surgery with CC Score 0-1

HC42Z - Intermediate Spinal Reconstructive Surgery

HC43Z - Minor Spinal Reconstructive Surgery
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
HRGs have been deleted
HC09Z Intradural Spine Intermediate 2 has been deleted as this HRG had a very low
volume of activity that did not meet minimum design criteria. The three procedure codes,
A531 Cerebrospinal syringostomy, A533 Creation of syringoperitoneal shunt and A576
Reimplantation of spinal nerves into spinal cord have been mapped to HC07* Intradural
Spine Major. As a result of this the label of HC10Z has been amended to Intradural Spine
Intermediate.
Interactive Complications and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determines the HRG derived.
There are 49 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design.
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to
CC lists. Diagnosis codes that should always indicate additional resource have been added
to all CC lists for consistency. To allow the interactive CC logic to be implemented, all major
CC lists have been deleted and all codes now appear on subchapter-specific CC lists. Major
CCs have a value of two and all other CCs have a value of one.
Other lists have been updated
OPCS code A84.4 Evoked Potential Recording (EPR) has been added to the lists used in
the escalation logic for this subchapter to recognised the additional resource usage
associated with EPR intraoperative monitoring.
Page 38 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
HD – Musculoskeletal Disorders
H – Musculoskeletal System
Scope and Composition
Composition and Concepts
Subchapter HD covers all
musculoskeletal disorders for adults.
It includes activity undertaken in an
inpatient and day case setting.
All diagnosis-driven activity relating to
the treatment of children (aged 18
years and under) groups to an HRG
in Chapter P, Diseases of Childhood
and Neonates, in line with the
requirements of the Casemix Design
Framework.
E16/17
LP
15/16
P14/15
Total HRGs
35
21
21
Total HRG Roots
7
7
7
Procedure-driven HRGs
0
0
0
Diagnosis-driven HRGs
35
21
21
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
Interactive Complications and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determine the HRG derived.
All of the 35 HRGs within this subchapter utilise interactive CC logic in the HRG4+
Engagement 2016/17 design.
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to
CC lists. Diagnosis codes that should always indicate additional resource have been added
to all CC lists for consistency. To allow the interactive CC logic to be implemented, all major
CC lists have been deleted and all codes now appear on subchapter-specific CC lists. Major
CCs have a value of two and all other CCs have a value of one.
Page 39 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
HR – Orthopaedic Reconstruction Procedures
H – Musculoskeletal System
Scope and Composition
Composition and Concepts
Subchapter HR covers reconstructive
orthopaedic surgery for patients of all
ages, and may also include very
complex or very resource intensive
surgery. It includes activity
undertaken in inpatient, day case and
non-admitted care settings. It
comprises of HRGs in a matrix grid
depending on resource usage based
on diagnosis and procedure scores.
E16/17
LP
15/16
P14/15
Total HRGs
9
9
9
Total HRG Roots
3
6
6
Procedure-driven HRGs
9
9
9
Diagnosis-driven HRGs
0
0
0
Age Splits
No
Complications and
Comorbidities Splits
No
Intervention Splits
No
All other orthopaedic procedures are
within subchapters HA Orthopaedic Trauma Procedures and HB Orthopaedic NonTrauma Procedures. Spinal activity can be found in Subchapter HC Spinal Procedures
and Disorders. Musculoskeletal disorders can be found in Subchapter HD,
Musculoskeletal Disorders.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
Changes made to logic
A number of spinal procedures have been mapped to subchapter HC Spinal Surgery and
Disorders, from HR Orthopaedic Reconstruction Procedures, in order to distinctly
recognise this complex, resource intensive reconstructive spinal surgery.
This subchapter employs grid logic, taking into account multiple procedures as well as
multiple diagnoses. This accurately reflects the complexity involved in in orthopaedic
reconstructive surgery.
Each procedure and diagnosis is allocated a score which ranges from 5 to 40 for procedures
and 5 to 20 for diagnosis. These scores are then totalled and the HRG is defined based on
the scores. The following grid shows the scoring logic used and the HRG produced.
<=43
44-65
>=66
Intervention score =>
Diagnoses score
<=22
HR07A
HR08A
HR09A
23-60
HR07B
HR08B
HR09B
>=61
HR07C
HR08C
HR09C
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
JA – Breast Procedures and Disorders
J – Skin, Breast and Burns
Scope and Composition
Composition and Concepts
Subchapter JA covers breast procedures
for patients of all ages and adult breast
disorders. It includes activity undertaken
in inpatient, day case and non-admitted
care settings.
It comprises of:






E
16/17
LP
15/16
P
14/15
Total HRGs
36
23
25
Total HRG Roots
20
14
11
Procedure-driven HRGs
25
19
21
Diagnosis-driven HRGs
11
4
4
Age Splits
Unilateral and bilateral breast
Complications and
procedures, including with lymph
Comorbidities Splits
node clearance
Intervention Splits
Unilateral and bilateral excision of
breast with immediate
reconstruction
Unilateral and bilateral delayed reconstruction of breast
Therapeutic mammaplasty
Malignant breast disorders
Non-malignant breast disorders
No
Yes
Yes
All diagnosis-driven activity relating to the treatment of children (aged 18 years and under)
groups to an HRG in Chapter P, Diseases of Childhood and Neonates, in line with the
requirements of the Casemix Design Framework.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
New HRGs have been created and HRGs have been deleted
A number of HRGs have been deleted and replaced by procedure-driven HRGs with
interactive CC splits, and diagnosis-driven HRGs with interactive CC and intervention splits.
There are 21 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design.
Several new HRGs have been created to distinguish unilateral from bilateral surgery where
this was not previously identified, including:


JA38A Unilateral Major Breast Procedures with Lymph Node Clearance, with
CC Score 5+
JA38B Unilateral Major Breast Procedures with Lymph Node Clearance, with
CC Score 2-4
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0

JA38C Unilateral Major Breast Procedures with Lymph Node Clearance, with
CC Score 0-1
 JA39Z Bilateral Major Breast Procedures with Lymph Node Clearance
 JA32Z Unilateral Excision of Breast with Immediate Pedicled Myocutaneous
Flap Reconstruction
 JA33Z Bilateral Excision of Breast with Immediate Pedicled Myocutaneous
Flap Reconstruction
 JA34Z Unilateral Delayed Free Perforator Flap Breast Reconstruction
 JA35Z Bilateral Delayed Free Perforator Flap Breast Reconstruction
 JA36Z Unilateral Excision of Breast with Immediate Free Perforator Flap
Reconstruction
 JA37Z Bilateral Excision of Breast with Immediate Free Perforator Flap
Reconstruction
In order to accommodate the new HRGs that separately identify unilateral from bilateral
surgery, the following HRGs have been deleted:






JA26A Major Breast Procedures with Lymph Node Surgery, with CC Score 5+
JA26B Major Breast Procedures with Lymph Node Surgery, with CC Score 2-4
JA26C Major Breast Procedures with Lymph Node Surgery, with CC Score 0-1
JA27Z Mastectomy with Simple Breast Reconstruction
JA28Z Mastectomy with Complex Breast Reconstruction
JA14Z Free Perforator Flap Breast Reconstruction
Two new HRGs, JA40Z Unilateral Therapeutic Mammoplasty and JA41Z Bilateral
Therapeutic Mammoplasty, have also been created to recognise this new reconstructive
surgery technique. Full details of all design changes can be found in the Code to Group
Excel document that accompanies this release.
Changes made to logic
A length of stay flag of 0-2 days has been added to JA18Z Unilateral Minor Breast
Procedures and JA19Z Bilateral Minor Breast Procedures to ensure that a longer lengths
of stay for these minor procedures ‘flip’ to derive the HRG from the primary diagnosis, in a
better reflection of the resource use of patient care.
Combination codes have been created to identify certain paired codes e.g. total mastectomy
with sampling of axillary lymph nodes, to ensure that bilateral logic is applied correctly
according to coding rules and the appropriate bilateral HRG is derived.
Logic has been added to all procedure codes to map to the bilateral HRGs if a bilateral
operation site code is recorded or alternatively where an additional procedure of the same
resource with both left and right sided operation site codes is recorded. This is to more
appropriately capture the additional resource associate with both breasts being operated on
at the same time but not necessarily having an identical procedure performed.
In addition the bilateral logic has been amended to check all code positions, not just that
immediately adjacent to the dominant procedure, as the majority of activity, in line with
current national coding rules, has additional breast or skin procedures sequenced between
the dominant procedure and the site code.
Multiple procedure logic has been added to the Intermediate procedure codes within this
subchapter. For example if the dominant procedure is an “Intermediate” procedure and
another “Intermediate” procedure for a specified list is also recorded this would “escalate” to
the next highest resource “Major” HRG.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Intervention splits added to Diagnosis-Driven HRGs
Intervention’ splits have been added to Subchapter JA. This reflects where, within a
diagnosis-driven HRG, there are ‘minor interventions’ performed which not only means that
they include the cost/resources associated with these procedures, but may indicate that the
patient’s condition was more severe resulting in more resource-intensive treatment.
The ‘Interventions’ list is only utilised for procedures that map to a base HRG with a
maximum length of stay check.
Interactive Complications and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determine the HRG derived.
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to
CC lists. Diagnosis codes that should always indicate additional resource have been added
to all CC lists for consistency. To allow the interactive CC logic to be implemented, all major
CC lists have been deleted and all codes now appear on subchapter-specific CC lists. Major
CCs have a value of two and all other CCs have a value of one.
Mapping of codes to more appropriately reflect resource
Some combination codes created to identify paired procedures have been mapped from
HRG Root JA24 Unilateral Intermediate Breast Procedures to HRG Root JA20 Unilateral
Major Breast Procedures to reflect that as these are, in effect, two Intermediate procedures
they should map to the higher resource “Major” HRG in line with multiple procedure logic
principles.
Diagnosis code T856 Mechanical complications of other specified internal prosthetic
devices, implants and grafts has been mapped from JA13* Non-Malignant Breast
Disorders to WA12* Complications of Procedures to reflect that this diagnosis is not
specific to breast implants.
Procedure code B37.5 Lipofilling of breast has been mapped to HRG Root JA20
Unilateral Major Breast Procedures to more appropriately reflect the resource associated
with this procedure.
Other lists have been updated
Mammoplasty procedure codes have been added to the list of breast reconstruction
procedures JA_Recon, to reflect that these are often performed as part of bilateral
reconstructive surgery.
Changes to HRG Labels
The breast reconstruction HRG labels have been amended to clarify the clinical content and
detail whether the reconstruction is immediate to the breast excision or delayed i.e. is
undertaken during a separate operation.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
JB – Burns Procedures and Disorders
J – Skin, Breast and Burns
Scope and Composition
Composition and Concepts
Subchapter JB covers all aspects of
burns care for both adults and
children.
The HRGs within this subchapter are
differentiated on the total body
surface area (TBSA) of the burn and
then whether the patient has
undergone a skin graft, other skin
procedure or has had no intervention.
E16/17
LP
15/16
P14/15
Total HRGs
12
11
11
Total HRG Roots
4
5
5
Procedure-driven HRGs
1
9
9
Diagnosis-driven HRGs
11
2
2
Age Splits
No
Complications and
Comorbidities Splits
No
Intervention Splits
No
It includes activity undertaken in inpatient, day case and non-admitted care settings.
Subchapter-specific grouping logic
This subchapter employs design concepts as identified in the composition table above,
further details of which can be found in sections 6 and 7 of the Casemix Companion. Details
of the concepts for each HRG can be found in the Reference Costs 2014/15 Design Matrix.
It should also be noted that, where an ICD-10 diagnosis code indicating a burn or corrosion
(ICD-10 rubrics T20-T32) is recorded, in any position, this diagnosis will be considered as
the primary diagnosis for grouping purposes and will derive the HRG irrespective of the other
diagnoses or procedures that are also recorded. This logic is sequenced after multiple
trauma logic.
ICD-10 burns diagnoses that specify the total body surface area (TBSA) of the burn will take
precedence and group to more specific HRGs (JB30*-JB32*) than the other ICD-10 burns
diagnoses, which map to HRG root JB33*.
The HRG splits are qualified by the presence of skin graft procedures, other skin procedures
or no skin procedures.
Certain OPCS-4.7 codes that specify skin procedure for burns e.g. S54.1 Debridement of
burnt skin of head or neck, are mapped directly to JB33B Other Burn with Other Skin
Procedure.
HRG4+ Design Changes
Subchapter Redesign
This chapter has undergone a complete redesign. All HRGs from this subchapter have been
deleted and replaced with new HRGs to better reflect the treatment and care of burns
patients.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
The HRGs within this subchapter neither employ interactive CC logic, nor intervention logic,
as both are deemed clinically unnecessary to appropriately reflect the expected resource use
of the patient care provided.
The new HRGs, as listed below, reflect the different expected resource usage associated
with the extent of the surface area of the burn and the surgical or clinical treatment provided.












JB30A Major Burn (TBSA of 60% or more) with Skin Graft
JB30B Major Burn (TBSA of 60% or more) with Other Skin Procedure
JB30C Major Burn (TBSA of 60% or more) without Skin Procedure
JB31A Intermediate Burn (TBSA of 20-59%) with Skin Graft
JB31B Intermediate Burn (TBSA of 20-59%) with Other Skin Procedure
JB31C Intermediate Burn (TBSA of 20-59%) without Skin Procedure
JB32A Minor Burn (TBSA of less than 20%) with Skin Graft
JB32B Minor Burn (TBSA of less than 20%) with Other Skin Procedure
JB32C Minor Burn (TBSA of less than 20%) without Skin Procedure
JB33A Other Burn with Skin Graft
JB33B Other Burn with Other Skin Procedure
JB33C Other Burn without Skin Procedure
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
JC – Skin Surgery
J – Skin, Breast and Burns
Scope and Composition
Composition and Concepts
Subchapter JC covers all procedures
for skin for patients of all ages and
includes groups specifically designed
for ambulatory care. It includes
activity undertaken in inpatient, day
case and non-admitted care settings.
It comprises of:




Skin surgery
Patch tests
Photodynamic therapy to skin
Phototherapy to skin
E16/17
LP
15/16
P14/15
Total HRGs
12
36
36
Total HRG Roots
8
23
23
Procedure-driven HRGs
12
36
36
Diagnosis-driven HRGs
0
0
0
Age Splits
Yes
Complications and
Comorbidities Splits
No
Intervention Splits
No
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
Subchapter Redesign
This chapter has undergone a complete redesign.
All HRGs from this subchapter have been deleted and replaced with new HRGs including
HRGs based on age associated with paediatric (<13 years) activity. This is in order to better
reflect resource use and to remove some of the unnecessary complexities within the chapter.
The following HRGs now comprise this subchapter:
 JC40Z Multiple Major Skin Procedures
 JC41Z Major Skin Procedures
 JC42A Intermediate Skin Procedures, 13 years and over
 JC42B Intermediate Skin Procedures, 12 years and under
 JC43A Minor Skin Procedures, 13 years and over
 JC43B Minor Skin Procedures, 12 years and under
 JC44Z Complex Patch Tests
 JC45A Standard Patch Tests, 13 years and over
 JC45B Standard Patch Tests, 12 years and under
 JC46Z Photodynamic Therapy
 JC47A Phototherapy, 13 years and over
 JC47B Phototherapy, 12 years and under
Page 46 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
JD – Skin Disorders
J – Skin, Breast and Burns
Scope and Composition
Composition and Concepts
Subchapter JD covers all skin
disorders in adults. It includes activity
undertaken in an inpatient and day
case setting.
All diagnosis-driven activity relating to
the treatment of children (aged 18
years and under) groups to an HRG
in Chapter P, Diseases of Childhood
and Neonates, in line with the
requirements of the Casemix Design
Framework.
E16/17
LP
15/16
P14/15
Total HRGs
10
17
17
Total HRG Roots
1
6
6
Procedure-driven HRGs
0
0
0
Diagnosis-driven HRGs
10
17
17
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
Yes
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
New HRGs have been created and HRGs have been deleted
All the HRGs within this subchapter have been deleted and replaced by HRGs with
interactive CC and intervention splits in the HRG4+ Engagement 2016/17 design.
Full details of all design changes can be found in the Code to Group Excel document that
accompanies this release.
Intervention splits added to Diagnosis-Driven HRGs
Intervention splits have been added to Subchapter JD. This reflects where, within a
diagnosis-driven HRG, there are ‘minor interventions’ performed which not only means that
they include the cost/resources associated with these procedures, but may indicate that the
patient’s condition was more severe resulting in more resource-intensive treatment.
The ‘Interventions’ list is only utilised for procedures that map to a base HRG with a
maximum length of stay check.
Interactive Complications and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determines the HRG derived.
Page 47 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to
CC lists. Diagnosis codes that should always indicate additional resource have been added
to all CC lists for consistency. To allow the interactive CC logic to be implemented, all major
CC lists have been deleted and all codes now appear on subchapter-specific CC lists. Major
CCs have a value of two and all other CCs have a value of one.
Page 48 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
KA – Endocrine System Disorders
K – Endocrine and Metabolic System
Scope and Composition
Composition and Concepts
Subchapter KA covers endocrine system
disorders for adults and procedures for
patients of all ages, with the exception of
diabetes which is covered in subchapter
KB Diabetic Medicine. It includes
activity undertaken in an inpatient, day
case and non-admitted care setting.
E
16/17
LP
15/16
P
14/15
Total HRGs
18
11
11
Total HRG Roots
7
7
7
Procedure-driven HRGs
7
5
5
Diagnosis-driven HRGs
11
6
6
Age Splits
No
It comprises of:
Complications and
 Parathyroid, thyroid and adrenal
Comorbidities Splits
procedures
Intervention Splits
 Adult pituitary and non-pituitary
disorder
 Other adult thyroid or endocrine disorder
Yes
No
All diagnosis-driven activity relating to the treatment of children (aged 18 years and under)
groups to an HRG in Chapter P, Diseases of Childhood and Neonates, in line with the
requirements of the Casemix Design Framework.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
New HRGs have been created and HRGs have been deleted
All the HRGs within this subchapter have been deleted and replaced by HRGs with
interactive CC splits in the HRG4+ Engagement 2016/17 design.
Interactive Complications and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determines the HRG derived.
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been. Diagnosis
codes that should always indicate additional resource have been added for consistency. To
allow the interactive CC logic to be implemented, all major CC lists have been deleted and
all codes now appear on subchapter-specific CC lists. Major CCs have a value of two and
all other CCs have a value of one.
Page 49 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
KB – Diabetic Medicine
K – Endocrine and Metabolic System
Scope and Composition
Composition and Concepts
Subchapter KB covers all diabetic
disorders in adults. It includes activity
undertaken in an inpatient and day case
setting. It comprises of:
 Diabetes with hyperglycaemic
disorders
 Diabetes with hypoglycaemic
disorders
 Diabetes with lower limb
complications
 Continuous subcutaneous insulin
infusion
E
16/17
LP
15/16
P
14/15
Total HRGs
12
11
10
Total HRG Roots
4
4
3
Procedure-driven HRGs
1
1
0
Diagnosis-driven HRGs
11
10
10
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
All diagnosis-driven activity relating to the treatment of children (aged 18 years and under)
groups to an HRG in Chapter P, Diseases of Childhood and Neonates, in line with the
requirements of the Casemix Design Framework.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
New HRGs have been created and HRGs have been deleted
A number of HRGs have been deleted and replaced by HRGs with interactive CC splits.
There are 11 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design. Full details of all design changes can be found in the Code to Group Excel
document that accompanies this release.
Interactive Complications and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determines the HRG derived.
Complications and Comorbidity lists updated
CC lists now include amendments made as part of the ICD-10 4th Edition update. Any
missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9 code
denoting other or unspecified conditions already on the CC list) have been added. Diagnosis
codes that should always indicate additional resource have been added. Major CCs have a
value of two and all other CCs have a value of one.
Page 50 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
KC – Metabolic Disorders
K – Endocrine and Metabolic System
Scope and Composition
Composition and Concepts
Subchapter KC covers all metabolic
disorders in adults. It includes activity
undertaken in an inpatient and day
case setting.
It comprises:

Fluid and electrolyte disorders

Inborn errors of metabolism
disorders
E16/17
LP
15/16
P14/15
Total HRGs
9
7
7
Total HRG Roots
2
2
2
Procedure-driven HRGs
0
0
0
Diagnosis-driven HRGs
9
7
7
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
Yes
All diagnosis-driven activity relating to the treatment of children (aged 18 years and under)
groups to an HRG in Chapter P, Diseases of Childhood and Neonates, in line with the
requirements of the Casemix Design Framework.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
New HRGs have been created and HRGs have been deleted
All the HRGs within this subchapter have been deleted and replaced by HRGs with
interactive CC splits, with 7 HRGs also having intervention splits in the HRG4+ Engagement
2016/17 design. Full details of all design changes can be found in the Code to Group Excel
document that accompanies this release.
Intervention splits added to Diagnosis-driven HRGs
Intervention’ splits have been added to Subchapter KC. This reflects where, within a
diagnosis-driven HRG, there are ‘minor interventions’ performed which not only means that
they include the cost/resources associated with these procedures, but may indicate that the
patient’s condition was more severe resulting in more resource-intensive treatment.
The ‘Interventions’ list is only utilised for procedures that map to a base HRG with a
maximum length of stay check.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Interactive Complications and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determines the HRG derived.
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to
CC lists. Diagnosis codes that should always indicate additional resource have been added
to all CC lists for consistency. To allow the interactive CC logic to be implemented, all major
CC lists have been deleted and all codes now appear on subchapter-specific CC lists. Major
CCs have a value of two and all other CCs have a value of one.
Page 52 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
LA – Renal Procedures and Disorders
L – Urinary Tract and Male Reproductive System
Scope and Composition
Composition and Concepts
Subchapter LA includes renal
procedures for patients of all ages
and all adult non-malignant renal
disorders. It includes activity
undertaken in an inpatient, day case
and non-admitted care setting.
It does not include dialysis for chronic
kidney disease HRGs, which are
generated from the National Renal
Dataset (NRD) and sit in subchapter
LD Renal Dialysis for Chronic
Kidney Disease.
E16/17
LP
15/16
P14/15
Total HRGs
48
32
32
Total HRG Roots
14
13
13
Procedure-driven HRGs
14
14
14
Diagnosis-driven HRGs
34
18
18
Age Splits
Yes
Complications and
Comorbidities Splits
Yes
Intervention Splits
Yes
Renal dialysis for acute kidney injury is unbundled and sits in subchapter LE Renal Dialysis
for Acute Kidney Injury.
HRGs covering non-transplant kidney procedures and treatment of renal neoplasms sit
within subchapter LB Urological and Male Reproductive System Procedures and
Disorders.
This subchapter comprises of:





Transplant surgery and pre- and post-transplant assessments
Dialysis associated procedures
Kidney or urinary tract infections and other renal disorder
Acute kidney injury
Chronic kidney disease
All diagnosis-driven activity relating to the treatment of children (aged 18 years and under)
groups to an HRG in Chapter P, Diseases of Childhood and Neonates, in line with the
requirements of the Casemix Design Framework.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
New HRGs have been created and HRGs have been deleted
A number of HRGs have been deleted and replaced by procedure-driven HRGs with
interactive CC splits, and diagnosis-driven HRGs with interactive CC and intervention splits.
Page 53 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
There are 32 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design.
To be consistent with other zero cost HRGs, two new HRGs (LA97A Same Day Dialysis
Admission or Attendance, 19 years and over and LA97B Same Day Dialysis Admission
or Attendance, 18 years and under) have been created to replace LA08E Chronic Kidney
Disease with a length of stay 1 day or less, associated with Renal Dialysis, which
represents an effectively empty core HRG due to the resource associated with the dialysis
being captured elsewhere within the HRG design. As of these HRGs utilise diagnosis in
their derivation, they cannot be generated in an outpatient care setting.
Full details of all design changes can be found in the Code to Group Excel document that
accompanies this release.
Changes made to logic
Logic has been added, in order to comply with specific coding rules regarding the recording
on acute kidney injury (AKI) or chronic kidney disease (CKD) in a secondary position when
the more specific cause of the renal failure is coded as the primary diagnosis, to map the
activity to the AKI or CKD specific HRGs to more appropriately reflect the type of activity.
Logic has been added to certain diagnosis codes that map to LA09* General Renal
Disorders as a base HRG to check if a secondary infectious agent cause diagnosis code
(ICD-10 rubrics B95-B98) is also recorded, and where so, map to the more appropriate HRG
root LA04 Kidney or Urinary Tract Infections to reflect that these are infectious disorders.
Intervention splits added to Diagnosis-Driven HRGs
Intervention splits have been added to Subchapter LA. This reflects where, within a
diagnosis-driven HRG, there are ‘minor interventions’ performed which not only means that
they include the cost/resources associated with these procedures, but may indicate that the
patient’s condition was more severe resulting in more resource-intensive treatment.
The ‘Interventions’ list is only utilised for procedures that map to a base HRG with a
maximum length of stay check.
Interactive Complications and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determines the HRG derived.
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to
CC lists. Diagnosis codes that should always indicate additional resource have been added
to all CC lists for consistency. To allow the interactive CC logic to be implemented, all major
CC lists have been deleted and all codes now appear on subchapter-specific CC lists. Major
CCs have a value of two and all other CCs have a value of one.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Mapping of codes to more appropriately reflect resource
Several diagnosis codes that were previously presumed to be infections have been mapped
to LA09* General Renal Disorders as a base HRG and now only map to LA04* Kidney or
Urinary Tract Infections if an additional infectious agent cause code (ICD-10 rubrics B95B98) is recorded.
N18.9 Chronic kidney disease, unspecified and N19.X Unspecified kidney failure have
been mapped from HRG root LA08 Chronic Kidney Disease to LA09 General Renal
Disorders as they are too unspecific to determine the stage of disease as with the
implementation of the new ICD-10 stage specific CKD codes only severest stages, 1 to 3,
map to HRG root LA08.
Page 55 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
LB – Urological and Male Reproductive System Procedures
and Disorders
L – Urinary Tract and Male Reproductive System
Scope and Composition
Composition and Concepts
Subchapter LB covers urological and
male reproductive system procedures
for patients of all ages and adult
disorders, with the exception of renal
conditions and procedures relating to
renal failure which are covered in
subchapters LA Renal Procedures
and Disorders, LD Renal Dialysis
for Chronic Kidney Disease and LE
Renal Dialysis for Acute Kidney
Injury. It includes activity undertaken
in an inpatient, day case and nonadmitted care setting.
E16/17
LP
15/16
P14/15
Total HRGs
148
103
87
Total HRG Roots
58
59
52
Procedure-driven HRGs
92
78
62
Diagnosis-driven HRGs
56
25
25
Age Splits
Yes
Complications and
Comorbidities Splits
Yes
Intervention Splits
Yes
It comprises of:

Open surgical procedures on the urinary tract

Laparoscopic surgical procedures on the urinary tract

Endoscopic procedures on the urinary tract

Disorders of the urinary tract with the exception of renal disease
All diagnosis-driven activity relating to the treatment of children (aged 18 years and under)
groups to an HRG in Chapter P, Diseases of Childhood and Neonates, in line with the
requirements of the Casemix Design Framework.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
New HRGs have been created and HRGs have been deleted
A number of HRGs have been deleted and replaced by procedure-driven HRGs with
interactive CC splits, and diagnosis-driven HRGs with interactive CC and intervention splits.
There are 101 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design.
Full details of all design changes can be found in the Code to Group Excel document that
accompanies this release.
Page 56 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Intervention splits added to Diagnosis-Driven HRGs
Intervention’ splits have been added to Subchapter LB. This reflects where, within a
diagnosis-driven HRG, there are ‘minor interventions’ performed which not only means that
they include the cost/resources associated with these procedures, but may indicate that the
patient’s condition was more severe resulting in more resource-intensive treatment.
The ‘Interventions’ list is only utilised for procedures that map to a base HRG with a
maximum length of stay check.
Interactive Complications and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determines the HRG derived.
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to
CC lists. Diagnosis codes that should always indicate additional resource have been added
to all CC lists for consistency. To allow the interactive CC logic to be implemented, all major
CC lists have been deleted and all codes now appear on subchapter-specific CC lists. Major
CCs have a value of two and all other CCs have a value of one.
Mapping of codes to more appropriately reflect resource
A new combination code specific to percutaneous cryotherapy to lesion of prostate has been
created, based on guidance published by NICE to ensure that the resource usage
associated with this specialised procedure is accurately captured and maps to a clinically
appropriate HRG.
With the deletion of HRG root LB01 Percutaneous Nephrostomy two procedure codes,
M13.2 Percutaneous drainage of kidney and M13.6 Percutaneous insertion of
nephrostomy tube have been mapped to LB61 Major Open or Percutaneous, Kidney or
Ureter Procedures as a base HRG.
Other lists have been updated
List LB_Int_Open has been amended and minor procedures removed to reflect that these
should not be included in a list of intermediate procedures. Full details of list contents can be
found in the Code to Group excel workbook on the ‘Other Lists’ tab.
Changes to HRG Labels
To reflect the mapping of a couple of percutaneous procedure codes to the HRG root the
label has been amended to LB61 Major Open or Percutaneous, Kidney or Ureter
Procedures.
Page 57 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
LD – Renal Dialysis for Chronic Kidney Disease
L – Urinary Tract and Male Reproductive System
Scope and Composition
Composition and Concepts
Subchapter LD covers renal dialysis
activity for patients of all ages
recorded within the National Renal
Dataset (NRD) which is specific to
renal dialysis for chronic kidney
disease. HRGs specific to dialysis for
acute kidney injury can be found in
unbundled subchapter LE Renal
Dialysis for Acute Kidney Injury.
It comprises of:
E16/17
LP
15/16
P14/15
Total HRGs
26
26
26
Total HRG Roots
13
13
13
Procedure-driven HRGs
N/A
N/A
N/A
Diagnosis-driven HRGs
N/A
N/A
N/A
Age Splits
Yes
Complications and
Comorbidities Splits
No
Intervention Splits
No
•
Hospital
Haemodialysis/Filtration
•
Satellite Haemodialysis/Filtration
•
Home Haemodialysis/Filtration
•
Continuous Ambulatory Peritoneal Dialysis
•
Automated Peritoneal Dialysis
•
Assisted Automated Peritoneal Dialysis
Subchapter-specific grouping logic
The HRGs in Subchapter LD are derived per session from the following data items [item
reference in brackets] in the National Renal Dataset (NRD):
Renal Care
[1] Renal Treatment Modality - e.g. Haemodialysis, CAPD
[6] Renal Treatment Supervision Code - e.g. home, hospital
[75] Person Observation (Blood Test HBV Surface Antigen) - e.g. negative, positive
[77] Person Observation (Blood Test HCV) - e.g. negative, positive
[79] Person Observation (Blood Test HIV) - e.g. negative, positive
Dialysis
[182] Dialysis Access Type - e.g. AV fistula, haemodialysis catheter
Patient age (in years derived from date of session – date of birth)
Page 58 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Appendix A is a flow diagram which demonstrates how each HRG is derived.
The Grouper validates against allowable values only for renal treatment modality and renal
treatment supervision code. However for dialysis access type, blank values are accepted
and if used will group to the “via haemodialysis catheter” HRG split. The 3 blood borne virus
fields also allow for blank values and if left blank will group to the “without blood borne
viruses” HRG splits.
Appendix B demonstrates the acceptable values for each field required for grouping and
where validation is applicable.
HRG4+ Design Changes
No changes have been made to this subchapter as part of the HRG4+ implementation.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
LD – Worked Examples
Cases A to E illustrate how HRG assignment will be derived from the data in the NRD for haemodialysis patients of differing ages, with and without blood borne viruses,
at different sites using different access types:
Case
Age
Renal
Treatment
Modality
Renal
Treatment
Supervision
Code
Blood Tests
Type of Dialysis
Access
Blood test HBV surface antigen = NEG
A
62
05
Haemodialysis
02 Hospital
Blood test HCV antibody = NEG
01 non-tunnelled
catheter
LD01A Hospital Haemodialysis or Filtration,
with Access via Haemodialysis Catheter, 19
years and over
01 non-tunnelled
catheter
LD01B Hospital Haemodialysis or Filtration,
with Access via Haemodialysis Catheter, 18
years and under
03 Arteriovenous
Fistula
LD02A Hospital Haemodialysis or Filtration,
with Access via Arteriovenous Fistula or
Graft, 19 years and over
03 Arteriovenous
Fistula
LD04A Hospital Haemodialysis or Filtration,
with Access via Arteriovenous Fistula or
Graft, with Blood-Borne Virus, 19 years and
over
03 Arteriovenous
Fistula
LD10A Home Haemodialysis or Filtration,
with Access via Arteriovenous Fistula or
Graft, 19 years and over
Blood test HIV = NEG
Blood test HBV surface antigen = NEG
B
14
05
Haemodialysis
02 Hospital
Blood test HCV antibody = NEG
Blood test HIV = NEG
Blood test HBV surface antigen = NEG
C
25
05
Haemodialysis
02 Hospital
Blood test HCV antibody = NEG
Blood test HIV = NEG
Blood test HBV surface antigen = NEG
D
25
05
Haemodialysis
02 Hospital
Blood test HCV antibody = POS
HRG4+
Blood test HIV = NEG
Blood test HBV surface antigen = NEG
E
25
05
Haemodialysis
01 Home
Blood test HCV antibody = POS
Blood test HIV = NEG
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Cases F to H illustrate how HRG assignment is derived using the data from the NRD for peritoneal dialysis patients of differing ages, with and without blood borne
viruses, at different sites using different access types:
Case
Age
Renal
Treatment
Modality
Renal
Treatment
Supervision
Code
Blood Tests
Type of Dialysis
Access
HRG4+
Blood test HBV surface antigen = NEG
F
62
02 CAPD
(standard)
01 Home
Blood test HCV antibody = NEG
06 PD catheter
LD11A Continuous Ambulatory Peritoneal
Dialysis, 19 years and over
06 PD catheter
LD12B Automated Peritoneal Dialysis, 18 years
and under
06 PD catheter
LD13A Assisted Automated Peritoneal Dialysis,
19 years and over
Blood test HIV = NEG
G
14
04 CCPD
(6/7
nights/wk)
Blood test HBV surface antigen = NEG
01 Home
Blood test HCV antibody = NEG
Blood test HIV = NEG
Blood test HBV surface antigen = NEG
H
62
Page 61 of 166
04 CCPD
(6/7
nights/wk)
04 Shared
supervision
Blood test HCV antibody = NEG
Blood test HIV = NEG
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Appendix A
RENAL CARE (1) Renal Treatment Modality = 01 CAPD
(disconnect) or 02 CAPD (standard)
RENAL CARE (3) End date (Renal
Treatment Modality) – DEMOGRAPHICS
(6) Person Birth Date [IN YEARS] <19
Yes
Yes
No
No
RENAL CARE (1) Renal Treatment Modality = 03 CCPD
(<6 nights/wk) or 04 CCPD (6/7 nights/wk)
HRG = LD11B
Continuous Ambulatory Peritoneal
Dialysis 18 years and under
HRG = LD11A
Continuous Ambulatory Peritoneal
Dialysis 19 years and over
HRG = LD13B
Assisted Automated Peritoneal
Dialysis 18 years and under
HRG = LD13A
Assisted Automated Peritoneal
Dialysis 19 years and over
HRG = LD12B
Automated Peritoneal Dialysis 18
years and under
HRG = LD12A
Automated Peritoneal Dialysis 19
years and over
Yes
RENAL CARE (6) Renal
Treatment Supervision Code = 04
Shared Supervision
Yes
RENAL CARE (3) End date (Renal
Treatment Modality) – DEMOGRAPHICS
(6) Person Birth Date [IN YEARS] <19
Yes
No
No
RENAL CARE (3) End date (Renal
Treatment Modality) – DEMOGRAPHICS
(6) Person Birth Date [IN YEARS] <19
No
Yes
RENAL CARE (3) End date (Renal
Treatment Modality) – DEMOGRAPHICS
(6) Person Birth Date [IN YEARS] <19
No
Yes
C1
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C1
RENAL CARE (1) Renal Treatment Modality = 05
Haemodialysis or 06 Haemofiltration or 07
Haemodiafiltration or 08 Ultrafiltration
No
HRG = UZ01Z
Data Invalid for Grouping
HRG = UZ01Z
Data Invalid for Grouping
Yes
RENAL CARE (3) End date (Renal
Treatment Modality) – DEMOGRAPHICS (6)
Person Birth Date [IN YEARS] <19
Yes
RENAL CARE (6) Renal
Treatment Supervision Code =
02 Hospital
No
RENAL CARE (6) Renal
Treatment Supervision Code = 03
Satellite or 04 Shared Supervision
No
No
Yes
RENAL CARE (6) Renal
Treatment Supervision Code = 01
Home
No
Yes
Yes
C2
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C3
C4
C5
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
C2
C3
C4
C5
DIALYSIS (182) Type of dialysis
access = 01 Non-tunnelled line or
02 Tunnelled Line
DIALYSIS (182) Type of dialysis
access = 01 Non-tunnelled line or
02 Tunnelled Line
Yes
HRG = LD09B
Home Haemodialysis/Filtration with
access via haemodialysis catheter 18
years and under
Yes
HRG = LD10B
Home Haemodialysis/Filtration with
access via arteriovenous fistula or
graft 18 years and under
HRG = LD09B
Home Haemodialysis/Filtration with
access via haemodialysis catheter
18 years and under
HRG = LD07B
Satellite Haemodialysis/Filtration
with access via haemodialysis
catheter with blood borne viruses 18
years and under
HRG = LD05B
Satellite Haemodialysis/Filtration
with access via haemodialysis
catheter 18 years and under
No
DIALYSIS (182) Type of dialysis
access = 03 Arteriovenous fistula or
04 Arteriovenous graft or 05 Vein
Loop
Yes
No
No
RENAL CARE (75) Person
observation (blood test HBV surface
antigen) = POS
Yes
No
RENAL CARE (77) Person
observation (blood test HCV
antibody) = POS
Yes
No
RENAL CARE (79) Person
observation (blood test HIV) = POS
Yes
No
C6
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C7
C8
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
C6
C7
C8
DIALYSIS (182) Type of dialysis
access = 03 Arteriovenous fistula or
04 Arteriovenous graft or 05 Vein
Loop
Yes
RENAL CARE (75) Person
observation (blood test HBV surface
antigen) = POS
No
Yes
RENAL CARE (77) Person
observation (blood test HCV
antibody) = POS
Yes
No
RENAL CARE (79) Person
observation (blood test HIV) = POS
No
Yes
HRG = LD08B
Satellite Haemodialysis/Filtration
with access via arteriovenous fistula or
graft with blood borne viruses 18 years
and under
HRG = LD06B
Satellite Haemodialysis/Filtration
with access via arteriovenous fistula or
graft 18 years and under
HRG = LD05B
Satellite Haemodialysis/Filtration
with access via haemodialysis
catheter 18 years and under
No
C9
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C10
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
C9
C10
DIALYSIS (182) Type of dialysis
access = 01 Non-tunnelled line or
02 Tunnelled Line
Yes
RENAL CARE (75) Person
observation (blood test HBV surface
antigen) = POS
Yes
No
RENAL CARE (77) Person
observation (blood test HCV antibody)
= POS
Yes
No
No
RENAL CARE (79) Person
observation (blood test HIV) = POS
Yes
No
DIALYSIS (182) Type of dialysis
access = 03 Arteriovenous fistula or
04 Arteriovenous graft or 05 Vein Loop
Yes
HRG = LD03B
Hospital Haemodialysis/Filtration
with access via haemodialysis
catheter with blood borne viruses 18
years and under
HRG = LD01B
Hospital Haemodialysis/Filtration
with access via haemodialysis
catheter 18 years and under
HRG = LD04B
Hospital Haemodialysis/Filtration
with access via arteriovenous fistula or
graft with blood borne viruses 18 years
and under
HRG = LD02B
Hospital Haemodialysis/Filtration
with access via arteriovenous fistula or
graft 18 years and under
HRG = LD01B
Hospital Haemodialysis/Filtration
with access via haemodialysis
catheter 18 years and under
RENAL CARE (75) Person
observation (blood test HBV surface
antigen) = POS
Yes
No
RENAL CARE (77) Person
observation (blood test HCV antibody)
= POS
Yes
No
RENAL CARE (79) Person
observation (blood test HIV) = POS
Yes
No
C11
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No
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C11
RENAL CARE (6) Renal Treatment
Supervision Code = 01 Home
DIALYSIS (182) Type of dialysis
access = 01 Non-tunnelled line or
02 Tunnelled Line
Yes
Yes
HRG = LD09A
Home Haemodialysis/Filtration with
access via haemodialysis catheter 19
years and over
Yes
HRG = LD10A
Home Haemodialysis/Filtration with
access via arteriovenous fistula or
graft 19 years and over
HRG = LD09A
Home Haemodialysis/Filtration with
access via haemodialysis catheter
19 years and over
HRG = UZ01Z
Data Invalid for Grouping
No
DIALYSIS (182) Type of dialysis
access = 03 Arteriovenous fistula or
04 Arteriovenous graft or 05 Vein
Loop
No
No
RENAL CARE (6) Renal
Treatment Supervision Code =
02 Hospital
Yes
No
RENAL CARE (6) Renal Treatment
Supervision Code = 03 Satellite or 04
Shared Supervision
No
Yes
C12
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C13
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
C12
C13
DIALYSIS (182) Type of dialysis
access = 01 Non-tunnelled line or
02 Tunnelled Line
Yes
RENAL CARE (75) Person
observation (blood test HBV surface
antigen) = POS
No
Yes
RENAL CARE (77) Person
observation (blood test HCV antibody)
= POS
Yes
No
No
RENAL CARE (79) Person
observation (blood test HIV) = POS
Yes
No
HRG = LD07A
Satellite Haemodialysis/Filtration
with access via haemodialysis
catheter with blood borne viruses 19
years and over
HRG = LD05A
Satellite Haemodialysis/Filtration
with access via haemodialysis
catheter 19 years and over
No
DIALYSIS (182) Type of dialysis
access = 03 Arteriovenous fistula or
04 Arteriovenous graft or 05 Vein Loop
Yes
RENAL CARE (75) Person
observation (blood test HBV surface
antigen) = POS
No
Yes
RENAL CARE (77) Person
observation (blood test HCV antibody)
= POS
Yes
No
RENAL CARE (79) Person
observation (blood test HIV) = POS
No
C14
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No
Yes
HRG = LD08A
Satellite Haemodialysis/Filtration
with access via arteriovenous fistula or
graft with blood borne viruses 19 years
and over
HRG = LD06A
Satellite Haemodialysis/Filtration
with access via arteriovenous fistula or
graft 19 years and over
HRG = LD05A
Satellite Haemodialysis/Filtration
with access via haemodialysis
catheter 19 years and over
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
C14
DIALYSIS (182) Type of dialysis
access = 01 Non-tunnelled line or
02 Tunnelled Line
RENAL CARE (75) Person
observation (blood test HBV surface
antigen) = POS
Yes
Yes
No
RENAL CARE (77) Person
observation (blood test HCV antibody)
= POS
Yes
No
No
RENAL CARE (79) Person
observation (blood test HIV) = POS
Yes
No
DIALYSIS (182) Type of dialysis
access = 03 Arteriovenous fistula or
04 Arteriovenous graft or 05 Vein Loop
RENAL CARE (75) Person
observation (blood test HBV surface
antigen) = POS
Yes
HRG = LD03A
Hospital Haemodialysis/Filtration
with access via haemodialysis
catheter with blood borne viruses 19
years and over
HRG = LD01A
Hospital Haemodialysis/Filtration
with access via haemodialysis
catheter 19 years and over
HRG = LD04A
Hospital Haemodialysis/Filtration
with access via arteriovenous fistula or
graft with blood borne viruses 19 years
and over
HRG = LD02A
Hospital Haemodialysis/Filtration
with access via arteriovenous fistula or
graft 19 years and over
HRG = LD01A
Hospital Haemodialysis/Filtration
with access via haemodialysis
catheter 19 years and over
Yes
No
RENAL CARE (77) Person
observation (blood test HCV antibody)
= POS
Yes
No
RENAL CARE (79) Person
observation (blood test HIV) = POS
Yes
No
No
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Appendix B
List of required NRD fields, acceptable values and validation applicable for the
generation of LD Renal Dialysis HRGs
Description
Person
observation
(blood test
HCV)
Description
01
CAPD (disconnect)
POS
Positive
02
CAPD (standard)
NEG
Negative
03
CCPD (<6 nights/wk)
UNK
Unknown
Validation
On list plus blank. Must
be upper case.
Description
Renal
Treatment
Modality
04
CCPD (6/7 nights/wk)
05
Haemodialysis
06
Haemofiltration
07
Haemodiafiltration
Person
observation
(blood test
HIV)
08
Ultrafiltration
POS
Positive
09
Transplant (cad - HB)
NEG
Negative
10
Transplant (cad - NHB)
UNK
Unknown
Validation
On list plus blank. Must
be upper case.
11
Transplant (LRD)
12
Transplant (LUD)
13
Conservative care
14
Recovery of renal
function
Age
Description
15
None
(number)
(Calculated from session
date - date of birth)
Validation
Only on list. Leading
zero must be included
for values lower than
10.
Validation
Within range 0 to 130
years
* Note 09-15 will map to U group HRG
(not dialysis activity)
Treatment
Supervision
Code
Description
01
Home
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Fields not required for grouping but
expected for identification of each
session
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
02
Hospital
Unique
Patient ID
Description
03
Satellite
Free text
An anonymised unique
ID for each patient. Not
NHS number
04
Shared supervision
Validation
None
Validation
Only on list. Leading
zero must be included.
Type of
dialysis
access
(Current)
Description
Date
Description
01
Non-tunnelled line
Free text
Date in standard format
e.g. 11/11/11 or 11-1111
02
Tunnelled line
Validation
None
03
Arteriovenous fistula
(AVF)
04
Arteriovenous graft
(AVG)
05
Vein loop
06
PD catheter
07
PD catheter temp
Validation
On list plus blank.
Leading zero must be
included.
Person
observation
(blood test
HBV surface
antigen)
Description
POS
Positive
NEG
Negative
UNK
Unknown
Validation
On list plus blank. Must
be upper case.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
LE – Renal Dialysis for Acute Kidney Injury
L – Urinary Tract and Male Reproductive System
Scope and Composition
Composition and Concepts
Subchapter LE covers renal dialysis
activity specifically for the treatment
of acute kidney injury as part of an
admitted care episode, for patients of
all ages. These HRGs are unbundled
in addition to the core HRG, and
include activity undertaken in an
inpatient and day case setting.
It comprises of:
E16/17
LP
15/16
P14/15
Total HRGs
4
4
4
Total HRG Roots
2
2
2
Procedure-driven HRGs
4
4
4
Diagnosis-driven HRGs
0
0
0
Age Splits
Yes
Complications and
Comorbidities Splits
No

Haemodialysis for adults and Intervention Splits
children with acute kidney injury

Peritoneal dialysis for adults and children with acute kidney injury
No
Dialysis for the treatment of chronic kidney disease is covered within subchapter LD Renal
Dialysis for Chronic Kidney Disease.
Subchapter-specific grouping logic
Unbundled HRG grouping is the second stage of the grouping process, occurring once the
data have been validated. Subsequently, HRGs for Multiple Trauma, Burns and core HRGs
are produced.
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
No changes have been made to this subchapter as part of the HRG4+ implementation.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
MA – Female Reproductive System Procedures
M – Female Reproductive System and Assisted Reproduction
Scope and Composition
Composition and Concepts
Subchapter MA covers all female upper
and lower genital tract procedures for
patients of all ages. It includes activity
undertaken in inpatient, day case and
non-admitted care settings. It comprises
of:








E
16/17
LP
15/16
P
14/15
Total HRGs
48
31
26
Total HRG Roots
34
25
20
Procedure-driven HRGs
48
31
26
Diagnosis-driven HRGs
0
0
0
Age Splits
Open surgical upper and lower
female genital tract procedures for Complications and
Comorbidities Splits
non-malignant conditions
Intervention Splits
Laparoscopic and endoscopic
upper and lower female
genital tract procedures for
non-malignant conditions
Termination of pregnancy
Surgical treatment of malignant gynaecological conditions
Surgical treatment of female pelvic peritoneal adhesions
Ambulatory gynaecological procedures
No
Yes
No
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
New HRGs have been created and HRGs have been deleted
A number of HRGs have been deleted and replaced by HRGs with interactive CC splits.
There are 18 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design. New HRGs have been created to specifically identify high-volume procedures and to
also capture the additional resource usage when multiple minor procedures are performed
during the same admission or attendance:






MA31Z Diagnostic Hysteroscopy
MA32Z Diagnostic Hysteroscopy with Biopsy
MA33Z Diagnostic Hysteroscopy with Biopsy and Implantation of Intrauterine
Device
MA34Z Diagnostic Hysteroscopy with Implantation of Intrauterine Device
MA35Z Implantation of Intrauterine Device
MA36Z Transvaginal Ultrasound
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0




MA37Z Transvaginal Ultrasound with Biopsy
MA38Z Diagnostic Colposcopy
MA39Z Diagnostic Colposcopy with Biopsy
MA40Z Therapeutic Colposcopy
As a result, MA21Z Diagnostic Hysteroscopy has been deleted as it has been replaced
with new more specific HRGs. Full details of all design changes can be found in the Code
to Group Excel document that accompanies this release.
Changes made to logic
Combination codes have been created to identify certain paired codes e.g. hysterectomy
with salpingoophrectomy, to ensure that laparoscopic logic is applied correctly according to
coding rules and the appropriate laparoscopic HRG is derived.
Logic has been added to procedure code T43.9 Unspecified diagnostic endoscopic
examination of peritoneum (which includes gynaecological laparoscopy) which maps to a
base HRG of FZ13* Minor Therapeutic or Diagnostic General Abdominal Procedures to
map to MA10Z Minor Laparoscopic or Endoscopic, Upper Genital Tract Procedures
where a primary diagnosis of a gynaecological disorder is recorded, to more appropriately
reflect the nature of this procedure.
Logic has been added to the procedure codes that map to base HRG MA11* Intermediate
Open Upper Genital Tract Procedures to map to MA29* Major Female Pelvic
Peritoneum Adhesion Procedures if an additional adhesiolysis procedure is also recorded
to reflect the additional resource use associated with the treatment of endometriosis.
Interactive Complications and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determines the HRG derived.
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to
CC lists. Diagnosis codes that should always indicate additional resource have been added
to all CC lists for consistency. To allow the interactive CC logic to be implemented, all major
CC lists have been deleted and all codes now appear on subchapter-specific CC lists. Major
CCs have a value of two and all other CCs have a value of one.
Other lists have been updated
Drainage of peritoneal abscess codes (OPCS-4 category T34.-) have been added to the
MA_Major list to reflect that these are major procedures which are often performed
concurrently with gynaecologic surgery.
T41.3 Freeing of adhesions of peritoneum and T41.5 Freeing of extensive adhesions of
peritoneum have been added to the MA_Adhesiolysis list to reflect that these are
adhesiolysis procedures.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
MB – Female Reproductive System Disorders
M – Female Reproductive System and Assisted Reproduction
Scope and Composition
Subchapter MB covers female
reproductive system disorders for
adults and some child activity. It
includes activity undertaken in
inpatient and day case settings. It
comprises of:



Composition and Concepts
E16/17
LP
15/16
P14/15
Total HRGs
17
12
12
Total HRG Roots
3
8
8
Procedure-driven HRGs
0
0
0
Diagnosis-driven HRGs
17
12
12
Age Splits
Non-malignant gynaecological
Complications and
disorders
Comorbidities Splits
Malignant gynaecological
Intervention Splits
disorders
Threatened or spontaneous miscarriages
No
Yes
Yes
The majority of diagnosis-driven activity relating to the treatment of children (aged 18 years
and under), groups to an HRG in Chapter P, Diseases of Childhood and Neonates, in line
with the requirements of the Casemix Design Framework.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
New HRGs have been created and HRGs have been deleted
A number of HRGs have been deleted and replaced by HRGs with interactive CC and
intervention splits.
There are 15 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design.
All the HRGs for non-malignant disorders (excluding MB08* Threatened or Spontaneous
Miscarriage) have been merged to a single HRG root MB09 Non-Malignant
Gynaecological Disorders to allow for a greater differentiation of splits based on
interventions and interactive CC splits.
Full details of all design changes can be found in the Code to Group Excel document that
accompanies this release.
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Intervention splits added to Diagnosis-Driven HRGs
Intervention’ splits have been added to Subchapter MB. This reflects where, within a
diagnosis-driven HRG, there are ‘minor interventions’ performed which not only means that
they include the cost/resources associated with these procedures, but may indicate that the
patient’s condition was more severe resulting in more resource-intensive treatment.
The ‘Interventions’ list is only utilised for procedures that map to a base HRG with a
maximum length of stay check.
Interactive Complications and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determines the HRG derived.
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to
CC lists. Diagnosis codes that should always indicate additional resource have been added
to all CC lists for consistency. To allow the interactive CC logic to be implemented, all major
CC lists have been deleted and all codes now appear on subchapter-specific CC lists. Major
CCs have a value of two and all other CCs have a value of one.
Mapping of codes to more appropriately reflect resource
The diagnosis codes for ectopic pregnancy (ICD-10 rubric O00) have been mapped from
HRG root MB04 Ovary, Fallopian Tube or Pelvic Disorders to HRG root MB08
Threatened or Spontaneous Miscarriage to more appropriately reflect the nature of these
diagnoses.
Changes to HRG Labels
MB05* Gynaecological Malignancy has been relabelled MB05* Malignant
Gynaecological Disorders for consistency of labels within this subchapter.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
MC – Assisted Reproductive Medicine
M – Female Reproductive System and Assisted Reproduction
Scope and Composition
Composition and Concepts
Subchapter MC covers procedures
within assisted reproductive medicine
for all ages of patient. It includes
activity undertaken in inpatient, day
case and non-admitted care settings.
It comprises of:
E16/17
LP
15/16
P14/15
Total HRGs
10
10
10
Total HRG Roots
10
10
10
Procedure-driven HRGs
10
10
10
Diagnosis-driven HRGs
0
0
0

Collection of sperm
Age Splits
No

Intra-uterine insemination (IUI)
No

Oocyte recovery
Complications and
Comorbidities Splits

Intervention Splits
No
Implantation of embryo
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
No changes have been made to this subchapter as part of the HRG4+ implementation.
Page 77 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
NZ – Obstetric Medicine
N – Obstetrics
Scope and Composition
Composition and Concepts
Subchapter NZ covers obstetric
procedures and diagnoses for
patients of all ages. It also
accommodates obstetric aspects of
embryology and placental disorders.
It includes activity undertaken in
inpatient, day case and non-admitted
care settings.
It comprises of:
 Normal, assisted and
caesarean section deliveries
E16/17
LP
15/16
P14/15
Total HRGs
56
32
30
Total HRG Roots
26
18
12
Procedure-driven HRGs
44
25
26
Diagnosis-driven HRGs
12
7
4
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
No

Ante-natal disorders

Ante-natal therapeutic procedures, such as induction

Obstetric scans and diagnostic procedures, such as amniocentesis

Post-natal disorders and procedures
 Fetal therapeutic and diagnostic procedures, and fetal ultrasound
To reiterate, this subchapter includes diagnosis-driven activity relating to the treatment of
children (aged 18 years and under) rather than grouping to an HRG in chapter P, Diseases
of Childhood and Neonates, to more appropriately reflect the service provision of obstetric
medicine.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
New HRGs have been created and HRGs have been deleted
A number of HRGs have been deleted and replaced by HRGs with interactive CC splits.
There are 48 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design.
Full details of all design changes can be found in the Code to Group Excel document that
accompanies this release.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
The normal and assisted delivery HRGs have been redesigned and new HRGs created to
distinguish between the additional resource usage associated with epidurals, inductions and
deliveries requiring post-partum surgical intervention and the different combinations thereof
patients may receive. In addition, new HRGs have been created to accommodate interactive
CC splits.
Three new HRGs not in the HRG4+ 2013/14 Reference Costs design have been created to
separately identify the clinical difference and resource usage associated with specialised and
non-specialised fetal medicine activity, namely NZ71Z Specialised Fetal Therapeutic
Procedures, NZ72Z Specialised Fetal Invasive Diagnostic Procedures and NZ73Z Fetal
Ultrasound or Other Related Fetal Interventions. The latter HRG also contains fetal
echocardiography which previously mapped to EA45Z Complex Echocardiogram,
including Transoesophageal and Fetal Echocardiography. These HRGs have maximum
length of stay logic to reflect that these procedures are deemed minor for grouping purposes
and therefore are inappropriate to drive HRG grouping where length of stay is greater than a
determined level.
As a result of the creation of the fetal medicine HRGs above, two HRGs NZ10Z Diagnostic
or Therapeutic Procedures on Fetus and NZ23Z Ante-Natal Diagnostic Procedures,
including Amniocentesis and Sampling of Chorionic Villus have been deleted.
Interactive Complications and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determines the HRG derived.
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to
CC lists. Diagnosis codes that should always indicate additional resource have been added
to all CC lists for consistency. To allow the interactive CC logic to be implemented, all major
CC lists have been deleted and all codes now appear on subchapter-specific CC lists. Major
CCs have a value of two and all other CCs have a value of one.
Page 79 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
PB – Neonatal Disorders
P – Diseases of Childhood and Neonates
Scope and Composition
Composition and Concepts
Subchapter PB covers neonatal
medicine for patients aged 18 years
and under. It does not include critical
care services which are covered in
unbundled subchapters XA Neonatal
Critical Care and XB Paediatric
Critical Care. It includes activity
undertaken in inpatient and day case
settings.
It comprises of:


E16/17
LP
15/16
P14/15
Total HRGs
3
3
3
Total HRG Roots
3
3
3
Procedure-driven HRGs
0
0
0
Diagnosis-driven HRGs
3
3
3
Age Splits
No
Complications and
Comorbidities Splits
No
Intervention Splits
No
Neonatal disorders
Healthy babies
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
Changes made to logic
For patients receiving treatment for conditions originating in the perinatal period the age
check logic has been increased from less than one year to less than two years of age to
reflect that there may be a minority of patients that continue to be treated for these
conditions past their first birthday.
ICD-10 codes P01.3 Fetus and newborn affected by polyhydramnios and P01.4 Fetus
and newborn affected by ectopic pregnancy have had an additional logic added to check
if the discharge method is stillbirth, in order to ensure the derivation of the most appropriate
HRG according to current national coding rules.
Changes to HRG Labels
All HRGs with labels containing 'with/without CC' have been updated to 'with CC score 0'
and 'with CC score 1+ respectively.
Page 80 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
PC – Paediatric Ear Nose and Throat Disorders
P – Diseases of Childhood and Neonates
Scope and Composition
Composition and Concepts
Subchapter PC covers ear, nose and
throat disorders for patients aged 18
years and under. It does not include
critical care services which are
covered in unbundled subchapters
XA Neonatal Critical Care and XB
Paediatric Critical Care. It includes
activity undertaken in inpatient and
day case settings.
E16/17
LP
15/16
P14/15
Total HRGs
4
N/A
N/A
Total HRG Roots
1
N/A
N/A
Procedure-driven HRGs
0
N/A
N/A
Diagnosis-driven HRGs
4
N/A
N/A
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
The HRGs for paediatric medicine have been expanded into 17 new subchapters based
largely on the body systems recognised by the current adult subchapters.
This subchapter specific to paediatric ear, nose and throat disorders enables better
differentiation of the care and treatment of children admitted to hospital, as well as improving
the way that their complications and comorbidities (CCs) are acknowledged by the HRG
design with a new subchapter-specific CC list.
Interactive CC splits have been employed within the one HRG root in this subchapter to
more appropriately reflect the additional resource usage for patients with multiple
comorbidities. The summed ‘score’ of all secondary diagnoses from the values assigned to
the CC list determine the HRG derived.
Complications and Comorbidity lists updated
A new CC list has been created specific to this subchapter. In line with interactive CC logic,
all major CCs have been assigned a value of two and all other CCs have a value of one.
Page 81 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
PD – Paediatric Respiratory Disorders
P – Diseases of Childhood and Neonates
Scope and Composition
Composition and Concepts
Subchapter PD covers respiratory
disorders for patients aged 18 years
and under. It does not include critical
care services which are covered in
unbundled subchapters XA Neonatal
Critical Care and XB Paediatric
Critical Care. It includes activity
undertaken in inpatient and day case
settings.
E16/17
LP
15/16
P14/15
Total HRGs
24
N/A
N/A
Total HRG Roots
6
N/A
N/A
Procedure-driven HRGs
0
N/A
N/A
Diagnosis-driven HRGs
24
N/A
N/A
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
The HRGs for paediatric medicine have been expanded into 17 new subchapters based
largely on the body systems recognised by the current adult subchapters.
This subchapter specific to respiratory disorders enables better differentiation of the care and
treatment of children admitted to hospital, as well as improving the way that their
complications and comorbidities (CCs) are acknowledged by the HRG design with a new
subchapter-specific CC list.
Interactive CC splits have been employed within all HRG roots in this subchapter to more
appropriately reflect the additional resource usage for patients with multiple comorbidities.
The summed ‘score’ of all secondary diagnoses from the values assigned to the CC list
determine the HRG derived.
Complications and Comorbidity lists updated
A new CC list has been created specific to this subchapter. In line with interactive CC logic,
all major CCs have been assigned a value of two and all other CCs have a value of one.
Page 82 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
PE – Paediatric Cardiology Disorders
P – Diseases of Childhood and Neonates
Scope and Composition
Composition and Concepts
Subchapter PE covers cardiac
disorders for patients aged 18 years
and under. It does not include critical
care services which are covered in
unbundled subchapters XA Neonatal
Critical Care and XB Paediatric
Critical Care. It includes activity
undertaken in inpatient and day case
settings.
E16/17
LP
15/16
P14/15
Total HRGs
12
N/A
N/A
Total HRG Roots
3
N/A
N/A
Procedure-driven HRGs
0
N/A
N/A
Diagnosis-driven HRGs
12
N/A
N/A
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
The HRGs for paediatric medicine have been expanded into 17 new subchapters based
largely on the body systems recognised by the current adult subchapters.
This subchapter specific to paediatric cardiac disorders enables better differentiation of the
care and treatment of children admitted to hospital, as well as improving the way that their
complications and comorbidities (CCs) are acknowledged by the HRG design with a new
subchapter-specific CC list.
Interactive CC splits have been employed within all HRG roots in this subchapter to more
appropriately reflect the additional resource usage for patients with multiple comorbidities.
The summed ‘score’ of all secondary diagnoses from the values assigned to the CC list
determine the HRG derived.
Complications and Comorbidity lists updated
A new CC list has been created specific to this subchapter. In line with interactive CC logic,
all major CCs have been assigned a value of two and all other CCs have a value of one.
Page 83 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
PF – Paediatric Gastroenterology Disorders
P – Diseases of Childhood and Neonates
Scope and Composition
Composition and Concepts
Subchapter PF covers
gastrointestinal disorders for patients
aged 18 years and under. It does not
include hepatobiliary or pancreatic
disorders which can be found in
subchapter PG Paediatric
Hepatobiliary Disorders. It also
does not include critical care services
which are covered in unbundled
subchapters XA Neonatal Critical
Care and XB Paediatric Critical
Care. It includes activity undertaken
in inpatient and day case settings
E16/17
LP
15/16
P14/15
Total HRGs
17
N/A
N/A
Total HRG Roots
5
N/A
N/A
Procedure-driven HRGs
0
N/A
N/A
Diagnosis-driven HRGs
17
N/A
N/A
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
The HRGs for paediatric medicine have been expanded into 17 new subchapters based
largely on the body systems recognised by the current adult subchapters.
This subchapter specific to paediatric gastroenterology disorders enables better
differentiation of the care and treatment of children admitted to hospital, as well as improving
the way that their complications and comorbidities (CCs) are acknowledged by the HRG
design with a new subchapter-specific CC list.
Interactive CC splits have been employed within all HRG roots in this subchapter to more
appropriately reflect the additional resource usage for patients with multiple comorbidities.
The summed ‘score’ of all secondary diagnoses from the values assigned to the CC list
determine the HRG derived.
Complications and Comorbidity lists updated
A new CC list has been created specific to this subchapter. In line with interactive CC logic,
all major CCs have been assigned a value of two and all other CCs have a value of one.
Page 84 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
PG – Paediatric Hepatobiliary Disorders
P – Diseases of Childhood and Neonates
Scope and Composition
Composition and Concepts
Subchapter PG covers hepatobiliary
and pancreatic disorders for patients
aged 18 years and under. It does not
include other gastrointestinal
disorders which can be found in
subchapter PF Paediatric
Gastroenterology Disorders. It also
does not include critical care services
which are covered in unbundled
subchapters XA Neonatal Critical
Care and XB Paediatric Critical
Care. It includes activity undertaken
in inpatient and day case settings.
E16/17
LP
15/16
P14/15
Total HRGs
3
N/A
N/A
Total HRG Roots
1
N/A
N/A
Procedure-driven HRGs
0
N/A
N/A
Diagnosis-driven HRGs
3
N/A
N/A
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
The HRGs for paediatric medicine have been expanded into 17 new subchapters based
largely on the body systems recognised by the current adult subchapters.
This subchapter specific to paediatric hepatobiliary disorders enables better differentiation of
the care and treatment of children admitted to hospital, as well as improving the way that
their complications and comorbidities (CCs) are acknowledged by the HRG design with a
new subchapter-specific CC list.
Interactive CC splits have been employed within the one HRG root in this subchapter to
more appropriately reflect the additional resource usage for patients with multiple
comorbidities. The summed ‘score’ of all secondary diagnoses from the values assigned to
the CC list determine the HRG derived.
Complications and Comorbidity lists updated
A new CC list has been created specific to this subchapter. In line with interactive CC logic,
all major CCs have been assigned a value of two and all other CCs have a value of one.
Page 85 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
PH – Paediatric Rheumatology Disorders
P – Diseases of Childhood and Neonates
Scope and Composition
Composition and Concepts
Subchapter PH covers
musculoskeletal and rheumatology
disorders for patients aged 18 years
and under. It does not include critical
care services which are covered in
unbundled subchapters XA Neonatal
Critical Care and XB Paediatric
Critical Care. It includes activity
undertaken in inpatient and day case
settings.
E16/17
LP
15/16
P14/15
Total HRGs
4
N/A
N/A
Total HRG Roots
1
N/A
N/A
Procedure-driven HRGs
0
N/A
N/A
Diagnosis-driven HRGs
4
N/A
N/A
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
The HRGs for paediatric medicine have been expanded into 17 new subchapters based
largely on the body systems recognised by the current adult subchapters.
This subchapter specific to musculoskeletal and rheumatology disorders enables better
differentiation of the care and treatment of children admitted to hospital, as well as improving
the way that their complications and comorbidities (CCs) are acknowledged by the HRG
design with a new subchapter-specific CC list.
Interactive CC splits have been employed within the one HRG root in this subchapter to
more appropriately reflect the additional resource usage for patients with multiple
comorbidities. The summed ‘score’ of all secondary diagnoses from the values assigned to
the CC list determine the HRG derived.
Complications and Comorbidity lists updated
A new CC list has been created specific to this subchapter. In line with interactive CC logic,
all major CCs have been assigned a value of two and all other CCs have a value of one.
Page 86 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
PJ – Paediatric Dermatology Disorders
P – Diseases of Childhood and Neonates
Scope and Composition
Composition and Concepts
Subchapter PJ covers skin disorders
for patients aged 18 years and under.
It does not include critical care
services which are covered in
unbundled subchapters XA Neonatal
Critical Care and XB Paediatric
Critical Care. It includes activity
undertaken in inpatient and day case
settings.
E16/17
LP
15/16
P14/15
Total HRGs
7
N/A
N/A
Total HRG Roots
2
N/A
N/A
Procedure-driven HRGs
0
N/A
N/A
Diagnosis-driven HRGs
7
N/A
N/A
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
The HRGs for paediatric medicine have been expanded into 17 new subchapters based
largely on the body systems recognised by the current adult subchapters.
This subchapter specific to skin disorders enables better differentiation of the care and
treatment of children admitted to hospital, as well as improving the way that their
complications and comorbidities (CCs) are acknowledged by the HRG design with a new
subchapter-specific CC list.
Interactive CC splits have been employed within both HRG roots in this subchapter to more
appropriately reflect the additional resource usage for patients with multiple comorbidities.
The summed ‘score’ of all secondary diagnoses from the values assigned to the CC list
determine the HRG derived.
Complications and Comorbidity lists updated
A new CC list has been created specific to this subchapter. In line with interactive CC logic,
all major CCs have been assigned a value of two and all other CCs have a value of one.
Page 87 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
PK – Paediatric Diabetology, Endocrinology and Metabolic
Disorders
P – Diseases of Childhood and Neonates
Composition and Concepts
E16/17
LP
15/16
P14/15
Total HRGs
11
N/A
N/A
Total HRG Roots
4
N/A
N/A
Procedure-driven HRGs
0
N/A
N/A
Diagnosis-driven HRGs
11
N/A
N/A
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
Scope and Composition
Subchapter PK covers diabetes,
endocrine and metabolic disorders for
patients aged 18 years and under. It
does not include critical care services
which are covered in unbundled
subchapters XA Neonatal Critical
Care and XB Paediatric Critical
Care. It includes activity undertaken
in inpatient and day case settings.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
The HRGs for paediatric medicine have been expanded into 17 new subchapters based
largely on the body systems recognised by the current adult subchapters.
This subchapter specific to diabetes, endocrine and metabolic disorders enables better
differentiation of the care and treatment of children admitted to hospital, as well as improving
the way that their complications and comorbidities (CCs) are acknowledged by the HRG
design with a new subchapter-specific CC list.
Interactive CC splits have been employed within all the HRG roots in this subchapter to more
appropriately reflect the additional resource usage for patients with multiple comorbidities.
The summed ‘score’ of all secondary diagnoses from the values assigned to the CC list
determine the HRG derived.
Complications and Comorbidity lists updated
A new CC list has been created specific to this subchapter. In line with interactive CC logic,
all major CCs have been assigned a value of two and all other CCs have a value of one.
Page 88 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
PL – Paediatric Renal Disorders
P – Diseases of Childhood and Neonates
Scope and Composition
Composition and Concepts
Subchapter PL covers renal and
urological disorders for patients aged
18 years and under. It does not
include critical care services which
are covered in unbundled
subchapters XA Neonatal Critical
Care and XB Paediatric Critical
Care. It includes activity undertaken
in inpatient and day case settings.
E16/17
LP
15/16
P14/15
Total HRGs
10
N/A
N/A
Total HRG Roots
3
N/A
N/A
Procedure-driven HRGs
0
N/A
N/A
Diagnosis-driven HRGs
10
N/A
N/A
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
The HRGs for paediatric medicine have been expanded into 17 new subchapters based
largely on the body systems recognised by the current adult subchapters.
This subchapter specific to renal and urological disorders enables better differentiation of the
care and treatment of children admitted to hospital, as well as improving the way that their
complications and comorbidities (CCs) are acknowledged by the HRG design with a new
subchapter-specific CC list.
Interactive CC splits have been employed within all the HRG roots in this subchapter to more
appropriately reflect the additional resource usage for patients with multiple comorbidities.
The summed ‘score’ of all secondary diagnoses from the values assigned to the CC list
determine the HRG derived.
Complications and Comorbidity lists updated
A new CC list has been created specific to this subchapter. In line with interactive CC logic,
all major CCs have been assigned a value of two and all other CCs have a value of one.
Page 89 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
PM – Paediatric Haematological-Oncology Disorders
P – Diseases of Childhood and Neonates
Scope and Composition
Composition and Concepts
Subchapter PM covers malignant
disorders for patients aged 18 years
and under. It does not include critical
care services which are covered in
unbundled subchapters XA Neonatal
Critical Care and XB Paediatric
Critical Care. It includes activity
undertaken in inpatient and day case
settings.
E16/17
LP
15/16
P14/15
Total HRGs
14
N/A
N/A
Total HRG Roots
6
N/A
N/A
Procedure-driven HRGs
0
N/A
N/A
Diagnosis-driven HRGs
14
N/A
N/A
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
The HRGs for paediatric medicine have been expanded into 17 new subchapters based
largely on the body systems recognised by the current adult subchapters.
This subchapter specific to malignant disorders enables better differentiation of the care and
treatment of children admitted to hospital, as well as improving the way that their
complications and comorbidities (CCs) are acknowledged by the HRG design with a new
subchapter-specific CC list.
Interactive CC splits have been employed within the majority of HRG roots in this subchapter
to more appropriately reflect the additional resource usage for patients with multiple
comorbidities. The summed ‘score’ of all secondary diagnoses from the values assigned to
the CC list determine the HRG derived.
The two HRGs that do not employ interactive CC logic within this subchapter relate to the
care of paediatric patients with Other Haematological Malignancies with a length of stay of
one day or more, and short stay care for paediatric patients with Neoplasm Diagnoses.
Complications and Comorbidity lists updated
A new CC list has been created specific to this subchapter. In line with interactive CC logic,
all major CCs have been assigned a value of two and all other CCs have a value of one.
Page 90 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
PN – Paediatric Non-Malignant Haematological Disorders
P – Diseases of Childhood and Neonates
Scope and Composition
Composition and Concepts
Subchapter PN covers non-malignant
haematological disorders for patients
aged 18 years and under. It does not
include critical care services which
are covered in unbundled
subchapters XA Neonatal Critical
Care and XB Paediatric Critical
Care. It includes activity undertaken
in inpatient and day case settings.
E16/17
LP
15/16
P14/15
Total HRGs
9
N/A
N/A
Total HRG Roots
4
N/A
N/A
N/A
N/A
N/A
N/A
Procedure-driven HRGs
Diagnosis-driven HRGs
9
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
The HRGs for paediatric medicine have been expanded into 17 new subchapters based
largely on the body systems recognised by the current adult subchapters.
This subchapter specific to non-malignant haematological disorders enables better
differentiation of the care and treatment of children admitted to hospital, as well as improving
the way that their complications and comorbidities (CCs) are acknowledged by the HRG
design with a new subchapter-specific CC list.
Interactive CC splits have been employed within all of the HRG roots in this subchapter to
more appropriately reflect the additional resource usage for patients with multiple
comorbidities. The summed ‘score’ of all secondary diagnoses from the values assigned to
the CC list determine the HRG derived.
Complications and Comorbidity lists updated
A new CC list has been created specific to this subchapter. In line with interactive CC logic,
all major CCs have been assigned a value of two and all other CCs have a value of one.
Page 91 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
PP – Paediatric Ophthalmic Disorders
P – Diseases of Childhood and Neonates
Scope and Composition
Composition and Concepts
Subchapter PP covers eye disorders
for patients aged 18 years and under.
It does not include critical care
services which are covered in
unbundled subchapters XA Neonatal
Critical Care and XB Paediatric
Critical Care. It includes activity
undertaken in inpatient and day case
settings.
E16/17
LP
15/16
P14/15
Total HRGs
2
N/A
N/A
Total HRG Roots
1
N/A
N/A
Procedure-driven HRGs
0
N/A
N/A
Diagnosis-driven HRGs
2
N/A
N/A
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
The HRGs for paediatric medicine have been expanded into 17 new subchapters based
largely on the body systems recognised by the current adult subchapters.
This subchapter specific to eye disorders enables better differentiation of the care and
treatment of children admitted to hospital, as well as improving the way that their
complications and comorbidities (CCs) are acknowledged by the HRG design with a new
subchapter-specific CC list.
Interactive CC splits have been employed within the one HRG root in this subchapter to
more appropriately reflect the additional resource usage for patients with multiple
comorbidities. The summed ‘score’ of all secondary diagnoses from the values assigned to
the CC list determine the HRG derived.
Complications and Comorbidity lists updated
A new CC list has been created specific to this subchapter. In line with interactive CC logic,
all major CCs have been assigned a value of two and all other CCs have a value of one.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
PR – Paediatric Neurosciences Disorders
P – Diseases of Childhood and Neonates
Scope and Composition
Composition and Concepts
Subchapter PR covers neurological
disorders for patients aged 18 years
and under. It does not include critical
care services which are covered in
unbundled subchapters XA Neonatal
Critical Care and XB Paediatric
Critical Care. It includes activity
undertaken in inpatient and day case
settings.
E16/17
LP
15/16
P14/15
Total HRGs
22
N/A
N/A
Total HRG Roots
7
N/A
N/A
Procedure-driven HRGs
0
N/A
N/A
Diagnosis-driven HRGs
22
N/A
N/A
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
The HRGs for paediatric medicine have been expanded into 17 new subchapters based
largely on the body systems recognised by the current adult subchapters.
This subchapter specific to neurological disorders enables better differentiation of the care
and treatment of children admitted to hospital, as well as improving the way that their
complications and comorbidities (CCs) are acknowledged by the HRG design with a new
subchapter-specific CC list.
Interactive CC splits have been employed within all HRG roots in this subchapter to more
appropriately reflect the additional resource usage for patients with multiple comorbidities.
The summed ‘score’ of all secondary diagnoses from the values assigned to the CC list
determine the HRG derived.
Complications and Comorbidity lists updated
A new CC list has been created specific to this subchapter. In line with interactive CC logic,
all major CCs have been assigned a value of two and all other CCs have a value of one.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
PT – Mental Health Disorders
P – Diseases of Childhood and Neonates
Scope and Composition
Composition and Concepts
Subchapter PT covers some mental
health disorders for patients aged 18
years and under. It does not include
critical care services which are
covered in unbundled subchapters
XA Neonatal Critical Care and XB
Paediatric Critical Care. It includes
activity undertaken in inpatient and
day case settings.
E16/17
LP
15/16
P14/15
Total HRGs
4
N/A
N/A
Total HRG Roots
2
N/A
N/A
Procedure-driven HRGs
0
N/A
N/A
Diagnosis-driven HRGs
4
N/A
N/A
Age Splits
No
Complications and
Comorbidities Splits
Yes
Some paediatric activity for mental
Intervention Splits
No
health conditions continues to map to
subchapter WD Treatment of Mental Health Patients by Non-Mental Health Service
Providers.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
The HRGs for paediatric medicine have been expanded into 17 new subchapters based
largely on the body systems recognised by the current adult subchapters.
This subchapter specific to mental health disorders enables better differentiation of the care
and treatment of children admitted to hospital, as well as improving the way that their
complications and comorbidities (CCs) are acknowledged by the HRG design with a new
subchapter-specific CC list.
Interactive CC splits have been employed within both HRG roots in this subchapter to more
appropriately reflect the additional resource usage for patients with multiple comorbidities.
The summed ‘score’ of all secondary diagnoses from the values assigned to the CC list
determine the HRG derived.
Complications and Comorbidity lists updated
A new CC list has been created specific to this subchapter. In line with interactive CC logic,
all major CCs have been assigned a value of two and all other CCs have a value of one.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
PV – Paediatric Trauma Medicine
P – Diseases of Childhood and Neonates
Scope and Composition
Composition and Concepts
Subchapter PV covers nonintracranial injuries for patients aged
18 years and under. It does not
include critical care services which
are covered in unbundled
subchapters XA Neonatal Critical
Care and XB Paediatric Critical
Care. It includes activity undertaken
in inpatient and day case settings.
Intracranial injuries are covered
within subchapter PR Paediatric
Neurosciences Disorders.
E16/17
LP
15/16
P14/15
Total HRGs
7
N/A
N/A
Total HRG Roots
3
N/A
N/A
Procedure-driven HRGs
0
N/A
N/A
Diagnosis-driven HRGs
7
N/A
N/A
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
The treatment of children suffering Multiple Trauma is covered within subchapter VA
Multiple Trauma.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
The HRGs for paediatric medicine have been expanded into 17 new subchapters based
largely on the body systems recognised by the current adult subchapters.
This subchapter specific to non-intracranial injuries enables better differentiation of the care
and treatment of children admitted to hospital, as well as improving the way that their
complications and comorbidities (CCs) are acknowledged by the HRG design with a new
subchapter-specific CC list.
Interactive CC splits have been employed within all HRG roots in this subchapter to more
appropriately reflect the additional resource usage for patients with multiple comorbidities.
The summed ‘score’ of all secondary diagnoses from the values assigned to the CC list
determine the HRG derived.
Complications and Comorbidity lists updated
A new CC list has been created specific to this subchapter. In line with interactive CC logic,
all major CCs have been assigned a value of two and all other CCs have a value of one.
Page 95 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
PW – Paediatric Infectious Diseases
P – Diseases of Childhood and Neonates
Scope and Composition
Composition and Concepts
Subchapter PW covers infectious
diseases for patients aged 18 years
and under. It does not include critical
care services which are covered in
unbundled subchapters XA Neonatal
Critical Care and XB Paediatric
Critical Care. It includes activity
undertaken in inpatient and day case
settings.
E16/17
LP
15/16
P14/15
Total HRGs
18
N/A
N/A
Total HRG Roots
5
N/A
N/A
Procedure-driven HRGs
0
N/A
N/A
Diagnosis-driven HRGs
18
N/A
N/A
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
The HRGs for paediatric medicine have been expanded into 17 new subchapters based
largely on the body systems recognised by the current adult subchapters.
This subchapter specific to infectious diseases enables better differentiation of the care and
treatment of children admitted to hospital, as well as improving the way that their
complications and comorbidities (CCs) are acknowledged by the HRG design with a new
subchapter-specific CC list.
Interactive CC splits have been employed within all HRG roots in this subchapter to more
appropriately reflect the additional resource usage for patients with multiple comorbidities.
The summed ‘score’ of all secondary diagnoses from the values assigned to the CC list
determine the HRG derived.
Complications and Comorbidity lists updated
A new CC list has been created specific to this subchapter. In line with interactive CC logic,
all major CCs have been assigned a value of two and all other CCs have a value of one.
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PX – Paediatric Medicine
P – Diseases of Childhood and Neonates
Scope and Composition
Composition and Concepts
Subchapter PX covers paediatric
medicine conditions for patients aged
18 years and under that do not map
to any of the other paediatric
medicine subchapters. It does not
include critical care services which
are covered in unbundled
subchapters XA Neonatal Critical
Care and XB Paediatric Critical
Care. It includes activity undertaken
in inpatient and day case settings.
E16/17
LP
15/16
P14/15
Total HRGs
26
N/A
N/A
Total HRG Roots
11
N/A
N/A
Procedure-driven HRGs
0
N/A
N/A
Diagnosis-driven HRGs
26
N/A
N/A
Age Splits
No
Complications and
Comorbidities Splits
Yes
Intervention Splits
No
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
The HRGs for paediatric medicine have been expanded into 17 new subchapters based
largely on the body systems recognised by the current adult subchapters.
This subchapter specific to other paediatric medicine enables better differentiation of the
care and treatment of children admitted to hospital, as well as improving the way that their
complications and comorbidities (CCs) are acknowledged by the HRG design with a new
subchapter-specific CC list.
Interactive CC splits have been employed within the majority of HRG roots in this subchapter
to more appropriately reflect the additional resource usage for patients with multiple
comorbidities. The summed ‘score’ of all secondary diagnoses from the values assigned to
the CC list determine the HRG derived.
The three HRGs that do not employ interactive CC logic within this subchapter relate to the
care of paediatric patients for the purposes of Child Safeguarding (Welfare and Protection),
Convalescent or Other Relief Care, and Respite Care.
Complications and Comorbidity lists updated
A new CC list has been created specific to this subchapter. In line with interactive CC logic,
all major CCs have been assigned a value of two and all other CCs have a value of one.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
RA – Diagnostic Imaging Procedures
R – Radiology and Nuclear Medicine
Scope and Composition
Subchapter RA covers diagnostic imaging
for all ages, delivered in admitted or nonadmitted care settings.
Nuclear medicine can be found in
Subchapter RN Nuclear Medicine
Procedures. This subchapter has been
newly introduced in the HRG4+ 2016/17
Engagement design and did not exist in
the HRG4+ 2013/14 Reference Costs
design. The unbundled HRGs in this
subchapter relate to the examination type.
Composition and
Concepts
E
16/17
LP
15/16
P
14/15
Total HRGs
42
49
39
Total HRG Roots
32
39
39
Procedure-driven HRGs
42
49
39
Diagnosis-driven HRGs
0
0
0
Age Splits
Yes
Complications and
Comorbidities Splits
No
Intervention Splits
No
It comprises of:

Magnetic Resonance Imaging (MRI)

Computerised Tomography (CT)

DEXA Scans

Contrast Fluoroscopy

Diagnostic Ultrasound

Echocardiogram
Subchapter-specific grouping logic
Unbundled HRG grouping is the second stage of the grouping process, occurring once the
data have been validated. Subsequently, HRGs for Multiple Trauma, Burns and core HRGs
are produced. An unbundled HRG is generated for each separate scan undertaken.
The diagnostic imaging HRGs are driven by OPCS-4 codes and the majority have a direct
mapping to HRGs based on type of procedure e.g. MRI, CT scan.
Within the HRG grouper algorithm, computed tomography (CT), magnetic resonance
imaging (MRI), fluoroscopy and ultrasound scans are subject to pre-processing logic which
replaced the body site specific codes with a generic proxy code which is then used in the
grouping.
Further differentiation may also be applied based on subsidiary procedures recorded
alongside the diagnostic imaging procedure e.g. contrast type, number of body areas
scanned or duration of scan where clinically relevant to do so, in order to take into account
the additional expected resource usage of more extensive scans.
Certain HRGs also differentiate based on the age of the patient, for example five years and
under, between six and 18 years, and 19 years and over.
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HRG4+ Design Changes
New HRGs have been created
A new HRG RA69Z Complex Computerised Tomography Scan has been created and
introduced in the HRG4+ 2016/17 Engagement design which did not exist in the underlying
HRG4+ 2013/14 Reference Costs design, which contains both cardiac CT and CT
colonography, as these are both more complex forms of CT scan.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
RN – Nuclear Medicine Procedures
R – Diagnostic Imaging and Nuclear Medicine
Scope and Composition
Composition and Concepts
Subchapter RN covers both
diagnostic and therapeutic nuclear
medicine procedures for patients of
all ages, delivered in admitted or nonadmitted care settings.
The unbundled HRGs in this
subchapter relate to the type of test.
This subchapter comprises of:
E16/17
LP
15/16
P14/15
Total HRGs
68
N/A
N/A
Total HRG Roots
37
N/A
N/A
Procedure-driven HRGs
68
N/A
N/A
Diagnosis-driven HRGs
0
N/A
N/A
Age Splits
Yes
Complications and
Comorbidities Splits
No
Intervention Splits
No

Octreotide scans

Dopamine Transporter scans

Metaiodobenzylguanidine (MIBG) scans

Positron Emission Tomography with Computed Tomography (PET-CT)

Single Photon Emission Computed Tomography with Computed Tomography
(SPECT-CT)

Positron Emission Tomography (PET) (including myocardial)

Single Photon Emission Computed Tomography (SPECT)

Other diagnostic nuclear medicine scans
 Nuclear medicine therapy
Subchapter-specific grouping logic
Unbundled HRG grouping is the second stage of the grouping process, occurring once the
data have been validated. Subsequently, HRGs for Multiple Trauma, Burns and core HRGs
are produced. An unbundled HRG is generated for each separate scan undertaken.
The nuclear medicine HRGs are driven by OPCS-4 codes and the majority have a direct
mapping to HRGs based on type of procedure.
Certain HRGs also differentiate based on the age of the patient, for example five years and
under, between six and 18 years, and 19 years and over.
HRG4+ Design Changes
A new subchapter has been created
This new subchapter RN Nuclear Medicine Procedures has been created from activity
previously within subchapter RA Diagnostic Imaging Procedures, as introduced in the
HRG4+ 2014/15 Reference Costs design. This facilitates the creation of HRGs for nuclear
medicine that more closely align with current clinical practice. The HRGs, where possible,
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differentiate on radiopharmaceutical use; as such the new HRGs are procedure-specific
HRGs e.g. RN19Z Sentinel Lymph Node scan.
Changes made to logic
Specific logic is applied to the nuclear medicine therapy HRGs RN50Z Radiation
Synovectomy, RN51Z Oral Delivery of Radiotherapy for Thyroid Ablation and RN52Z
Delivery of Other Radionuclide Therapy to derive the core HRG SC97Z Same Day
Radiotherapy Admission or Attendance (excluding Brachytherapy), in addition to the
nuclear medicine therapy unbundled HRG, where there is no other significant procedure and
a length of stay of zero days.
Mapping of codes to more appropriately reflect resource
The OPCS-4 code X65.5 Oral delivery of radiotherapy for thyroid ablation that previously
mapped into HRG SC29Z Other Radiotherapy Treatment now maps to RN51Z Oral
Delivery of Radiotherapy for Thyroid Ablation to reflect the fact that this is nuclear
medicine therapy, and different from radiotherapy.
In addition a new combination code has been created for partial synovectomy with
introduction of radioactive substance into organ for brachytherapy, which has been mapped
to the procedure-specific HRG, RN50Z Radiation Synovectomy.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
SA –Haematological Procedures and Disorders
S – Haematology, Chemotherapy, Radiotherapy and Specialist Palliative Care
Scope and Composition
Composition and Concepts
Subchapter SA covers procedures for
all ages and adult diagnoses relating
to haematological conditions. It
includes activity undertaken in
inpatient, day case and non-admitted
care settings.
It comprises of:
E16/17
LP
15/16
P14/15
Total HRGs
96
56
56
Total HRG Roots
35
33
33
Procedure-driven HRGs
25
25
25
Diagnosis-driven HRGs
71
31
31
Age Splits
Yes

Bone marrow transplant and
related procedures
Complications and
Comorbidities Splits
Yes

Peripheral blood stem cell
transplant and related
procedures
Intervention Splits
No

Blood transfusions

Anaemia disorders

Coagulation defects and haemorrhagic conditions

Other non-malignant blood disorders

Malignant lymphoid, haematopoietic and related disorders
All diagnosis-driven activity relating to the treatment of children (aged 18 years and under)
groups to an HRG in Chapter P, Diseases of Childhood and Neonates, in line with the
requirements of the Casemix Design Framework.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A number of HRGs have been deleted and replaced by HRGs with interactive CC splits.
There are 70 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design.
To support the high-volume, distinctive disorder Agranulocytosis (including neutropenia),
ICD-10 code D70.X Agranulocytosis has been mapped to a new HRG SA35*
Agranulocytosis.
HRG SA01 has therefore been renamed to accommodate the mapping of D70.X. HRG
SA01 is now called Acquired Pure Red Cell Aplasia and Other Aplastic Anaemia.
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Following discussions with Clinicians on the Expert Working Group and with the
implementation of new Interactive Complications and comorbidities, HRG SA10 Sickle Cell
Anaemia has been replaced with two new HRGs, SA36* Sickle Cell with Crisis and SA37Z
Sickle Cell without Crisis.
Full details of all design changes can be found in the Code to Group Excel document that
accompanies this release.
Interactive Complications and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determines the HRG derived.
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to
CC lists. Diagnosis codes that should always indicate additional resource have been added
to all CC lists for consistency. To allow the interactive CC logic to be implemented, all major
CC lists have been deleted and all codes now appear on subchapter-specific CC lists. Major
CCs have a value of two and all other CCs have a value of one.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
SB – Chemotherapy
S – Haematology, Chemotherapy, Radiotherapy and Specialist Palliative Care
Scope and Composition
Composition and Concepts
Subchapter SB covers both the
Procurement and Delivery of
Chemotherapy Regimens for patients
of all ages. All but one of the HRGs in
this subchapter are unbundled, and
include activity undertaken in
inpatient, day case and non-admitted
care settings.
It comprises of:
E16/17
LP
15/16
P14/15
Total HRGs
18
18
18
Total HRG Roots
18
18
18
Procedure-driven HRGs
18
18
18
Diagnosis-driven HRGs
0
0
0
Age Splits
No
Complications and
Comorbidities Splits
No

Intervention Splits
No
Procurement of chemotherapy
drugs for regimens in cost
bands from Band 1 (lowest expected cost) to Band 10 (highest expected cost)

Delivery of chemotherapy
This subchapter includes one core HRG (SB97Z) that is driven by both procedure and
diagnosis logic for both inpatients and day cases and by procedure only for non-admitted
care patients.
Subchapter-specific grouping logic
Unbundled HRG grouping is the second stage of the grouping process, occurring once the
data have been validated. Subsequently, HRGs for Multiple Trauma, Burns and core HRGs
are produced.
There is specific logic required to derive the HRG root SB97 Same Day Chemotherapy
Admission or Attendance, which requires a delivery or procurement of chemotherapy
procedure code and no other significant procedures and a length of stay of zero days.
HRG4+ Design Changes
No changes have been made to this subchapter as part of the HRG4+ implementation.
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SB - Worked Examples
Case
Age
Length
of Stay
(days)
Primary Diagnosis
(ICD-10)
Secondary
Diagnoses
(ICD-10)
Dominant Procedure
(OPCS-4)
Other Procedures
(OPCS-4)
HRG4+
Case A illustrates the first inpatient treatment for a soft tissue sarcoma patient receives Doxorubicin and Ifosfamide and chemotherapy as an inpatient.
This consists of Doxorubicin treatment on day one, followed by 24 hours of Ifosfamide and Mesna continuous infusion. This is repeated every 21 days.
C49.9
A
45
1
Malignant
neoplasm:
Connective
and soft
tissue,
unspecified
X70.4
Procurement
of drugs for
chemotherapy
for neoplasm
for regimens in
Band 4
HD40H
+
SB04Z
Malignancy of Bone or
Connective Tissue, with CC
Score 0-1
+
Procure Chemotherapy Drugs
for Regimens in Band 4
Case B illustrates the first day case treatment a lymphoma patient is receiving ABVD chemotherapy. This consists of four drugs and is given every 14 days.
SB97Z Same Day Chemotherapy
C81.9
Hodgkin
X70.2
Procurement
X72.2
Delivery of
Admission or Attendance+
lymphoma,
of drugs for
complex
+
unspecified
chemotherapy
parenteral
SB02Z Procure Chemotherapy Drugs
for neoplasm
chemothera +
for Regimens in Band 2
B
45
0
for regimens in
py for
SB13Z +
Band 2
neoplasm at
Deliver more Complex
first
Parenteral Chemotherapy at
attendance
First Attendance
Case C and D illustrates the first two outpatient treatments of each cycle of treatment of a breast cancer patient is receiving Trastuzumab 7 loading dose followed by
Trastuzumab 7 maintenance dose on a weekly basis. This is repeated every seven days.
Do not use X72.4 Delivery of subsequent element of cycle of chemotherapy for neoplasm because the cycle length is seven days. These are classed as different cycles
because they are different regimens.
SB97Z
Same Day Chemotherapy
X70.5
Procurement
X72.1
Delivery of
Admission or Attendance+
of drugs for
complex
+
chemotherapy
chemothera SB05Z
Procure Chemotherapy Drugs
for neoplasm
py for
+
for Regimens in Band 5
for regimens in
neoplasm
SB14Z
+
st
C
1 attendance
Band 5
including
Deliver Complex
prolonged
Chemotherapy, including
infusional
Prolonged Infusional Treatment,
treatment
at First Attendance
at first
attendance
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Case
Age
Length
of Stay
(days)
Primary Diagnosis
(ICD-10)
Secondary
Diagnoses
(ICD-10)
Dominant Procedure
(OPCS-4)
Other Procedures
(OPCS-4)
HRG4+
SB97Z
Same day Chemotherapy
Delivery of
admission/attendance
complex
+
chemothera SB03Z
+
py for
+
Procure Chemotherapy Drugs
neoplasm
SB14Z
for Regimens in Band 3
nd
D
2 attendance
including
+
prolonged
Deliver Complex
infusional
Chemotherapy, including
treatment
Prolonged Infusional Treatment,
at first
at First Attendance
attendance
Case E illustrates the first inpatient treatment to receive BEP 5 day chemotherapy for a testicular solid tumour. The chemotherapy consists of three different drugs given
over three inpatient days and cases F and G illustrate the two consecutive outpatient treatments at seven day intervals. The whole cycle is repeated every 21 days.
LB35H Scrotum, Testis or Vas Deferens
C62.9
Malignant
X70.3
Procurement
Disorders, without Interventions,
neoplasm:
of drugs for
+
Testis,
chemotherapy
SB03Z with CC Score 0
E
45
3
unspecified
for neoplasm
+
for regimens
Procure Chemotherapy Drugs
Band 3
for Regimens in Band 3
SB97Z Same Day Chemotherapy
X72.4
Delivery of
Admission or Attendance+
subsequent
+
element of
SB15Z Deliver Subsequent Elements of
st
F
1 attendance
cycle of
a Chemotherapy Cycle
chemotherapy
for neoplasm
SB97Z Same Day Chemotherapy
X72.4
Delivery of
Admission or Attendance+
subsequent
+
element of
SB15Z Deliver Subsequent Elements of
nd
G
2 attendance
cycle of
a Chemotherapy Cycle
chemotherapy
for neoplasm
Case H illustrates the first outpatient treatment for a lung cancer patient who is receiving Carboplatin + Vinorelbine chemotherapy. This consists of one day of treatment
with Carboplatin and Vinorelbine both IV. Case I illustrates that this is followed seven days later by Vinorelbine therapy oral. The cycle is repeated every 21 days.
X70.3
Page 106 of 166
Procurement
of drugs for
chemotherapy
for neoplasm
for regimens in
Band 3
X72.1
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Case
H
I
Age
Length
of Stay
(days)
Primary Diagnosis
(ICD-10)
Secondary
Diagnoses
(ICD-10)
Dominant Procedure
(OPCS-4)
X70.4
Procurement
of drugs for
chemotherapy
for neoplasms
for regimens in
Band 4
X72.4
Delivery of
subsequent
element of
cycle of
chemotherapy
for neoplasm
st
1 attendance
2
nd
attendance
Page 107 of 166
Other Procedures
(OPCS-4)
X72.3
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Delivery of
simple
parenteral
chemothera
py for
neoplasm
first
attendance
HRG4+
SB97Z
+
SB04Z
+
SB12Z
SB97Z
+
SB15Z
Same Day Chemotherapy
Admission or Attendance+
Procure Chemotherapy Drugs
for Regimens in Band 4
+
Deliver Simple Parenteral
Chemotherapy at First
Attendance
Same Day Chemotherapy
Admission or Attendance
+
Deliver Subsequent Elements of
a Chemotherapy Cycle
HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
SC – Radiotherapy
S – Haematology, Chemotherapy, Radiotherapy and Specialist Palliative Care
Scope and Composition
Composition and Concepts
Subchapter SC covers both the
preparation and delivery of
radiotherapy for patients of all ages.
All the HRGs but one in this
subchapter are unbundled and
include activity undertaken in
inpatient, day case and non-admitted
care settings.
It comprises of:


Radiotherapy planning
Radiotherapy treatment (delivery
per fraction)
E16/17
LP
15/16
P14/15
Total HRGs
30
30
30
Total HRG Roots
30
30
30
Procedure-driven HRGs
30
30
30
Diagnosis-driven HRGs
0
0
0
Age Splits
No
Complications and
Comorbidities Splits
No
Intervention Splits
No
This subchapter includes one core HRG (SC97Z) that is driven by both procedure and
diagnosis logic for Admitted Patient Care and by procedure only for non-admitted care.
The planning HRGs are intended to cover all attendances required for completion of the
planning process. It is not intended that individual attendances for parts of this process will
be recorded separately.
The planning HRGs do not include the consultation at which the patient consents to
radiotherapy, nor do they cover any outpatient attendance for medical review required by
any change in status of the patient.
Subchapter-specific grouping logic
Unbundled HRG grouping is the second stage of the grouping process, occurring once the
data have been validated. Subsequently, HRGs for Multiple Trauma, Burns and core HRGs
are produced.
There is specific logic required to derive the HRG root SC97 Same Day Radiotherapy
Admission or Attendance (excluding Brachytherapy) which requires an external beam
radiotherapy delivery procedure code and no other significant procedures and a length of
stay of zero days.
HRG4+ Design Changes
No changes have been made to this subchapter as part of the HRG4+ implementation.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
SC – Worked Examples
Outpatient Example
Cases A to E illustrate the five fraction course of Total body irradiation (TBI) of a patient diagnosed as having Hodgkin’s lymphoma prior to a bone marrow
transplant. The TBI is planned and the first treatment is given immediately afterwards (same attendance):
Case
Attendance
Other Procedures
(OPCS-4)
X65.1 Delivery of a fraction of
total body irradiation
HRG4+
X65.1
Delivery of a fraction
of total body
irradiation
SC97Z
+
SC42Z
+
SC25Z
SC97Z
+
SC25Z
rd
X65.1
th
X65.1
th
X65.1
Delivery of a fraction
of total body
irradiation
Delivery of a fraction
of total body
irradiation
Delivery of a fraction
of total body
irradiation
SC97Z
+
SC25Z
SC97Z
+
SC25Z
SC97Z
+
SC25Z
st
A
1
attendance
B
2
attendance
C
3
attendance
D
4
attendance
E
5
attendance
nd
Page 109 of 166
Dominant Procedure
(OPCS-4)
X67.2 Preparation for total
body irradiation
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Same Day Radiotherapy Admission or Attendance
(excluding Brachytherapy)+
Preparation for Total Body Irradiation
+
Deliver a fraction of Total Body irradiation
Same Day Radiotherapy Admission or Attendance
(excluding Brachytherapy)
+
Deliver a fraction of Total Body irradiation
Same Day Radiotherapy Admission or Attendance
(excluding Brachytherapy)+
Deliver a fraction of Total Body irradiation
Same Day Radiotherapy Admission or Attendance
(excluding Brachytherapy)+
Deliver a fraction of Total Body irradiation
Same Day Radiotherapy Admission or Attendance
(excluding Brachytherapy)+
Deliver a fraction of Total Body irradiation
HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Inpatient Example
Length
Secondary
Primary Diagnosis
Dominant Procedure
Other Procedures
of Stay
Diagnoses
HRG4+
(ICD-10)
(OPCS-4)
(OPCS-4)
(days)
(ICD-10)
Case F highlights a patient is diagnosed with malignant neoplasm of breast and undergoes total mastectomy, followed by radiotherapy treatment delivered as part of the
inpatient episode:
Case
Age
C50.9
Malignant
neoplasm of
breast,
unspecified
B27.4
Total mastectomy
NEC
X67.4
+
X65.8
F
32
2
+
Y91.2
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Preparation for
simple
radiotherapy with
imaging and
dosimetry
+
Other specified
radiotherapy
delivery
+
Megavoltage
treatment for
simple
radiotherapy
JA20F
+
SC45Z
+
SC22Z
Unilateral Major
Breast Procedures
with CC Score 0-2
+
Preparation for
simple radiotherapy
with imaging and
dosimetry
+
Deliver a fraction of
treatment on a
megavoltage
machine
HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
SD – Specialist Palliative Care
S – Haematology, Chemotherapy, Radiotherapy and Specialist Palliative Care
Scope and Composition
Composition and Concepts
Subchapter SD relates to care in
which the clinical intent or treatment
goal is primarily quality of life for a
patient with an active, progressive
disease with little or no prospect of
cure in both adults and children.
E16/17
LP
15/16
P14/15
Total HRGs
10
10
10
Total HRG Roots
5
5
5
Procedure-driven HRGs
N/A
N/A
N/A
Diagnosis-driven HRGs
N/A
N/A
N/A
Age Splits
No
Specialist Palliative Care (SPC) is
Complications and
usually evidenced by an
Comorbidities Splits
interdisciplinary assessment and/or
Intervention Splits
management of the physical,
psychological, emotional and spiritual
needs of the patient, and a grief and bereavement support
service for the patient and their carers/family.
No
No
SPC includes care provided under the principal clinical management of a Specialist Palliative
Care medicine consultant, either in a
In the table above, it can be seen that diagnoses do not drive the
HRGs. The main driver for these HRGs is a combination of
Palliative Care unit or in a designated
Treatment Function Codes and the Main Specialty Codes.
Palliative Care programme. It can be
However, it should be noted that diagnoses are used in the
delivered by NHS, voluntary sector
Subchapter-specific grouping logic, in conjunction with length of stay
and other accredited providers.
and age, when determining the HRG.
For further information of how this logic works, please refer to the
It comprises of:
Subchapter-specific grouping logic section of this document. For
 Specialist support services
information on data input and processing, please refer to the Grouper
delivered to inpatients
Reference Manual.
 Outpatients, day therapy assessments and interventions for inpatients and day cases
The services provided by palliative care specialists include:






Clinical consultancy/care
Personal care
Spiritual/emotional support/counselling
Home care/support
Education
Case management/care coordination
If an inpatient is not admitted under the care of a Specialist Palliative Medicine consultant but
is receiving support from a member of a Specialist Palliative Care Team, this is classed as
Specialist Palliative Care Support.
Specialist Palliative Care not covered in HRG4+:


General Palliative Care
Community Specialist Palliative Care
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0


Bereavement care as a separate HRG. However, some bereavement care costs are
expected to be included within the costs covered by other HRGs. Bereavement costs
which are to be included in HRG costs are detailed in the Service Level Agreements,
drafted by the National Partnership Group for Palliative Care
Patients admitted for Holiday Relief/Respite
Subchapter-specific grouping logic
Unbundled HRG grouping is the second stage of the grouping process, occurring once the
data have been validated. Subsequently, HRGs for Multiple Trauma, Burns and core HRGs
are produced.
For inpatient Specialist Palliative Care (not day cases), SPC HRGs are generated based on
duration of specialist palliative care (as identified by the Grouper Input Field SPCDAYS) to
ensure that the HRGs are rightly generated on a per diem basis. The grouper generates
these in addition to the core HRG.
For day case Specialist Palliative Care, a single SPC HRG will be generated plus a core
HRG.
For non-admitted care, HRGs have been defined for both medical and non-medical specialist
palliative care attendances. For non-admitted attendances, the grouper allocates an
appropriate SPC HRG, plus a core HRG, which may be a default core HRG from subchapter
WF Non-Admitted Care Consultations if no significant procedure has been recorded.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Specialised Palliative Care HRGs explained by setting
Inpatient SPC HRGs:
HRG
SD01A
Label
Inpatient Specialist
Palliative Care, 19
years and over
Definition
Age = 19 years and over
AND
Main Specialty Code = 315 (Palliative
Medicine)
AND
Treatment Function Code = 315
(Palliative Medicine)
AND
Length of Stay > 0 OR Discharge
Method = 4 (Patient Died)
AND
Secondary Diagnosis (ICD-10)= Z51.5
(Palliative Care)
AND NOT
Primary Diagnosis (ICD-10) = Z75.5
(Holiday Relief Care)
Inpatient Specialist
Palliative Care, 18
years and under
As above with:
Age = 18 years and under
SD02A
Inpatient Specialist
Palliative Care, Same
Day, 19 years and over
Age = 19 years and over
AND
Main Specialty Code = 315 (Palliative
Medicine)
AND
Treatment Function Code = 315
(Palliative Medicine)
AND
Length of Stay = 0
AND
Discharge Method ≠ 4 (Patient did not
die)
AND
Secondary Diagnosis (ICD-10)= Z51.5
Palliative care
AND NOT
Primary Diagnosis (ICD-10) = Z75.5
Holiday relief care
SD02B
Inpatient Specialist
Palliative Care, Same
Day, 18 years and
under
As above with:
Age = 18 years and under
Hospital Specialist
Palliative Care Support,
19 years and over
Age = 19 years and over
AND
Secondary Diagnosis (ICD-10)= Z51.5
Palliative care
AND NOT
Main Specialty Code = 315 (Palliative
Medicine)
SD01B
SD03A
Page 113 of 166
Notes
Adult inpatients under the care
of a Specialist Palliative
Medicine consultant,
excluding patients discharged
on the day of admission
(unless they die on the day of
admission), excluding patients
admitted for respite care.
Paediatric inpatients under the
care of a Specialist Palliative
Medicine consultant,
excluding patients discharged
on the day of admission
(unless they die on the day of
admission) excluding patients
admitted for respite care.
Adult inpatients not under the
care of a Specialist Palliative
Medicine consultant, but
receiving input from a
Specialist Palliative Care
specialist support service
Copyright © 2015, Health and Social Care Information Centre. All rights reserved.
HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
HRG
SD03B
Label
Hospital Specialist
Palliative Care Support,
18 years and under
Definition
Notes
As above with:
Age = 18 years and under
Paediatric inpatients not
under the care of a Specialist
Palliative Medicine
consultant, but receiving
input from a Specialist
Palliative Care specialist
support service.
Outpatient, Day Therapy Assessment and Intervention HRGs
HRG
Label
Definition
Age = 19 years and over
SD04A
Medical Specialist Palliative Care
Attendance, 19 years and over
SD04B
Medical Specialist Palliative Care
Attendance, 18 years and under
AND
Main Specialty Code = 315 (Palliative Medicine)
AND
Treatment Function Code = 315 (Palliative Medicine)
As above with:
Age = 18 years and under
Age = 19 years and over
SD05A
Non-Medical Specialist Palliative
Care Attendance, 19 years and
over
SD05B
Non-Medical Specialist Palliative
Care Attendance, 18 years and
under
AND
Main Specialty Code = 950 (Nursing Episode) OR 960 (Allied
Health Profession Episode)
AND
Treatment Function Code = 315 (Palliative Medicine)
As above with:
Age = 18 years and under
The Outpatient Attendance Commissioning Data set (CDS) can record contacts by Medical,
Nursing and Allied Health Professionals (AHPs), for example Physiotherapists, Speech and
Language Therapists, Occupational Therapists, Podiatrists, Dieticians and Clinical
Psychologists. Chaplains and Social Workers may also record contacts as AHPs.
HRG4+ Design Changes
No changes have been made to this subchapter as part of the HRG4+ implementation.
Page 114 of 166
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
SD - Worked Examples
Inpatient Example
Case
Age
Length
of Stay
(days)
Discharge
Method
Main
Specialty
Code
Treatment
Function
Code
Primary Diagnosis
(ICD-10)
Secondary
Diagnoses
(ICD-10)
Dominant
Procedure
(OPCS-4)
Other
Procedures
(OPCS-4)
HRG4+
Case A and B illustrates how the HRG root SD01 Inpatient Specialist Palliative Care are generated differentiating between adults and children in inpatients
under the care of a Specialist Palliative Medicine consultant:
A
B
45
15
3
4
1 – Patient
discharged
on clinical
advice or
with clinical
consent
315
(Palliative
Medicine)
1 – Patient
discharged
on clinical
advice or
with clinical
consent
315
(Palliative
Medicine)
315
(Palliative
Medicine)
C71.1
Malignant
neoplasm:
Frontal lobe
Z51.5
Palliative
Care
AA24H
+
SD01A*
3
315
(Palliative
Medicine)
C71.1
Malignant
neoplasm:
Frontal lobe
Z51.5
Palliative
Care
PM42B
+
SD01B*
4
Brain Tumours or
Cerebral Cysts, with
CC Score 0-1
+
Inpatient Specialist
Palliative Care 19
years and over
Paediatric Brain
Tumours with length of
stay 1 day or more,
with CC score 0
+
Inpatient Specialist
Palliative Care 18
years and under
Cases C and D illustrate the impact of discharge method on patients with a length of stay of zero. If discharge method is died as in Case C then the HRG
root SD01 Inpatient Specialist Palliative Care is derived:
C
D
45
45
0
1 – Patient
discharged
on clinical
advice or
with clinical
consent
315
(Palliative
Medicine)
4 – Patient
Died
315
(Palliative
Medicine)
315
(Palliative
Medicine)
C71.1
Malignant
neoplasm:
Frontal lobe
Z51.5
Palliative
Care
AA24H
+
SD02A
315
(Palliative
Medicine)
C71.1
Malignant
neoplasm:
Frontal lobe
Z51.5
Palliative
Care
AA24H
+
0
SD01A
Page 115 of 166
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Brain Tumours or
Cerebral Cysts, with
CC Score 0-1
+
Inpatient Specialist
Palliative Care Same
Day 19 years and over
Brain Tumours or
Cerebral Cysts, with
CC Score 0-1
+
Inpatient Specialist
Palliative Care 19
years and over
HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Case
Age
Length
of Stay
(days)
Discharge
Method
Main
Specialty
Code
Treatment
Function
Code
Primary Diagnosis
(ICD-10)
Secondary
Diagnoses
(ICD-10)
Dominant
Procedure
(OPCS-4)
Other
Procedures
(OPCS-4)
HRG4+
Case E and F illustrates how the HRG root SD03 Hospital Specialist Palliative Care Support are generated differentiating between adults and children in
inpatients not under the care of a Specialist Palliative Medicine consultant but receiving input from a Specialist Palliative Care specialist support service:
E
F
45
15
3
4
1 – Patient
discharged
on clinical
advice or
with clinical
consent
400
(Neurolog
y)
1 – Patient
discharged
on clinical
advice or
with clinical
consent
421
(Paediatric
Neurology
)
400
(Neurology)
C71.1
Malignant
neoplasm:
Frontal lobe
Z51.5
Palliative
Care
AA24H
+
SD03A*
3
421
(Paediatric
Neurology)
C71.1
Malignant
neoplasm:
Frontal lobe
Z51.5
Palliative
Care
PM42B
+
SD03B*
4
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Brain Tumours or
Cerebral Cysts, with
CC Score 0-1
+
Hospital Specialist
Palliative Care
Support 19 years and
over
Paediatric Brain
Tumours with length of
stay 1 day or more,
with CC score 0
+
Hospital Specialist
Palliative Care
Support 18 years and
under
HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Outpatient Example
Cases G to J illustrate the SPC HRGs that will be generated for non-admitted patient care where the TFC is 315 Palliative Medicine:
Age
Case
Attendance
G
First
attendance
H
Follow-up
attendance
I
First
attendance
J
Follow-up
attendance
Page 117 of 166
45
Main
Specialty
Code
Treatment
Function
Code
315 (Palliative
Medicine)
315 (Palliative
Medicine)
315 (Palliative
Medicine)
315 (Palliative
Medicine)
950 (Nursing
Episode)
315 (Palliative
Medicine)
(Allied Health
Profession
Episode)
315 (Palliative
Medicine)
Dominant Procedure
(OPCS-4)
A70.6
Other Procedures
(OPCS-4)
Acupuncture NEC
15
AB06Z
+
SD04A
WF01A
+
SD04B
15
45
HRG4+
X62.3
Assessment by
multidisciplinary team
NEC
Copyright © 2015, Health and Social Care Information Centre. All rights reserved.
WF02B
+
SD05A
WF01A
+
SD05B
Minor Pain Procedures
+
Medical Specialist Palliative Care
Attendance 19 years and over
Non-Admitted Face to Face
Attendance, Follow-Up
+
Medical Specialist Palliative Care
Attendance 18 years and under
Multiprofessional Non-Admitted Face
to Face Attendance, First
+
Non-Medical Specialist Palliative
Care Attendance 19 years and over
Non-Admitted Face to Face
Attendance, Follow-Up
+
Non-Medical Specialist Palliative
Care Attendance 18 years and under
HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
UZ – Undefined Groups
U – Undefined Groups
Scope and Composition
Composition and Concepts
Subchapter UZ relates to data not valid
for grouping. There is only one HRG;
UZ01Z Data invalid for grouping. The
aim is to help an organisation to identify
such issues and take action, e.g. to
understand whether clinical coding errors
are due to lack of information specificity
or unavailability at the time of the coding.
Subchapter UZ comprises ten underlying
U categories in HRG4+ that lead to the
assignment of HRG UZ01Z. These are:










E
16/17
LP
15/16
P
14/15
Total HRGs
1
1
1
Total HRG Roots
1
1
1
Procedure-driven HRGs
N/A
N/A
N/A
Diagnosis-driven HRGs
N/A
N/A
N/A
Age Splits
N/A
Complications and
Comorbidities Splits
N/A
Intervention Splits
N/A
UZ01 Invalid Primary Diagnosis
UZ02 Poorly Coded Primary Diagnosis
UZ03 Age Conflicting with Diagnosis
UZ04 Diagnosis conflicting with anatomical sites
UZ05 Invalid procedure for Casemix grouping purposes
UZ06 Poorly coded procedure for Casemix grouping purposes
UZ11 Neonatal Critical Care Error
UZ13 Adult Critical Care Error
UZ14 Renal (NRD) Error
UZ21 CCAC Inappropriate for NCC
Subchapter-specific grouping logic
The grouping software ensures that the data are complete, valid and within expected value
ranges. The software applies three stages of validation to the data during a processing run:
 Field content within record
 Cross validation of episodes within spell
 Grouping Logic (assignment of flag values)
Where the HRG4+ Grouper cannot assign a valid HRG, UZ01Z Data invalid for grouping is
returned in the output record signifying that the record is unclassified.
If there are errors in the input data these will be reported in the data quality report but
processing will not be halted. There can be more than one reason for non-assignment of an
HRG, so there may be more than one data quality message for each data row, all of which
need to be reviewed to identify the underlying problems.
UZ01 Invalid Primary Diagnosis
This error indicates that the primary diagnosis code, although a valid ICD-10 code, may not
be used as a primary diagnosis.
UZ02 Poorly Coded Primary Diagnosis
This error is generated where a diagnosis code exists and is valid as a primary diagnosis but
is too vague to determine resource use.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
UZ03 Diagnosis Conflicts with Age
This error indicates that a paediatric diagnosis has been recorded for an adult patient (age 19
years and over).
UZ04 Diagnosis Conflicts with Anatomical Site
This error indicates an invalid combination of diagnosis and anatomical site. This only applies
to specific musculoskeletal codes entered at ICD-10 5th digit level.
UZ05 Invalid procedure for Casemix grouping purposes
This error is reported if the OPCS-4 code with the highest procedure hierarchy in the record
is a valid OPCS-4 code but is not valid for grouping. For example, if the code represents an
anatomical site rather than a procedure.
UZ06 Poorly coded procedure for Casemix grouping purposes
This error indicates that a procedure code is valid as a dominant procedure but is
insufficiently specific to determine the resource use from an HRG design perspective. This
error is produced when one of the codes from the following list is identified as the dominant
procedure.
UZ11 Neonatal Critical Care Error
This is a general error for Neonatal Critical Care and is generated when conditions in the
grouping algorithm have not been met.
UZ13 ACC Grouping Error
This is a general error for Adult Critical Care and is generated when conditions in the
grouping algorithm have not been met.
UZ14 Renal (NRD) Error
This is a general error for grouping renal activity using the national renal dataset and is
generated when conditions in the grouping algorithm have not been met.
UZ21 CCAC Inappropriate in NCC
Certain Critical Care Activity Codes are not valid for Neonatal Critical Care grouping or are
valid only when used in combination with other codes. UZ21 is generated when the Critical
Care Activity Code or combination of codes in the input record is not appropriate for the
derivation of a Neonatal Critical Care HRG.
HRG4+ Design Changes
Error categories have been deleted
Error categories UZ12 and UZ22 have been removed as they have been rendered
unnecessary by the creation of the new HRG XB09Z Paediatric Critical Care, Enhanced
Care.
Further details of how Paediatric Critical Care HRGs can be generated may be found in the
Chapter Summary for Subchapter XB Paediatric Critical Care.
Changes to Error Category Labels
UZ05 Invalid procedure for Casemix grouping purposes and UZ06 Poorly coded
procedure for Casemix grouping purposes have been renamed to better describe the
content.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
VA – Multiple Trauma
V – Multiple Trauma, Emergency Medicine and Rehabilitation
Scope and Composition
Composition and Concepts
Subchapter VA covers high resource,
complex diagnoses and treatments
associated with multiple trauma cases
for patients of all ages, where multiple
trauma is determined by the presence
of significant simultaneous traumatic
injuries involving more than one body
area.
Traumatic single injuries are
addressed elsewhere within the
relevant subchapters.
E16/17
LP
15/16
P14/15
Total HRGs
24
24
24
Total HRG Roots
6
6
6
Procedure-driven HRGs
20
20
20
Diagnosis-driven HRGs
4
4
4
Age Splits
No
Complications and
Comorbidities Splits
No
Intervention Splits
No
It includes activity undertaken in inpatient and day case settings.
It comprises of HRGs in a matrix grid depending on resource usage based on diagnosis and
procedure scores.
Subchapter-specific grouping logic
This subchapter employs design concepts as identified in the composition table above,
further details of which can be found in sections 6 and 7 of the Casemix Companion. Details
of the concepts for each HRG can be found in the Reference Costs 2014/15 Design Matrix.
Following validation, multiple trauma grouping takes precedence over any other grouping
logic that might otherwise be applied across the episode or spell.



For single episode spells, where the episode HRG is multiple trauma, the HRG of the
spell will be the same multiple trauma HRG
A multiple trauma spell HRG will be generated where the HRG of the first episode of a
multi-episode spell is multiple trauma. The multiple trauma HRG of the first episode, that
of any later episode(s) and that of the spell may be different because of the additive
nature of the logic employed
For multi-episode spells where the first episode is not multiple trauma, but a later episode
is multiple trauma, the spell HRG will not be multiple trauma
All multiple trauma HRGs require at least two diagnosis codes (one primary) relating to more
than one body site. The trauma diagnoses are listed under nine body sites:







Page 120 of 166
Abdominal trauma diagnoses
Chest trauma diagnoses
Head trauma diagnoses
Kidney trauma diagnoses
Lower Limb trauma diagnoses
Other trauma diagnoses
Pelvis or Spine trauma diagnoses
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0


Upper Limb trauma diagnoses
Urinary trauma diagnoses
If a patient has trauma diagnoses for two or more body sites within an episode, this will
generate a multiple trauma HRG for that episode.
This subchapter employs grid logic, taking into account multiple procedures as well as
multiple diagnoses. This accurately reflects the complexity involved in treating patients that
have multiple traumatic injuries. Each procedure and diagnosis is allocated a score which
ranges from 3 to 25, these scores are then totalled and the HRG is defined based on the
scores. The following grid provides the scoring logic used and shows which HRG would be
produced. Worked examples of this logic can be found in the worked examples section
below.
HRG Derivation Grid:
Procedure score =>
Diagnoses score
0
1-8
9 - 18
19 - 29
30 - 44
>=45
<=23
VA10A
VA11A
VA12A
VA13A
VA14A
VA15A
24 - 32
VA10B
VA11B
VA12B
VA13B
VA14B
VA15B
33 - 50
VA10C
VA11C
VA12C
VA13C
VA14C
VA15C
>=51
VA10D
VA11D
VA12D
VA13D
VA14D
VA15D
HRG4+ Design Changes
Other lists have been updated
Minor updates have been added to the VA Multiple Trauma list for reasons of design
consistency with regard to updated primary classifications.
Full details of all design changes can be found in the Code to Group Excel document that
accompanies this release.
Page 121 of 166
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VB –Emergency Medicine
V – Multiple Trauma, Emergency Medicine and Rehabilitation
Scope and Composition
Composition and Concepts
Subchapter VB covers activity for
patients of all ages treated within
emergency departments including:

Type 01
Emergency Departments:
Consultant-led 24 hour service
with full resuscitation facilities and
designated accommodation for the
reception of accident and
emergency patients.

E16/17
LP
15/16
P14/15
Total HRGs
12
11
11
Total HRG Roots
12
11
11
Procedure-driven HRGs
N/A
N/A
N/A
Diagnosis-driven HRGs
N/A
N/A
N/A
Age Splits
No
Complications and
Comorbidities Splits
No
Intervention Splits
No
Type 02
Consultant-led mono-specialty accident and emergency service (e.g. ophthalmology,
dental) with designated accommodation for the reception of patients, with the exception of
Gynaecology casualty departments.

Type 03
Other types of units with designated accommodation for the reception of minor accident
and emergency patients, including other open access treatment services offering at least
minor injury/illness services, whether located alongside a main A&E department or at
another location.

Type 04
NHS Walk in Centres
The Emergency Medicine HRGs do not cover activity within clinical decision units and
observation type wards/units.
The subchapter comprises of HRGs split by a combination of investigation and treatment
categories.
Subchapter-specific grouping logic
In Subchapter VB, assignment depends on the investigations and treatments recorded within
the A&E Commissioning Dataset. The HRG assigned to each attendance depends on the
dominant investigation and dominant treatment.
Grouping for each attendance works as follows:
1. Each treatment and investigation on the attendance record has an associated
category. (See Appendix C for investigations and Appendix D for treatments).
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2. This category information determines the treatment and investigation combination
which results in the HRG generated.
Please note, for each patient record, the grouper will work out the HRG for every possible
investigation and treatment combination and assign the most resource intensive HRG.
Records with neither an investigation nor treatment code will generate the UZ01Z HRG.
When determining the category assigned to each investigation and treatment there are
certain exceptions where the category is one of two possible values. This is explained after
the tables within Appendices C and D.
The hierarchies presented in Appendices C and D can be used as an approximate guide to
help users understand which investigations and treatments are considered dominant and
used for HRG derivation.
HRG4+ Design Changes
New HRGs have been created
A new HRG VB99Z Emergency Medicine, Patient Dead On Arrival has been created
within this subchapter that was not in the HRG4+ 2013/14 Reference Costs design, for
patients that are dead on arrival (DOA).
This HRG is derived from a value of 70 brought in dead in the data item A&E Patient Group.
This HRG will be derived in preference to any other HRG within this subchapter, where the
relevant value is present.
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Appendix C – List of investigations (with category and approximate
hierarchy value) used in the A&E CDS and required for HRG4+ derivation
Investigation Code Label
Category (3 is
highest 1 is
lowest)
Approximate
Hierarchy
(7 is highest
1 is lowest)
01
X-ray plain film
2
6
02
Electrocardiogram
1
3
03
Haematology
2
6
04
Cross match blood/group and save serum for later cross
match
2
6
05
Biochemistry
1
5
06
Urinalysis
1
3
07
Bacteriology
2
6
08
Histology
2
6
10
Ultrasound
3
7
11
Magnetic Resonance Imaging
3
7
12
Computerised Tomography (excludes genito urinary contrast
examination/tomography)
3
7
13
Genito urinary contrast examination/tomography
3
7
14
Clotting studies
2
6
15
Immunology
2
6
16
Cardiac enzymes
2
6
17
Arterial/capillary blood gas
1
4
18
Toxicology
2
6
19
Blood culture
2
6
20
Serology
2
6
21
Pregnancy test
1
3
22
Dental investigation
2
2
23
Refraction, orthoptic tests and computerised visual fields
2
6
24
None*
1
1
99
Other
1
3
Investigation
Code
For investigations please note the following comments:
The hierarchies presented in Appendix 1 should only be used as an approximate guide to
working out which investigation is considered dominant and used for HRG derivation.
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* If the dominant investigation is “None” and the dominant treatment is from the following list
the HRG assigned will be VB11Z. Otherwise these treatments and investigations will be
considered as category 1.
Code
Treatment
12
Intravenous cannula
221
Guidance/advice only – written
222
Guidance/advice only – verbal
241
Tetanus – immune
99
None (consider guidance/advice option)
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Appendix D – List of treatments (with category and approximate hierarchy
value) used in the A&E CDS and required for HRG4+ derivation
Treatment Code Label
Category
(5 is highest
1 is lowest)
Approximate
Hierarchy
(8 is highest
1 is lowest)
011
Dressing minor wound/burn/eye
2
4
012
Dressing major wound/burn/eye
3
5
02
Bandage/support
1
3
031
Primary sutures
4
6
032
Secondary/complex suture
3
6
033
Removal of sutures/clips
1
3
041
Wound closure - steristrips
2
4
042
Wound closure - wound glue
2
4
043
Wound closure - other (e.g. clips)
2
4
051
Application Plaster of Paris
2
4
052
Removal Plaster of Paris
1
3
06
Splint
2
4
08
Removal foreign body
3
5
091
Physiotherapy - strapping, ultra sound treatment, short wave
diathermy, manipulation
2
4
092
Physiotherapy - gait re-education, falls prevention
2
4
101
Manipulation of upper limb fracture
4
7
102
Manipulation of lower limb fracture
4
7
103
Manipulation of dislocation
4
7
11
Incision & drainage
3
5
12
Intravenous cannula
1
2
13
Central line
3
5
14
Lavage/emesis/charcoal/eye irrigation
2
4
15
Intubation & Endotracheal tubes/laryngeal mask airways/rapid
sequence induction
4
7
16
Chest drain
4
7
17
Urinary catheter/suprapubic
3
6
181
Defibrillation
4
7
182
External pacing
4
7
19
Resuscitation/cardiopulmonary resuscitation
5
8
20
Minor surgery
3
5
21
Observation/electrocardiogram, pulse oximetry/head
injury/trends
1
3
221
Guidance/advice only - written
1
2
Treatment
Code
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Treatment Code Label
Category
(5 is highest
1 is lowest)
Approximate
Hierarchy
(8 is highest
1 is lowest)
222
Guidance/advice only - verbal
1
2
231
Anaesthesia - general anaesthetic
4
7
232
Anaesthesia - local anaesthetic
2
4
233
Anaesthesia - regional block
2
4
234
Anaesthesia - entonox
2
4
235
Anaesthesia - sedation
3
6
236
Anaesthesia - other
2
4
241
Tetanus - immune
1
2
242
Tetanus - tetanus toxoid course
2
4
243
Tetanus - tetanus toxoid booster
2
4
244
Tetanus - human immunoglobulin
2
4
245
Tetanus - combined tetanus/diphtheria course
2
4
246
Tetanus - combined tetanus/diphtheria booster
2
4
25
Nebuliser/spacer
3
5
27
Other (consider alternatives)
1
3
281
Parenteral thrombolysis - streptokinase parenteral thrombolysis
4
7
282
Parenteral thrombolysis - recombinant - plasminogen activator
5
8
291
Other Parenteral drugs - intravenous drug, e.g. stat/bolus
4
7
292
Other Parenteral drugs - intravenous infusion
4
7
30
Recording vital signs
1
3
31
Burns review
1
3
32
Recall/x-ray review
1
3
33
Fracture review
1
3
34
Wound cleaning
1
3
35
Dressing/wound review
1
3
36
Sling/collar cuff/broad arm sling
1
3
37
Epistaxis control
2
4
38
Nasal airway
2
4
39
Oral airway
2
4
40
Supplemental oxygen
3
5
41
Continuous positive airways pressure/nasal intermittent positive
pressure ventilation/bag valve mask
3
5
42
Arterial line
3
5
43
Infusion fluids
2
4
44
Blood product transfusion
4
7
Treatment
Code
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Treatment Code Label
Category
(5 is highest
1 is lowest)
Approximate
Hierarchy
(8 is highest
1 is lowest)
45
Pericardiocentesis
4
7
46
Lumbar puncture
4
7
47
Joint aspiration
3
5
48
Minor plastic procedure/split skin graft
4
7
49
Active rewarming of the hypothermic patient
3
5
50
Cooling - control body temperature
1
3
511
Medication administered - oral
2
4
512
Medication administered - intra-muscular
3
6
513
Medication administered - subcutaneous
3
5
514
Medication administered - per rectum
2
4
515
Medication administered - sublingual
3
6
516
Medication administered - intra-nasal
2
4
517
Medication administered - eye drops
1
3
518
Medication administered - ear drops
1
3
519
Medication administered - topical skin cream
1
3
521
Occupational Therapy - OT functional assessment
3
5
522
Occupational Therapy - OT activities of daily living equipment
provision
1
3
53
Loan of walking aid (crutches)
1
3
54
Social work intervention
3
5
551
Eye - orthoptic exercises
1
3
552
Eye - laser of retina/iris or posterior capsule
5
8
553
Eye - retrobulbar injection
3
5
554
Eye - epilation of lashes
3
5
555
Eye - subconjunctival injection
4
7
56
Dental treatment
2
2
57
Prescription\medicines prepared to take away
1
3
99
None (consider guidance/advice option)
0
1
Treatment
Code
For treatments please note the following comments:
The hierarchies presented in Appendix 2 should only be used as an approximate guide to
working out which treatment is considered dominant and used for HRG derivation.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
VC – Rehabilitation
V – Multiple Trauma, Emergency Medicine and Rehabilitation
Scope and Composition
Composition and Concepts
Subchapter VC covers all activities
relating to the assessment for and
delivery of rehabilitation for patients of
all ages. It includes activity
undertaken in inpatient, day case and
non-admitted care settings. It
comprises of:




E16/17
LP
15/16
P14/15
Total HRGs
23
23
23
Total HRG Roots
23
23
23
Procedure-driven HRGs
23
23
23
Diagnosis-driven HRGs
0
0
0
Age Splits
No
Assessment for rehabilitation
Complications and
No
Comorbidities Splits
Specific rehabilitation services
for both inpatients and
Intervention Splits
No
outpatients
Rehabilitation services delivered to adults, children and older people
Rehabilitation services delivered by the NHS and, potentially other accredited
providers
The Rehabilitation HRGs do not cover:


Rehabilitation within an acute care treatment episode
The identification of highly complex specialist rehabilitation
Subchapter-specific grouping logic
Unbundled HRG grouping is the second stage of the grouping process, occurring once the
data have been validated. Subsequently, HRGs for Multiple Trauma, Burns and core HRGs
are produced.
Rehabilitation HRGs are unbundled on a per diem basis for and are only generated where
care is identified as taking place under a specialist rehabilitation consultant or within a
discrete rehabilitation unit. They require the use of OPCS-4 codes U50.- – U54.- to generate
a rehabilitation HRG, plus duration of rehabilitative care (as identified by the Grouper Input
Field REHABILITATIONDAYS) to ensure that the HRGs are rightly generated on a per diem
basis. The grouper generates these in addition to the core HRG.
Rehabilitation assessment is identified by OPCS-4 code X60.-. A rehabilitation diagnosis
code is not required to generate any of the three (event-based rather than per diem-based)
rehabilitation assessment HRGs.
The grouper produces an unbundled rehabilitation HRG for each day of an episode that is
identified as being discrete rehabilitation and where that episode contains an appropriate
rehabilitation code. The per diem calculation is generated from the REHABILITATIONDAYS
field within the grouper input file.
HRG4+ Design Changes
No changes have been made to this subchapter as part of the HRG4+ implementation.
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WA – Immunology, Infectious Diseases, Poisoning, Shock,
Special Examinations, Screening and Other Healthcare
Contacts
W – Immunology, Infectious Diseases and other contacts with Health Services
Scope and Composition
Composition and Concepts
E16/17
Subchapter WA covers multi-systemic
Total HRGs
52
infectious diseases, immune system
disorders and various other
Total HRG Roots
23
healthcare activities, including
Procedure-driven HRGs
3
poisoning, toxic effects, special
examinations and screening. It also
Diagnosis-driven HRGs
49
includes lymphatic system procedures
Age Splits
No
on patients of all ages, genito-urinary
Complications and
medicine, procedures not carried out,
Yes
Comorbidities Splits
certain diagnoses related to donation
Intervention Splits
No
and certain diagnoses related to
procreative management. All other
diagnosis HRGs within this subchapter are for adult care activities only
LP
15/16
P14/15
55
56
23
23
3
3
52
52
It includes activity undertaken in inpatient, day case and non-admitted care settings.
It comprises:









Multi-systemic infectious diseases including HIV and GUM
Poisoning, toxic effects, shock and anaphylaxis
Immune disorders
Complications of procedures
Respite care
Neoplasm related admissions
Falls without specific causes
Admissions for unexplained symptoms and other examinations or counselling
Lymphatic system procedures
All diagnosis-driven activity, with the exception of some donation, procreative management
and genito-urinary medicine diagnoses, relating to the treatment of children (aged 18 years
and under) groups to an HRG in Chapter P, Diseases of Childhood and Neonates, in line with
the requirements of the Casemix Design Framework.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which can
be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have any
other specific grouping logic employed.
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HRG4+ Design Changes
New HRGs have been created and HRGs have been deleted
A number of HRGs have been deleted and replaced by HRGs with interactive CC splits.
There are 38 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design.
In particular, the CC splits have been removed from WA04* Acute Febrile Illness with
length of stay 4 days or less, WA05* Pyrexia of Unknown Origin with length of stay 5
days or more and WA15* Respite Care, as these were unnecessary due to the length of
stay qualification on these HRGs.
Full details of all design changes can be found in the Code to Group Excel document that
accompanies this release.
Intervention splits added to Diagnosis-driven HRGs
Intervention splits have been added to WA18* Admission for Unexplained Symptoms.
This reflects where, within a diagnosis-driven HRG, there are ‘minor interventions’ performed
which not only means that they include the cost/resources associated with these procedures,
but may indicate that the patient’s condition was more severe resulting in more resourceintensive treatment.
The ‘Interventions’ list is only utilised for procedures that map to a base HRG with a
maximum length of stay check.
Interactive Complications and Comorbidity splits added to HRGs
Standard CC splits in this subchapter have been replaced with new Interactive CC splits
based on summed scores, to more appropriately reflect the additional resource use expected
when treating patients with multiple comorbidities. The summed ‘score’ of all secondary
diagnoses from the values assigned to the CC list determines the HRG derived.
Complications and Comorbidity lists updated
CC lists have been reviewed to include amendments made as part of the ICD-10 4th Edition
updates. Any missing codes (e.g. codes within a three digit ICD-10 rubric where there is a .9
code denoting other or unspecified conditions already on the CC list) have been added to CC
lists. Diagnosis codes that should always indicate additional resource have been added to all
CC lists for consistency. To allow the interactive CC logic to be implemented, all major CC
lists have been deleted and all codes now appear on subchapter-specific CC lists. Major
CCs have a value of two and all other CCs have a value of one.
Mapping of codes to more appropriately reflect resource
ICD-10 code T85.6 Mechanical complication of other specified internal prosthetic
devices, implants and grafts has been mapped from HRG root JA13 Non-Malignant
Breast Disorders to WA12* Complications of Procedures to reflect that this diagnosis
specifically does not relate to breast implants.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
WD – Treatment of Mental Health Patients by Non-Mental
Health Service Providers
W – Immunology, Infectious Diseases and other contacts with Health Services
Scope and Composition
Composition and Concepts
Subchapter WD covers the treatment
of mental health patients by NHS
organisations that do not provide
specialist mental health services but
do provide treatment to patients with a
mental health primary diagnosis prior
to discharge or transfer to specialist
mental health providers.
E16/17
LP
15/16
P14/15
Total HRGs
3
3
3
Total HRG Roots
3
3
3
Procedure-driven HRGs
0
0
0
Diagnosis-driven HRGs
3
0
0
Age Splits
Yes
Complications and
No
Given the fact that mental health
Comorbidities Splits
services provided by specialist
Intervention Splits
No
providers are captured using the
mental health clustering classification, the HRGs within Subchapter WD effectively form
the residue of treatment of mental health patients by non-specialist mental health
service providers.
The HRGs are therefore not measures of Casemix. or intended to be iso-resource, but
merely complete the casemix classification whilst further development work is undertaken
to develop mental health currencies.
They include activity undertaken in inpatient, day case and non-admitted care settings.
This subchapter comprises:



WD11Z All patients 70 years and older with a Mental Health Primary Diagnosis,
treated by a Non-Specialist Mental Health Service Provider
WD22Z All patients between 19 and 69 years with a Mental Health Primary
Diagnosis, treated by a Non-Specialist Mental Health Service Provider
WD33Z All patients 18 years and younger with a Mental Health Primary
Diagnosis, treated by a Non-Specialist Mental Health Service Provider
Note that some treatments of patients younger than 19 years with a primary mental health
diagnosis are grouped to HRGs in Subchapter PT Paediatric Mental Health Disorders.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which can
be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have any
other specific grouping logic employed.
HRG4+ Design Changes
No changes have been made to this subchapter as part of the HRG4+ implementation.
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WF – Non-admitted Consultations
W – Immunology, Infectious Diseases and other contacts with Health Services
Scope and Composition
Composition and Concepts
Subchapter WF covers non-admitted
consultations including outpatients
and ward attenders, for patients of all
ages.
It comprises of:




E16/17
LP
15/16
P14/15
Total HRGs
8
8
8
Total HRG Roots
2
2
2
Procedure-driven HRGs
8
8
8
Diagnosis-driven HRGs
0
0
0
Uni-professional face to face
Age Splits
No
both first and follow-up
Complications and
No
attendances
Comorbidities Splits
Multi-professional face to face
Intervention Splits
No
both first and follow-up
attendances
Uni-professional non face to face both first and follow-up attendances
Multi-professional non face to face both first and follow-up attendances
Subchapter-specific grouping logic
Where significant procedures are coded in outpatient attendances, then the appropriate
procedure-driven HRG will be generated. For outpatients or ward attenders, a significant
procedure may not always be recorded. In these cases grouping is to Subchapter WF and is
based on the type of attendance (using the FIRST ATTENDANCE data item in the NHS Data
Model and Dictionary), modified by the presence of the following OPCS-4 codes:
 X62.2 Assessment by multi-professional team NEC
 X62.3 Assessment by multi-disciplinary team NEC
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The matrix below shows how the type of attendance and the presence of OPCS-4 codes for
uni-professional or multi-professional assessments drive the derivation of the HRGs in this
Subchapter:
* Attendance Type
1 First
Attendance
Face to Face
2 Follow-up
Attendance
Face to Face
3 First
Telephone or
Telemedicine
Consultation
4 Follow-up
Telephone or
Telemedicine
Consultation
None
** OPCS-4 Code
or
WF01B
WF01A
WF01D
WF01C
WF02B
WF02A
WF02D
WF02C
X62.1 Assessment by
uni-professional team NEC**
X62.2 Assessment by multiprofessional team NEC
or
X62.3 Assessment by multidisciplinary team NEC
*Attendance Type refers to the NHS Data Dictionary item FIRST ATTENDANCE.
**OPCS-4 code X62.1 Assessment by uni-professional team NEC does not influence
grouping; attendances are considered uni-professional unless OPCS-4 coding indicates
otherwise.
HRG4+ Design Changes
No changes have been made to this subchapter as part of the HRG4+ implementation.
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XA – Neonatal Critical Care
X – Critical Care and High Cost Drugs
Scope and Composition
Composition and Concepts
Subchapter XA includes unbundled
HRGs and covers Neonatal Critical
Care, including transportation
(retrieval). Other critical care services
are addressed in subchapters XC
Adult Critical Care and XB
Paediatric Critical Care.
E16/17
LP
15/16
P14/15
Total HRGs
6
6
6
Total HRG Roots
6
6
6
Procedure-driven HRGs
N/A
N/A
N/A
Diagnosis-driven HRGs
N/A
N/A
N/A
Age Splits
No
Complications and
It comprises of:
Comorbidities Splits
 Intensive Care
Intervention Splits
 High Dependency Care
 Special Care
 Normal Care
 Neonatal critical care transportation
No
No
Subchapter-specific grouping logic
Unbundled HRG grouping is the second stage of the grouping process, occurring once the
data have been validated. Subsequently, HRGs for Multiple Trauma, Burns and core HRGs
are produced.
Grouping is based primarily on data items from the Neonatal Critical Care dataset. In
addition, data items are required from the Admitted Patient Care dataset (Discharge Date
and Discharge Method). The main driver for grouping is Critical Care Activity Code.
Neonatal Critical Care HRGs are generated on a per diem basis; one HRG for each day the
baby receives critical care. The HRGs are unbundled, being generated in addition to the
HRGs for the associated Admitted Patient Care episode and spell.
The Neonatal Critical Care transportation HRG represents the transportation component of
the transfer, from one provider trust to another of a baby requiring neonatal care. It is derived
from the Admitted Patient Care dataset using Admission Method, Source of Admission,
Treatment Function Code and Neonatal Level of Care.
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All of the following criteria must be met in order to derive the transportation HRG:
Data Item
Value
Notes
Admission Method
81: Transfer of any admitted patient from other hospital
Hospital transfer
provider other than in an emergency (Data submitted using
CDS 6.1 or 6.2)
or
28: Other Means (includes transfer of an admitted patient
from another hospital provider in an emergency) (Data
submitted using CDS 6.1 only)
or
2B: Transfer of an admitted PATIENT from another Hospital
Provider in an emergency (Data submitted using CDS 6.2
only)
Source of Admission
52: NHS other hospital provider - ward for maternity patients Confirms the transfer is
or neonates
from another hospital
(Admission Method 28
or
includes other
87: Non NHS run hospital
locations)
Treatment Function
Code
422: Neonatology - Special Care, High Dependency and
Intensive Care
Neonatal Level of Care 3: Level 1 Intensive Care (Maximal Intensive Care)
or
2: Level 2 Intensive Care (High Dependency Intensive Care)
Please see the grouping algorithm flowchart shown in Appendix E for further information.
HRG4+ Design Changes
Other lists have been updated
From April 1st 2013, version 6.2 of the Comissioning Data Set (CDS) was released for
providers to submit Admitted Patient Care data via the Secondary Uses Service. This
updated version of the CDS contains changes to the valid codes that can be used to record
admission method.
As a result, code 28: Other Means (includes transfer of an admitted patient from another
hospital provider in an emergency) has been discontinued and replaced with four new
codes, which are to be used to record activity that would have been previously recorded to
code 28.
As this admission method field forms one of the criteria necessary for the generation of the
transportation HRG XA06Z Neonatal Critical Care, Transportation to facilitate those
providers now using CDS 6.2, the recording of code 2B (Transfer of an admitted PATIENT
from another Hospital Provider in an emergency) has been added to the list Admimeth
within the grouper and thus may also be used in the derivation of the HRG.
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Appendix E
Neonatal Critical Care HRG Derivation
CRITICAL CARE UNIT FUNCTION = 13
(NICU) or 14 (Neonatal Transitional Care
Ward) Or 15 (Maternity Ward)
No
HRG = UZ01Z
Not a neonatal period of care
Yes
ACTIVITY DATE (NEONATAL CRITICAL
CARE) - PERSON BIRTH DATE < 2
Yes
No
Yes
Gestation Length (At Delivery) < 29
weeks
HRG = XA01Z
Less than 29 weeks gestational age and less
than 48 hours old
HRG = XA01Z
A baby on the day of death
HRG = XA01Z
Receiving any respiratory support via a tracheal
tube and in the first 24 hours after its withdrawal
HRG = XA01Z
Receiving any respiratory support via a tracheal
tube and in the first 24 hours after its withdrawal
HRG = XA01Z
Below 1000g current weight and receiving
NCPAP for any part of the day and for 24 hours
after withdrawal
HRG = XA01Z
Below 1000g current weight and receiving
NCPAP for any part of the day and for 24 hours
after withdrawal
HRG = XA01Z
Receiving nCPAP for any part of the day and
less than five days old
HRG = XA01Z
Requiring surgery, for the pre-operative period
and post-operatively for 24 hours
HRG = XA01Z
Requiring surgery, for the pre-operative period
and post-operatively for 24 hours
No
ACTIVITY DATE (NEONATAL CRITICAL
CARE) = DISCHARGE DATE (HOSPITAL
PROVIDER SPELL)
Yes
DISCHARGE METHOD (HOSPITAL
PROVIDER SPELL) = 4 (Patient died)
Yes
No
Yes
No
No
CC ACTIVITY CODE (TODAY) = 01
(Respiratory support via a tracheal tube)
CRITICAL CARE UNIT
FUNCTION = 13 (NICU)
Yes
No
CC ACTIVITY CODE (YESTERDAY) = 01
(Respiratory support via a tracheal tube)
Yes
No
CC ACTIVITY CODE (TODAY) = 02 (nCPAP)
Yes
PERSON WEIGHT <1,000g
Yes
No
No
CC ACTIVITY CODE (YESTERDAY) = 02
(nCPAP)
Yes
No
Yes
PERSON WEIGHT (YESTERDAY) < 1,000g
No
CC ACTIVITY CODE (TODAY) = 02 (nCPAP)
Yes
No
ACTIVITY DATE (NEONATAL CRITICAL
CARE) MINUS PERSON BIRTH DATE < 5
days
Yes
No
CC ACTIVITY CODE (TODAY) = 03 (Surgery Yes
today)
No
CRITICAL CARE
UNIT FUNCTION = 13 (NICU)
Yes
No
CC ACTIVITY CODE (YESTERDAY) = 03
(Surgery today)
Yes
CRITICAL CARE
UNIT FUNCTION = 13 (NICU)
Grouper uses value from yesterday’s record
Yes
No
No
Key
CNN
C1
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C1
CC ACTIVITY CODE (TODAY) = 04 (Exchange
Transfusion)
Yes
HRG = XA01Z
Exchange transfusion
HRG = XA01Z
Peritoneal dialysis
HRG = XA01Z
Haemofiltration
HRG = XA01Z
Infusion of an inotrope, pulmonary vasodilator or
prostaglandin and for 24 hours afterwards
HRG = XA01Z
Infusion of an inotrope, pulmonary vasodilator or
prostaglandin and for 24 hours afterwards
HRG = XA02Z
Receiving NCPAP for any part of the day and
not fulfilling any of the criteria for intensive care
HRG = XA02Z
Below 1000g current weight and not fulfilling any
of the criteria for intensive care
HRG = XA02Z
Receiving parenteral nutrition
No
CC ACTIVITY CODE (TODAY) = 05 (Peritoneal
Dialysis)
Yes
No
CC ACTIVITY CODE (TODAY) = 16
(Haemofiltration)
Yes
No
CC ACTIVITY CODE (TODAY) = 06 (Continuous
infusion of inotrope, vasodilator or prostaglandin)
Yes
No
CC ACTIVITY CODE (YESTERDAY) = 06
(Continuous infusion of inotrope, pulmonary
vasodilator or prostaglandin)
Yes
No
Yes
CC ACTIVITY CODE (TODAY) = 02 (nCPAP)
No
Yes
PERSON WEIGHT <1,000g
No
CC ACTIVITY CODE (TODAY) = 07 (Parentral
Nutrition)
Yes
No
C2
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C2
Yes
CC ACTIVITY CODE (TODAY) = 08 (Convulsions)
HRG = XA02Z
Having convulsions
HRG = XA02Z
Requiring treatment for neonatal abstinence
syndrome
HRG = XA02Z
Care of an intra-arterial catheter or chest drain
HRG = XA02Z
Partial exchange transfusion
HRG = XA02Z
Tracheostomy care until supervised by a parent
HRG = XA02Z
Requiring frequent stimulation for severe
apnoea.
HRG = XA02Z
Receiving oxygen therapy and below 1500g
current weight
HRG = XA03Z
Receiving oxygen therapy and current weight
1500g or above
No
CC ACTIVITY CODE (TODAY) = 10 (neonatal
abstinence syndrome)
Yes
No
CC ACTIVITY CODE (TODAY) = 11 (Care of an
intra-arterial catheter or chest drain)
Yes
No
CC ACTIVITY CODE (TODAY) = 12 (Dilution
Exchange Transfusion)
Yes
No
CC ACTIVITY CODE (TODAY) = 13
(Tracheostomy supervised by nursing Staff)
Yes
No
CC ACTIVITY CODE (TODAY) = 15 (Recurrent
apnoea)
Yes
No
CC ACTIVITY CODE (TODAY) = 09 (Oxygen
Therapy)
No
Yes
PERSON WEIGHT <
1,500g
Yes
No
C3
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C3
CC ACTIVITY CODE (TODAY) = 22 (continuous
monitoring)
Yes
No
CC ACTIVITY CODE (TODAY) = 23 (intravenous
glucose and electrolyte solutions)
Yes
NOTE: The grouping algorithm assigns Levels of Care in the sequence XA01Z, XA02Z,
XA03Z, XA04Z, XA05Z i.e. most resource-intensive to least resource-intensive.
No
CC ACTIVITY CODE (TODAY) = 24 (tube-fed)
Yes
No
CC ACTIVITY CODE (TODAY) = 25 (barrier
nursed)
Yes
No
CC ACTIVITY CODE (TODAY) =
21 (Carer Resident)
CC ACTIVITY CODE (TODAY) = 26
(phototherapy)
Yes
HRG = XA04Z
Special care is provided for all other babies
who could not reasonably be expected to be
looked after at home by their mother – Mother
resident in unit/ward.
HRG = XA03Z
Special care is provided for all other babies
who could not reasonably be expected to be
looked after at home by their mother.
HRG = XA04Z
Tracheostomy care until supervised by an
external carer
HRG = XA05Z
Babies who themselves have no medical
indication to be in hospital. Note: Applies to
NICU Normal Care babies only
HRG = UZ01Z
Not a neonatal period of care
Yes
No
No
CC ACTIVITY CODE (TODAY) = 27 (special
monitoring)
Yes
No
CC ACTIVITY CODE (TODAY) = 28
(observations at regular intervals)
Yes
No
CC ACTIVITY CODE (TODAY) = 29 (intravenous
medication)
Yes
No
CC ACTIVITY CODE (TODAY) = 14
(tracheostomy supervised by external carer)
Yes
No
CC ACTIVITY CODE (TODAY) = 21 (Carer
Resident)
Yes
No
Page 140 of 166
Yes
No
CC ACTIVITY CODE (TODAY) = 99 (No Defined
CC Activity)
No
CRITICAL CARE UNIT
FUNCTION = 13 (NICU)
Yes
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
XB – Paediatric Critical Care
X – Critical Care and High Cost Drugs
Scope and Composition
Composition and Concepts
Subchapter XB includes unbundled
Total HRGs
HRGs and covers paediatric critical
care, including transportation
Total HRG Roots
(retrieval). Other critical care services
Procedure-driven HRGs
are addressed in subchapters XC
Adult Critical Care and XB
Diagnosis-driven HRGs
Paediatric Critical Care.
Age Splits
It comprises of:
Complications and
 Paediatric advanced critical
Comorbidities Splits
care (5 levels)
Intervention Splits
 Paediatric intermediate critic
care
 Paediatric basic critical care
 Paediatric enhanced care
 Paediatric critical care transportation
E16/17
LP
15/16
P14/15
9
8
8
9
8
8
N/A
N/A
N/A
N/A
N/A
N/A
No
No
No
Subchapter-specific grouping logic
Unbundled HRG grouping is the second stage of the grouping process, occurring once the
data have been validated. Subsequently, HRGs for Multiple Trauma, Burns and core HRGs
are produced.
Grouping is based primarily on data items from the Paediatric Critical Care dataset. In
addition, data items are required from the Admitted Patient Care dataset (Discharge Date,
Discharge Method and Diagnoses).
Paediatric Critical Care HRGs are generated on a daily basis; one HRG for each day the
child receives critical care. The HRGs are unbundled, being generated in addition to the
HRGs for the associated Admitted Patient Care episode and spell.
The Paediatric Critical Care transportation HRG is derived from the Admitted Patient Care
dataset.
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All of the following criteria must be met in order to derive the transportation HRG:
Data Item
Value
Notes
81: Transfer of any admitted patient from other hospital
provider other than in an emergency (Data submitted
using CDS 6.1 or 6.2)
or
Admission Method
28: Other Means (includes transfer of an admitted patient
from another hospital provider in an emergency) (Data
submitted using CDS 6.1 only)
Hospital transfer
or
2B: Transfer of an admitted PATIENT from another
Hospital Provider in an emergency (Data submitted using
CDS 6.2 only)
Source of Admission
51: NHS other hospital provider - ward for general
patients or the younger physically disabled or A&E
department
or
Confirms the transfer is
from another hospital
(Admission Method 28
includes other locations)
87: Non NHS run hospital
Treatment Function
Code of the first
episode in the spell
242: Paediatric Intensive Care - Only to be used by
designated Paediatric Intensive Care Units
HRG descriptions can be found on the HRG4+ Code to Group workbook ‘HRG’ sheet.
Please see the grouping algorithm flowchart shown in the Appendix F for further information.
HRG4+ Design Changes
A new HRG has been created
A new HRG XB09Z Enhanced Care has been created in order to represent the resources
involved in providing critical care to children where the critical care activity codes recorded do
not indicate high resource use. HRG XB09Z is derived when valid data do not match any of
the criteria in the grouping algorithm; such records previously grouped to HRG UZ01Z. The
logic for XB09Z is shown in the flowchart in the appendix. Note that UZ01Z is still derived
where validation rules are not met.
Changes made to logic
The logic which results in escalation to a higher resource HRG if a patient is looked after in a
cubicle has been removed on clinical advice, to reflect that this does not automatically
increase expected resource usage.
Mapping of codes to more appropriately reflect resource
The activity related to the following interventions, as recorded by Critical Care Activity Codes
(CCAC), has been mapped to more appropriately reflect expected resource use:
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

CCAC 58 Apnoea Requiring Intervention : mapped from XB07Z Paediatric Critical
Care, Basic Critical Care to XB06Z Paediatric Critical Care, Intermediate Critical
Care
CCAC 62 Central venous pressure monitoring, 55 Nasopharyngeal airway and 13
Tracheostomy Cared for by Nursing Staff : mapped from XB06Z Paediatric
Critical Care, Intermediate Critical Care to XB07Z Paediatric Critical Care, Basic
Critical Care
Other lists have been updated
From April 1st 2013, version 6.2 of the Comissioning Data Set (CDS) was released for
providers to submit Admitted Patient Care data via the Secondary Uses Service. This
updated version of the CDS contains changes to the valid codes that can be used to record
admission method. Code 28: Other Means (includes transfer of an admitted patient from
another hospital provider in an emergency) has been discontinued and replaced with four
new codes, which are to be used to record activity that would have been previously recorded
to code 28. As this admission method field forms one of the criteria necessary for the
generation of the transportation HRG XB08Z Paediatric Critical Care, Transportation to
facilitate those providers now using CDS 6.2, the recording of code 2B (Transfer of an
admitted PATIENT from another Hospital Provider in an emergency) has been added to
the list Admimeth within the grouper and thus may also be used in the derivation of the
HRG.
Changes to HRG Labels
All the non-transportation HRGs have been relabelled to more closely match the clinical
terminology currently in use within this service area.
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Appendix F
Paediatric Critical Care HRG Derivation
CRITICAL CARE UNIT FUNCTION = 04 (PICU) or 16 (Ward for children and young
people) or 17 (HDU for children and young people) or 18 (Renal Unit for children and
young people) or 19 (Burns Unit for children and young people) or 92 (non standard
location using the operating department for children and young people)
No
Data Invalid for Grouping
HRG = XB01Z
Paediatric Critical Care,
Advanced Critical Care 5
HRG = XB02Z
Paediatric Critical Care,
Advanced Critical Care 4
Not Paediatric Critical Care
Yes
CC ACTIVITY CODE = 65
(Extracorporeal membrane
oxygenation (ECMO) or Ventricular
Assist Device (VAD) or aortic balloon
pump)
HRG = UZ01Z
Yes
No
CC ACTIVITY CODE = 51 (Invasive
Ventilation via endotracheal tube)
Yes
No
CC ACTIVITY CODE = 52 (Invasive
Ventilation via Tracheostomy)
Yes
No
CC ACTIVITY CODE = 56 (Advanced Yes
ventilatory support (Jet or Oscillatory
ventilation))
PRIMARY DIAGNOSIS (ICD) Or
SECONDARY DIAGNOSIS (ICD)
=
T318 Burns involving 80-89% of body surface Or
T319 Burns involving 90% or more of body surface Or
T328 Corrosions involving 80-89% of body surface Or
T329 Corrosions involving 90% or more of body surface
Yes
No
No
Yes
CC ACTIVITY CODE = 63 (Bolus IV fluids (>80 ml/kg/day))
HRG = XB02Z
Paediatric Critical Care,
Advanced Critical Care 4
No
CC ACTIVITY CODE = 16 (Haemofiltration)
Yes
No
Yes
CC ACTIVITY CODE = 66 (Haemodialysis)
XB03Z / XB02Z (XB03Z + Isolation)
No
CC ACTIVITY CODE = 05 (Peritoneal dialysis)
Yes
No
C1
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C2
C3
CNN
Key
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C1
C2
C3
PRIMARY DIAGNOSIS (ICD) Or
SECONDARY DIAGNOSIS (ICD)
=
T315 Burns involving 50-59% of body surface
T316 Burns involving 60-69% of body surface
T317 Burns involving 70-79% of body surface
T325 Corrosions involving 50-59% of body surface
T326 Corrosions involving 60-69% of body surface
T327 Corrosions involving 70-79% of body surface
XB03Z / XB02Z (XB03Z + Isolation)
Yes
No
CC ACTIVITY CODE = (72 Extracorporeal Liver Support
using Molecular Absorbent Recirculating System
(MARS))
Yes
No
Yes
CC ACTIVITY CODE = (04 Exchange Transfusion)
No
Yes
OPCS = X84.1 (Nitric Oxide)
No
Yes
OPCS = X84.2 (Pulmonary Surfactant Drugs Band 1)
No
CC ACTIVITY CODE = 67 (Plasma Filtration or Plasma
Exchange)
No
CCAC = 74 Patient nursed in single
occupancy cubicle
+
PRIMARY DIAGNOSIS (ICD) Or
SECONDARY DIAGNOSIS (ICD)
= Z29.0 (Isolation)
Yes
HRG = XB02Z
Paediatric Critical Care,
Advanced Critical Care 4
HRG = XB02Z
Paediatric Critical Care,
Advanced Critical Care 4
HRG = XB03Z
Paediatric Critical Care,
Advanced Critical Care 3
Yes
No
CCAC = 74 Patient nursed in single
occupancy cubicle
+
ACTIVITY DATE (PAEDIATRIC CRITICAL
CARE) = DISCHARGE DATE (HOSPITAL
PROVIDER SPELL)
AND DISCHARGE METHOD (HOSPITAL
PROVIDER SPELL) = 4 (Patient died)
Yes
No
C4
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C4
C5
CC ACTIVITY CODE = 56 (Advanced
ventilatory support (Jet or Oscillatory
ventilation))
Yes
No
CC ACTIVITY CODE = 06
(Continuous Infusion of inotrope,
vasodilator or prostaglandin)
Yes
No
CC ACTIVITY CODE = 68 (ICPintracranial pressure monitoring)
Yes
XB04Z / XB03Z (XB04Z + Isolation)
No
PRIMARY DIAGNOSIS (ICD) Or
SECONDARY DIAGNOSIS (ICD)
=
T312 Burns involving 20-29% of body surface
T313 Burns involving 30-39% of body surface
T314 Burns involving 40-49% of body surface
T322 Corrosions involving 20-29% of body surface
T323 Corrosions involving 30-39% of body surface
T324 Corrosions involving 40-49% of body surface
Yes
No
CC ACTIVITY CODE = 71
(Intravenous thrombolysis)
Yes
No
CC ACTIVITY CODE = 64 (CardioPulmonary Resuscitation)
Yes
No
XB05Z / XB04Z (XB05Z + Isolation)
C6
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C6
C7
C8
CCAC = 74 (Patient nursed in single occupancy
cubicle)
+
PRIMARY DIAGNOSIS (ICD) Or
SECONDARY DIAGNOSIS (ICD)
=
Z29.0 (Isolation)
Yes
HRG = XB03Z
Paediatric Critical Care,
Advanced Critical Care 3
HRG = XB03Z
Paediatric Critical Care,
Advanced Critical Care 3
HRG = XB04Z
Paediatric Critical Care,
Advanced Critical Care 2
HRG = XB04Z
Paediatric Critical Care,
Advanced Critical Care 2
HRG = XB04Z
Paediatric Critical Care,
Advanced Critical Care 2
HRG = XB05Z
Paediatric Critical Care,
Advanced Critical Care 1
No
CCAC = 74 (Patient nursed in single occupancy
cubicle)
+
ACTIVITY DATE (PAEDIATRIC CRITICAL CARE) =
DISCHARGE DATE (HOSPITAL PROVIDER SPELL)
AND DISCHARGE METHOD (HOSPITAL
PROVIDER SPELL) = 4 (Patient died)
Yes
No
CCAC = 74 (Patient nursed in single occupancy
cubicle)
+
PRIMARY DIAGNOSIS (ICD) Or
SECONDARY DIAGNOSIS (ICD)
=
Z29.0 (Isolation)
Yes
No
CCAC = 74 (Patient nursed in single occupancy
cubicle)
+
ACTIVITY DATE (PAEDIATRIC CRITICAL CARE) =
DISCHARGE DATE (HOSPITAL PROVIDER SPELL)
AND DISCHARGE METHOD (HOSPITAL
PROVIDER SPELL) = 4 (Patient died)
Yes
No
C9
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C9
CC ACTIVITY CODE = 53 (Non-invasive
ventilatory support)
No
Yes
PRIMARY DIAGNOSIS (ICD) Or
SECONDARY DIAGNOSIS (ICD)
=
T318 Burns involving 80-89% of body surface Or
T319 Burns involving 90% or more of body surface Or
T328 Corrosions involving 80-89% of body surface Or
T329 Corrosions involving 90% or more of body surface
Yes
No
CC ACTIVITY CODE = 63 Bolus IV fluids (>80 ml/kg/day)
Yes
No
Yes
CC ACTIVITY CODE = 16 (Haemofiltration)
No
CC ACTIVITY CODE = 66 (Haemodialysis)
Yes
No
CC ACTIVITY CODE = 05 (Peritoneal dialysis)
Yes
XB05Z / XB04Z (XB05Z + Isolation)
No
PRIMARY DIAGNOSIS (ICD) Or
SECONDARY DIAGNOSIS (ICD)
=
T315 Burns involving 50-59% of body surface
T316 Burns involving 60-69% of body surface
T317 Burns involving 70-79% of body surface
T325 Corrosions involving 50-59% of body surface
T326 Corrosions involving 60-69% of body surface
T327 Corrosions involving 70-79% of body surface
Yes
No
CC ACTIVITY CODE = 72 (Extracorporeal Liver Support
using Molecular Absorbent Recirculating System (MARS))
Yes
No
Yes
CC ACTIVITY CODE = 04 (Exchange Transfusion)
No
C10
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C11
C12
OPCS = X84.1 (Nitric Oxide)
Yes
No
Yes
OPCS = X84.2 (Pulmonary Surfactant Drugs Band 1)
No
CC ACTIVITY CODE = 67 (Plasma Filtration or Plasma
Exchange)
Yes
No
CC ACTIVITY CODE = 06 (Continuous Infusion of
inotrope, vasodilator or prostaglandin)
Yes
XB05Z / XB04Z (XB05Z + Isolation)
No
CC ACTIVITY CODE = 68 (ICP-intracranial pressure
monitoring)
Yes
No
PRIMARY DIAGNOSIS (ICD) Or
SECONDARY DIAGNOSIS (ICD)
=
T312 Burns involving 20-29% of body surface
T313 Burns involving 30-39% of body surface
T314 Burns involving 40-49% of body surface
T322 Corrosions involving 20-29% of body surface
T323 Corrosions involving 30-39% of body surface
T324 Corrosions involving 40-49% of body surface
Yes
No
CC ACTIVITY CODE = 71 (Intravenous thrombolysis)
Yes
No
CC ACTIVITY CODE = 64 (Cardio-Pulmonary
Resuscitation)
No
C13
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C14
Yes
XB06Z
C15
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C13
C14
C15
CCAC = 74 Patient nursed in single occupancy
cubicle
+
PRIMARY DIAGNOSIS (ICD) Or
SECONDARY DIAGNOSIS (ICD)
=
Z29.0 (Isolation)
Yes
HRG = XB04Z
Paediatric Critical Care,
Advanced Critical Care 2
HRG = XB04Z
Paediatric Critical Care,
Advanced Critical Care 2
HRG = XB05Z
Paediatric Critical Care,
Advanced Critical Care 1
No
CC ACTIVITY CODE = 60 (Arterial line
monitoring)
CCAC = 74 Patient nursed in single occupancy
cubicle
+
ACTIVITY DATE (PAEDIATRIC CRITICAL
CARE) = DISCHARGE DATE (HOSPITAL
PROVIDER SPELL)
AND DISCHARGE METHOD (HOSPITAL
PROVIDER SPELL) = 4 (Patient died)
Yes
No
Yes
No
CC ACTIVITY CODE = 16
(Haemofiltration)
Yes
No
Yes
CC ACTIVITY CODE = 66 (Haemodialysis)
No
CC ACTIVITY CODE = 05 (Peritoneal
dialysis)
Yes
XB06Z
No
No
C16
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Yes
PRIMARY DIAGNOSIS (ICD) Or
SECONDARY DIAGNOSIS (ICD)
=
N170 Acute renal failure with tubular necrosis Or
N171 Acute renal failure with acute cortical necrosis Or
N172 Acute renal failure with medullary necrosis Or
N178 Other acute renal failure Or
N179 Acute renal failure unspecified Or
N990 Post procedural renal failure
C17
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
C16
CC ACTIVITY CODE = 67 (Plasma Filtration or
Plasma Exchange)
C17
Yes
No
CC ACTIVITY CODE = 04 (Exchange
Transfusion)
Yes
No
CC ACTIVITY CODE = 61 (External pacing)
Yes
No
CC ACTIVITY CODE = 06 (Continuous infusion of
inotrope, vasodilator or prostaglandin)
XB06Z
Yes
No
CC ACTIVITY CODE = 71 (Intravenous
thrombolysis)
Yes
No
CC ACTIVITY CODE = 68 (ICP-intracranial
pressure monitoring)
Yes
No
CC ACTIVITY CODE = 69 (Intraventricular
catheter or external ventricular drain)
Yes
No
CC ACTIVITY CODE = (64 Cardio-Pulmonary
Resuscitation)
Yes
No
C18
Page 151 of 166
C19
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
C18
C19
XB06Z
Yes
OPCS = X84.1 (Nitric Oxide)
No
Yes
OPCS = X84.2 (Pulmonary Surfactant Drugs
Band 1)
No
CC ACTIVITY CODE = 72 (Extracorporeal
Liver Support using Molecular Absorbent
Recirculating System (MARS))
Yes
No
Yes
CC ACTIVITY CODE = 63 (Bolus IV fluids
(>80 ml/kg/day))
No
Yes
CC ACTIVITY CODE = 62 (Central venous
pressure monitoring)
No
CC ACTIVITY CODE = 55
(Nasopharyngeal airway)
Yes
No
CC ACTIVITY CODE = 13 (Tracheostomy
Cared for by Nursing Staff)
No
Yes
Increment (+1)
Tracheostomy care
days count
Yes
Tracheostomy care
days count <= 7
Yes
(set to zero at start of
critical care period)
No
No
C20
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HRG = XB06Z
Paediatric Critical Care,
Intermediate Critical Care
HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Yes
C20
No
CC ACTIVITY CODE = 09 (Supplemental
oxygen therapy (Irrespective of ventilatory
state))
Yes
No
No
CC ACTIVITY CODE = 57 (Upper airway
obstruction requiring nebulised
epinephrine/adrenaline)
No
CC ACTIVITY CODE = 73 (Continuous
Pulse Oximetry)
Yes
CC ACTIVITY CODE = 50 (Continuous
ECG monitoring)
No
Yes
XB07Z
C21
Page 153 of 166
Yes
C22
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
C21
CC ACTIVITY CODE = 58 (Apnoea Requiring
Intervention)
CC ACTIVITY CODE = 59 Acute severe
asthma requiring intravenous
bronchodilator therapy or continuous
nebuliser
C22
Yes
XB07Z
Yes
HRG = XB07Z
No
CC ACTIVITY CODE = 70 (Diabetic
ketoacidosis (DKA) requiring continuous
infusion of insulin)
Paediatric Critical Care,
Basic Critical Care
Yes
No
HRG = XB09Z
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Paediatric Critical Care,
Enhanced Care
HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
XC – Adult Critical Care
X – Critical Care and High Cost Drugs
Scope and Composition
Composition and Concepts
Subchapter XC includes unbundled
HRGs and covers adult critical care.
Other critical care services are addressed
in subchapters XC Adult Critical Care
and XB Paediatric Critical Care.
It comprises of HRGs specific to the
numbers of organs that patients require to
be supported.
E
16/17
LP
15/16
P
14/15
Total HRGs
7
7
7
Total HRG Roots
7
7
7
Procedure-driven HRGs
N/A
N/A
N/A
Diagnosis-driven HRGs
N/A
N/A
N/A
Age Splits
No
Complications and
Comorbidities Splits
No
Intervention Splits
No
Subchapter-specific grouping logic
The Adult Critical Care HRGs are unbundled from the rest of the patient episode. The HRGs
are based on the data in the Adult Critical Care Minimum Data Set and differentiate on the
level of support required by the patient as evidenced by the number of organ systems
supported. Adult Critical Care HRGs are generated per Critical Care Period i.e. one HRG is
generated for each Critical Care Period and not a per-diem basis.
 In addition to the Critical Care Unit Function field, the following additional fields from
the Adult Critical Care MDS are used in the derivation of these HRGs, these are
related to the organ support groups: Critical Care Unit Function
 Advanced Respiratory Support Days
 Basic Respiratory Support Days
 Advanced Cardiovascular Support Days
 Basic Cardiovascular Support Days
 Renal Support Days
 Neurological Support Days
 Dermatological Support Days
 Liver Support Days
Gastro-intestinal support days do not contribute to the derivation of critical care HRGs, on
clinical advice. The expected cost of providing this support is subsumed within other organ
support groups. Note that the field ‘Organ Support Maximum’ is not used in grouping; the
number of organs systems supported is calculated based on the existence of support days
for each of the organ systems. In addition to the fields listed above, the grouper requires
Critical Care Start Date and Critical Care Discharge Date in the input data. These are used to
calculate critical care days in the grouper output file. They are not used in HRG derivation.
Please see the grouping algorithm flowchart shown in the Appendix G for further information.
HRG4+ Design Changes
No changes have been made to this subchapter as part of the HRG4+ implementation.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Appendix G
CCUF in
(4,16,17,18,19,92)
[PICU]
or in(13,14,15)
[NICU] ?
Adult Critical Care Algorithm
YES
HRG = UZ01Z
NO
NO
L2 + L3 days > 0 ?
YES
HRG = XC07Z
Organs supported count = 0
ARS days > 0 ?
YES
Increment (+1) organs
supported count
NO
NO (Organs supported count = 0)
Organs
supported count
=1?
YES
HRG = XC06Z
NO
ACS days > 0
OR BCS days > 0
OR BRS days > 0
?
YES
Increment (+1) organs
supported count
Organs
supported count
=2?
YES
HRG = XC05Z
NO
NO
ACS days > 0
AND
BRS days > 0 ?
YES
Increment (+1) organs
supported count
Organs
supported count
=3?
YES
HRG = XC04Z
NO
NO
RS days > 0 ?
NO
YES
Increment (+1) organs
supported count
Organs
supported count
=4?
YES
HRG = XC03Z
NO
NS days > 0 ?
YES
Increment (+1) organs
supported count
Organs
supported count
=5?
YES
HRG = XC02Z
NO
NO
DS days > 0 ?
NO
LS days > 0 ?
NO
Page 156 of 166
YES
Organs
supported count
>= 6 ?
YES
HRG = XC01Z
Increment (+1) organs
supported count
Key
CCUF: Critical Care Unit Function
PICU: Paediatric Intensive Care Unit
NICU: Neonatal Intensive Care Unit
YES
ACS: Advanced Cardiovascular Support
NS: Neurological Support
BRS: Basic Respiratory Support
Increment (+1) organs
DS: Dermatological Support
supported count
ARS: Advanced Respiratory Support
RS: Renal Support
BCS: Basic Cardiovascular Support
LS: Liver
Support
Copyright © 2015, Health and Social Care Information
Centre.
All rights reserved.
HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
XD – High Cost Drugs
X – Critical Care and High Cost Drugs
Scope and Composition
Composition and Concepts
Subchapter XD includes unbundled
HRGs and covers a selected number
of high cost drugs across all body
systems.
The list of named High Cost Drugs
was specified by the NHS England
and Monitor pricing teams, in
conjunction with advice from the High
Cost Drugs Steering Group.
E16/17
LP
15/16
P14/15
Total HRGs
58
58
58
Total HRG Roots
58
58
58
Procedure-driven HRGs
58
58
58
Diagnosis-driven HRGs
0
0
0
Age Splits
No
Complications and
Comorbidities Splits
No
Intervention Splits
No
Subchapter-specific grouping logic
Unbundled HRG grouping is the second stage of the grouping process, occurring once the
data have been validated. Subsequently, HRGs for Multiple Trauma, Burns and core HRGs
are produced.
In Subchapter XD, there is a one-to-one mapping of High Cost Drug OPCS-4 code to High
Cost Drug HRG.
Where multiple High Cost Drugs are recorded, multiple High Cost Drug HRGs will be
generated as one unbundled HRG is generated for each High Cost Drug code recorded in
the patient record.
HRG4+ Design Changes
To accommodate one-to-one mapping, new HRGs have been created for each of the eight
new OPCS-4.7 high cost drug procedure codes.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
YQ – Vascular Open Procedures and Disorders
Y – Vascular Procedures and Disorders and Imaging Interventions
Scope and Composition
Composition and Concepts
E16/17
LP
15/16
P14/15
Total HRGs
59
N/A
N/A
Total HRG Roots
27
N/A
N/A
Procedure-driven HRGs
48
N/A
N/A
This activity is now separate from YR
Vascular Imaging Interventions.
Diagnosis-driven HRGs
11
N/A
N/A
Age Splits
No
It comprises of:
Complications and
Comorbidities Splits
Yes
Subchapter YQ covers vascular open
procedures for patients of all ages
and adult disorders. It includes
activity undertaken in inpatient, day
case and non-admitted care settings.






Open procedures on the aorta
Intervention Splits
No
or abdominal blood vessels
Amputation procedures for vascular disease
Open procedures on blood vessels of lower limbs, including open varicose vein
procedures
Open procedures on blood vessels of upper limbs
Open arteriovenous fistula, graft or shunt procedures
Vascular disorders
All diagnosis-driven activity relating to the treatment of children (aged 18 years and under)
groups to an HRG in Chapter P, Diseases of Childhood and Neonates, in line with the
requirements of the Casemix Design Framework.
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
This subchapter has been created specific to open vascular procedures and vascular
disorders that previously sat within Subchapter QZ Vascular Procedures and Disorders,
which has been deleted.
The subchapter contains 59 HRGs, of which the procedure-driven HRGs are separated
largely based on which blood vessel is operated on.
The majority of procedures within the subchapter have multiple procedure logic, to map to
higher expected resource HRGs thereby taking account of the additional resource usage
associated with undertaking multiple procedures.
Interactive CC splits have been employed in the majority of HRG roots in this subchapter to
more appropriately reflect the expected additional resource usage for patients with multiple
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
comorbidities. The summed ‘score’ of all secondary diagnoses from the values assigned to
the CC list determine the HRG derived.
There are 51 HRGs that utilise interactive CC logic in the HRG4+ Engagement 2016/17
design.
Changes made to logic
Multiple procedure logic has been added to the majority of procedure codes within this
subchapter to appropriately reflect the expected additional resource usage associated with
performing multiple operations on a patient.
For example if the dominant procedure, when recorded alone, would map to YQ12D Single
Open Procedure on Blood Vessel of Lower Limb with CC Score 0-3, an additional
imaging intervention recorded from list YQ_Vasc_IR will derive the HRG YQ11C Single
Open Procedure on Blood Vessel of Lower Limb with Imaging Intervention, with CC
Score 0-3.
Alternatively, if an additional open vascular procedure from list YQ_Mult was recorded, the
HRG derived would be YQ10D Multiple Open Procedures on Blood Vessels of Lower
Limbs with CC Score 0-3.
Where appropriate, laterality has also been taken into account to map bilateral procedures,
e.g. the amputation of both feet, to a higher expected resource HRG than the equivalent
unilateral procedure, to reflect the additional resource usage associated with operating on
two sites.
New combination codes have been created where the driving code does not specify the
actual blood vessel that is being operated on, to map the activity to the appropriate sitespecific HRG, if a subsequent blood vessel site code is present. This occurs prior to
defaulting to the YQ41Z Open Operations on Other or Unspecified Blood Vessels.
Logic has been added to the aortic aneurysm repair HRGs to check the primary diagnosis for
the type of aneurysm, in order to map to the most clinically appropriate HRG.
In addition logic has been added to map to HRG root YQ01 Multiple or Revisional, Open
Repair of Abdominal or Thoracoabdominal Aortic Aneurysm if a subsidiary revisional
operation code is recorded.
Likewise the subsidiary revisional operation code is also checked to map revisional open
varicose vein procedures to higher expected resource HRGs.
Logic has also been added to all varicose vein procedure codes to map to the bilateral HRGs
where a bilateral operation site code is recorded, or alternatively where an additional
varicose vein procedure with both left and right sided operation site codes is recorded. This
is to more appropriately capture the additional resource associated with both legs being
operated on but not necessarily having the identical type of surgical intervention performed.
All the minor procedure HRGs within this subchapter have had maximum length of stay logic
added to reflect that these procedures are deemed minor for grouping purposes and
therefore are inappropriate to drive HRG grouping where length of stay is greater than this.
Many procedure codes within the previous subchapter QZ Vascular Procedures and
Disorders had logic to map to subchapter RC Interventional Radiology where a subsidiary
‘under radiological control’ approach code was recorded. This logic has been removed from
all procedures, with the exception of those that map to YQ42Z Open Arteriovenous Fistula,
Graft or Shunt Procedures, as the majority of these procedures now map directly to HRGs
within the new subchapter YR Vascular Imaging Interventions.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Complications and Comorbidity lists updated
A new CC list has been created for this subchapter, which is shared with subchapter YR
Vascular Imaging Interventions. In line with interactive CC logic, all major CCs have been
assigned a value of two and all other CCs have a value of one.
Mapping of codes to more appropriately reflect resource
Although the HRGs within this subchapter have been formed from the former QZ Vascular
Procedure and Disorders subchapter, many of the percutaneous and minimally-invasive
procedures that were also within QZ Vascular Procedure and Disorders have now been
mapped to HRGs within Subchapter YR Vascular Imaging Interventions.
Other lists have been updated
The vascular disorders list, YQ_Vasc_Dis, which is used to map surgical amputations to
HRGs within this subchapter rather than HRGs within Chapter H Orthopaedics, has been
updated to ensure that it contains all relevant vascular disorders. This ensures that
amputations, when undertaken for the treatment of vascular rather than bone disease, are
appropriately mapped to the amputation HRGs within this subchapter, because of the
clinically different nature of these amputations.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
YR – Vascular Imaging Interventions
Y – Vascular Procedures and Disorders and Imaging Interventions
Scope and Composition
Composition and Concepts
E
16/17
LP
15/16
P
14/15
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Subchapter YR covers vascular imaging
Total HRGs
48
interventions for patients of all ages. It
includes activity undertaken in inpatient,
Total HRG Roots
30
day case and non-admitted care
Procedure-driven HRGs
48
settings.
This activity is now separate from both
Diagnosis-driven HRGs
0
YQ Vascular Open Procedure and
Age Splits
Yes
Disorders and YZ Other Imaging
Complications and
Interventions.
Yes
Comorbidities Splits
It comprises of:
No
 Endovascular repair of abdominal Intervention Splits
aortic aneurysms
 Percutaneous transluminal angioplasty, with and without stenting
 Percutaneous transluminal embolisation of blood vessels and aneurysms
 Other percutaneous transluminal blood vessel procedures
 Arteriography and venography
 Minimally invasive treatment of varicose veins
 Vascular access procedures
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
This subchapter has been created specific to vascular imaging interventions that were
previously split between Subchapter QZ Vascular Procedures and Disorders and
Subchapter RC Interventional Radiology.
The subchapter contains 48 HRGs, which are separated based on the type of procedure
performed.
Many procedures within the subchapter have multiple procedure logic, to take account of the
additional expected resource usage associated with undertaking multiple procedures, e.g.
angioplasty with stenting, endovascular repair of abdominal aortic aneurysm with bypass
procedure.
Many HRGs within this subchapter have paediatric age splits to reflect the different resource
usage associated with treating these patients compared to adults undergoing the same
procedures.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Changes made to logic
Multiple procedure logic has been added to many procedure codes within this subchapter to
appropriately reflect the additional resource usage associated with performing multiple
operations on a patient. For example if the dominant procedure, when recorded alone,
would map to YR04Z Endovascular Repair of Abdominal Aortic Aneurysm, the recording
of an additional bypass procedure from list YR_Bypass will derived the HRG YR03Z
Complex Endovascular Repair of Abdominal Aortic Aneurysm.
Where appropriate, laterality has also been taken into account to map bilateral procedures,
e.g. angioplasty of femoral artery of both legs, to a higher expected resource HRG than the
equivalent unilateral procedure to reflect the additional resource usage associated with
operating on two sites.
Logic has been added to all varicose vein procedure codes to map to the bilateral HRGs
where a bilateral operation site code is recorded, or alternatively where an additional
varicose vein procedure with both left and right sided operation site codes is recorded. This
is to more appropriately capture the additional resource associate with both legs being
operated on but not necessarily having the identical type of surgical intervention performed.
Logic has been added to the percutaneous transluminal embolisation and endovascular
aortic aneurysm repair (EVAR) HRGs to check the primary diagnosis for the type of
aneurysm in order to map to the most clinically appropriate HRG. In addition, logic has been
added to map to the “Complex EVAR” HRGs where a subsidiary branched stent graft
operation code is recorded. Likewise, the HRGs for angioplasty with stenting also check
subsidiary codes for number and type of stent to ensure they are mapped to the most
appropriate HRG.
All of the minor procedure HRGs within this subchapter have had maximum length of stay
check logic added to reflect that these procedures are deemed minor for grouping purposes
and therefore are inappropriate to drive HRG grouping where length of stay is greater than
this.
New combination codes have been created to more accurately identify the different types of
vascular access procedures to map to the most clinically appropriate HRG.
Many procedure codes within previous Subchapter QZ Vascular Procedures and
Disorders had logic to map to Subchapter RC Interventional Radiology where a subsidiary
‘under radiological control’ approach code was recorded. This logic has been removed from
all procedures, with the exception of those that map to YQ42Z Open Arteriovenous Fistula,
Graft or Shunt Procedures, which map to YR48Z Attention to Arteriovenous Fistula,
Graft or Shunt when performed under radiological control. The majority of procedures that
had previously included this logic now map directly to HRGs within this subchapter.
Complications and Comorbidity lists updated
A new CC list has been created for this subchapter, shared with Subchapter YQ Vascular
Open Procedures and Disorders. In line with interactive CC logic, all major CCs have been
assigned a value of two and all other CCs have a value of one. There are 21 HRGs that
utilise interactive CC logic in the HRG4+ Engagement 2016/17 design.
Mapping of codes to more appropriately reflect resource
Although the HRGs within this subchapter has been formed from the former QZ Vascular
Procedure and Disorders and RC Interventional Radiology subchapters, some of the
non-vascular imaging interventions that were within these subchapters have been mapped to
HRGs within the new subchapter YZ Other Imaging Interventions. In addition, several
procedures that were insignificant (i.e. very low resource) have been ignored for grouping, to
reflect this fact.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
YZ – Other Imaging Interventions
Y – Vascular Procedures and Disorders and Imaging Interventions
Scope and Composition
Composition and Concepts
Subchapter YZ covers non-vascular
imaging interventions for patients of
all ages. It includes activity
undertaken in inpatient, day case and
non-admitted care settings.
This activity is now separate from YR
Vascular Imaging Interventions.
E16/17
LP
15/16
P14/15
Total HRGs
8
N/A
N/A
Total HRG Roots
8
N/A
N/A
Procedure-driven HRGs
8
N/A
N/A
Diagnosis-driven HRGs
0
N/A
N/A
Age Splits
No
Complications and
It is designed to be an interim
No
Comorbidities Splits
subchapter until the activity within it,
Intervention Splits
No
and non-vascular imaging
interventions within other
subchapters, are redesigned in new subchapters (e.g. specific to neurological imaging
intervention, urological imaging interventions, etc. in the same way vascular imaging
interventions have been) as part of the final phase of HRG4+ implementation.
It comprises of:





Urological imaging interventions
Hepatobiliary imaging interventions
Gastrointestinal imaging interventions
Thoracic imaging interventions
Lymphatic imaging interventions
 Neurological imaging interventions
 Obstetric and gynaecological imaging interventions, including uterine fibroid
embolisation
Subchapter-specific grouping logic
Apart from the concepts identified in the composition table above (further details of which
can be found in sections 6 and 7 of the Casemix Companion), this subchapter does not have
any other specific grouping logic employed.
HRG4+ Design Changes
A new subchapter has been created
This subchapter has been created specific to other non-vascular imaging interventions that
were previously mainly within Subchapter RC Interventional Radiology.
The subchapter contains 8 HRGs, which are separated based on the body site associated
with the procedure.
The majority of procedures within the subchapter only map to HRGs within this subchapter
when specific subsidiary procedures are recorded e.g. under radiological control, or when a
certain primary diagnosis is recorded.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
Changes made to logic
The majority of the procedure codes that map to the HRGs within this subchapter still utilise
the same logic as that which mapped them previously to HRGs within Subchapter RC
Interventional Radiology.
All of the minor procedure HRGs within this subchapter have had maximum length of stay
logic added to reflect that these procedures are deemed minor for grouping purposes and
therefore are inappropriate to drive HRG grouping where length of stay is greater than this.
Mapping of codes to more appropriately reflect resource
Some procedure codes that previously mapped to HRGs within Subchapter RC
Interventional Radiology with additional logic, such as the recording of subsidiary
procedure codes, have been mapped directly to base HRG roots within this subchapter.
The vascular imaging interventions that previously mapped to HRGs within Subchapter RC
Interventional Radiology now all map to HRGs within the new YR Vascular Imaging
Interventions subchapter.
New combination codes have been created where the driving code does not specify the
actual blood vessel that is being operated on to map the activity to the appropriate sitespecific HRG, if a subsequent blood vessel site code is present.
For example, HRG YZ06Z Neurological Imaging Interventions is derived if the dominant
OPCS-4 procedure code is O01.1 Percutaneous transluminal coil embolisation of small
aneurysm of artery with a subsidiary site code of Z35.9 Cerebral artery NEC.
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HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0
The Documentation Suite
Below is a list of the various documents which are available to download from the National
Casemix Office website www.hscic.gov.uk/casemix. It is a comprehensive resource of
supporting materials, designed to assist users in understanding the design concepts, logic
and practical use of the Grouper.

The Casemix Companion is a starting point and general reference for new and existing
users, providing an introduction to HRGs, groupers, HRG4+ design concepts (including
worked examples of each one), grouping logic and useful links to further information

The Grouper User Manual provides full instructions on how to prepare and group data
using the Grouper software application. This generic document is updated with every
new grouper software toolkit released

The Summary of Changes document provides an overview of the main changes
between the current grouper design and its predecessor

The Chapter Summaries document provides an overview of the scope, composition
and relevant grouping logic of individual subchapters, along with the design concepts
incorporated. Also included in the document are updates on the changes within
subchapters

The Worked Examples document contains subchapter specific worked examples to
highlight how the different types of grouping logic implemented within each subchapter
works

The Code to Group Workbook is a spreadsheet that provides details on all mappings
between primary classification (e.g. ICD-10, OPCS-4, A&E codes, etc.) and their
respective HRGs. Also detailed within the workbook are the logic conditions required to
generate the HRGs

The Code to Group User Manual serves as an introduction to using the Code to Group
workbook to perform manual grouping. It also details some basic design concepts and
provides worked examples of a variety of different grouping scenarios

The Specialised Service Identification Code Sets is a spreadsheet containing details
about how the Grouper allocates specific identification flags relating to specialised
services that may attract a national tariff top-up which will then be applied in the National
System for Reimbursement (SUS PbR)

The Best Practice Guide is a spreadsheet produced to help users understand how Best
Practice flags, which are output by the Casemix Groupers, are generated
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Published by the Health and Social Care Information Centre
Part of the Government Statistical Service
This publication may be requested in large print or
other formats.
For further information
www.hscic.gov.uk
0300 303 5678
[email protected]
Copyright © 2015 Health and Social Care Information Centre. All rights reserved.
This work remains the sole and exclusive property of the Health and Social Care
Information Centre and may only be reproduced where there is explicit reference to
the ownership of the Health and Social Care Information Centre.
This work may be re-used by NHS and government organisations without permission.
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