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HRG4+ 2016/17 Engagement Grouper Chapter Summaries Published August 2015 HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 We are the trusted national provider of high-quality information, data and IT systems for health and social care. www.hscic.gov.uk [email protected] @hscic Author: National Casemix Office Health and Social Care Information Centre Version: V1.0 Date of publication: August 2015 Page 2 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 3 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 4 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 5 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 10 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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. Page 11 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 14 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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. Page 17 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 19 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 23 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 25 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 27 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 29 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 30 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 31 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 35 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 37 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 40 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 41 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 42 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 43 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 44 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 45 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 51 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 54 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 59 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 60 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 62 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Page 63 of 166 C3 C4 C5 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 64 of 166 C7 C8 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 65 of 166 C10 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 66 of 166 No Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Page 67 of 166 C13 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 68 of 166 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 69 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 70 of 166 Fields not required for grouping but expected for identification of each session Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 71 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 72 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 73 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 74 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 75 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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. Page 76 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 78 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 92 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 93 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 94 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 96 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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. Page 97 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 98 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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. Page 99 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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, Page 100 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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. Page 101 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 102 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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. Page 103 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 104 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Page 105 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 108 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 110 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 111 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 112 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 116 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 118 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 119 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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). Page 122 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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. Page 123 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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. Page 124 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 * 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) Page 125 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Page 126 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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) 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 Page 127 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 128 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 129 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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. Page 130 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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. Page 131 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 132 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Page 133 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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. Page 134 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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. Page 135 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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. Page 136 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Page 137 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. A circle containing ‘C’ followed by a number indicates continuation on another page. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Page 138 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Page 139 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 141 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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: Page 142 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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. Page 143 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Page 144 of 166 C2 C3 CNN Key A circle containing ‘C’ followed by a number indicates continuation on another page. Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Page 145 of 166 C5 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Page 146 of 166 C7 C8 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Page 147 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Page 148 of 166 C11 C12 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 C10 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 Page 149 of 166 C14 Yes XB06Z C15 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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 Page 150 of 166 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 152 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 154 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 155 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 157 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 158 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 159 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 160 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 161 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 162 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 163 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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. Page 164 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. 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 Page 165 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved. HRG4+ 2016/17 Engagement Grouper Chapter Summaries v1.0 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. Page 166 of 166 Copyright © 2015, Health and Social Care Information Centre. All rights reserved.