HRG4 Summary of Changes:

HRG4 Summary of Changes: HRG4 2014/15 Payment Grouper from HRG4 2013/14 Local Payment Grouper The National Casemix Office Published February 2014

We are the trusted source of authoritative data and information relating to health and care. www.hscic.gov.uk enquiries@hscic.gov.uk Author: The National Casemix Office Health and Social Care Information Centre Version: v1.0 Date of publication: February 2014 2 Copyright 2014, Health and Social Care Information Centre. All rights reserved.

HRG4 Summary of Changes Purpose The HRG4 classification is updated by the National Casemix Office on an annual basis to ensure optimal performance in supporting policy and maintaining clinical relevance. Documentation is available to assist end-users in generating HRGs and interpreting grouper output. Further information on the national tariff for 2014/15 can be found on the Monitor website: http://www.monitor.gov.uk/pricing The purpose of this summary is to provide an overview of the main changes between the HRG4 2013/14 Local Payment Grouper and the HRG4 2014/15 Payment Grouper. Changes are broken down by: Grouper Input Changes Grouper Output Changes Grouper Design Changes HRG Design Changes This document is intended as a high level summary to be used to form the basis of further analysis and investigation rather than a comprehensive list of all differences between grouper releases. Further HRG4 supporting documentation is available from the National Casemix Office. 3 Copyright 2014, Health and Social Care Information Centre. All rights reserved.

HRG4 Summary of Changes HRG4 2014/15 Payment Grouper from HRG4 2013/14 Local Payment Grouper Following introduction of a new software supplier at the 2014/15 Engagement Grouper build there has been a number of amendments made to the Grouper including the user interface. The main differences to be noted are: It is faster when processing data in bulk Tabs on the front screen will allow multiple, simultaneous runs of batch grouping When the Grouper is run from the command line, another window is no longer opened Multiple concurrent batch runs can be initiated from the same installation Decimal points in diagnosis and procedure codes are now automatically removed The executable name, when using the command line, has been changed The Single Spell Grouper has been reworked and improvements include: o opens independently in a new window o window is resizable and movable o grouping errors are highlighted in yellow o multiple single spell windows can be opened concurrently o amended layout of input and output fields o copy and paste functionality has been added to the input and output fields. Please see the HRG4 Grouper Reference Manual for full details including screen shots of the new Grouper. Grouper Input Changes There have been no changes to the inputs of the Grouper. Grouper Output Changes There have been no changes to the outputs of the Grouper. Grouper Design Changes U Group Error message Error messages for U group codes UZ05 and UZ06 have been amended to read as follows: - UZ05 Invalid procedure for Casemix grouping purposes in OPER_nn; and - UZ06 Poorly coded procedure for Casemix grouping purposes in OPER_nn. 4 Copyright 2014, Health and Social Care Information Centre. All rights reserved.

HRG Design Changes Base Design Update of Base Design The base design used for the HRG4 2014/15 Payment Grouper is the HRG4 2010/11 Reference Costs Grouper. Subchapter Changes 1% increase in the number of HRGs The number of HRGs has increased by 16 (+1%) from 1,576 in the HRG4 2013/14 Local Payment Grouper to 1,592 in the HRG4 2014/15 Payment Grouper to accommodate national tariff policy requirements, reflect changes to clinical practice and support service redesign. Net movements in the numbers of HRGs at Subchapter level can be found in Appendix A. Introduction of new OPCS-4.7 codes The HRG design has been updated to include codes newly introduced in OPCS-4.7. For new OPCS-4.7 codes where it is found, in HRG terms, that it is not appropriate to copy or clone an existing OPCS-4 code, the grouper will map OPCS-4.7 codes directly to an appropriate HRG. Details of the logic employed for this direct mapping can be found in the Code to Group worksheet. Further details can be found in the HRG4 2014/15 Payment Grouper Code to Group workbook available from the National Casemix Office website. o OPCS-4.7 High Cost Drugs codes A total of eight new High Cost Drugs OPCS-4.7 codes have been created and implemented into the HRG design for use in the HRG4 2014/15 Payment Grouper. o OPCS-4.7 Specialised Services Codes (SSC) & Best Practice Tariffs (BPT) Updates have been made to the SSC and BPT lists to ensure that the design reflects the changes in the OPCS-4.7 classification. Creation of a new unbundled subchapter and HRGs for Dialysis for Acute Kidney Injury (AKI) To ensure the appropriate capture, costing and funding of patients receiving dialysis for the treatment of Acute Kidney Injury a new Subchapter, LE Renal Dialysis for Acute Kidney Injury consisting of 4 new unbundled HRGs has been created. The new HRGs created are as follows: o LE01A Haemodialysis for Acute Kidney Injury, 19 years and over o LE01B Haemodialysis for Acute Kidney Injury, 18 years and under o LE02A Peritoneal Dialysis for Acute Kidney Injury, 19 years and over o LE02A Peritoneal Dialysis for Acute Kidney Injury, 18 years and under 5 Copyright 2014, Health and Social Care Information Centre. All rights reserved.

Unlike the renal dialysis HRGs for Chronic Kidney Disease which are generated from the National Renal Database, the unbundled HRGs for Dialysis for AKI are generated from the content of the Commissioning Data Set(s). New HRG created in subchapter DZ Thoracic Procedures A new HRG DZ54Z Complex Bronchoscopy has been created to improve identification of complex bronchoscopy activity such as endobronchial valve placements and bronchial thermoplasty. Changes to subchapter FZ Digestive System Procedures and Disorders A new HRG FZ89Z Complex Therapeutic Endoscopic Upper or Lower GI Tract Procedures has been created to appropriately capture the resource use associated with specialised endoscopy, in particular those that have high cost consumables. In addition, a new combination code, H41.2+Y26.3 Stapled transanal rectal resection, has been created to identify the STARR procedure, This has been mapped to HRG root FZ11* Large Intestine - Major Procedures, to better reflect the resource use associated when undertaking this specialised procedure. New HRGs created in subchapter LB, Urinary Male Urology To more appropriately identify and reflect the resource usage associated with both complex surgery and laparoscopic surgery the following HRGs have been deleted: o LB02A Kidney Major Open Procedure 19 years and over with Major CC o LB02B Kidney Major Open Procedure 19 years and over with Intermediate CC o LB02C Kidney Major Open Procedure 19 years and over without CC o LB02D Kidney Major Open Procedure 18 years and under o LB03Z Laparoscopic Operations on Kidney and Ureter o LB07Z Ureter Open Procedure And replaced with new HRGs: o LB60A Complex Open or Laparoscopic, Kidney or Ureter Procedures, with Major CC o LB60B Complex Open or Laparoscopic, Kidney or Ureter Procedures, without Major CC o LB61A Major Open Kidney or Ureter Procedures, 19 years and over with Major CC o LB61B Major Open Kidney or Ureter Procedures, 19 years and over without Major CC o LB62A Major Laparoscopic Kidney or Ureter Procedures, 19 years and over with CC o LB62B Major Laparoscopic Kidney or Ureter Procedures, 19 years and over without CC o LB63A Major Open or Laparoscopic, Kidney or Ureter Procedures, 18 years and under with CC o LB63B Major Open or Laparoscopic, Kidney or Ureter Procedures, 18 years and under without CC 6 Copyright 2014, Health and Social Care Information Centre. All rights reserved.

The implementation of multiple procedure logic has also been utilised on these HRGs, in addition to HRG roots LB01* Percutaneous Nephostomy and LB05* Kidney Intermediate, Endoscopic and Percutaneous Interventions, to appropriately recognise the expected resource increase when undertaking more than a single procedure at the same time. Subchapter HC and HR, Spinal Surgery and Disorder and Orthopaedic Reconstruction Procedures Addition of logic to OPCS codes V40.2, V40.3 and V40.4 To ensure that procedures are accurately captured and map to an appropriate HRG in terms of resource use, logic has been added to posterior instrumented spinal instrumentations and decompressions completed for tumour and infection (OPCS codes V40.2 Posterior instrumented fusion of cervical spine NEC, V40.3 Posterior instrumented fusion of thoracic spine NEC, V40.4 Posterior instrumented fusion of lumbar spine NEC). New HRGs created in Subchapter AA, Nervous System Procedures and Disorders To more appropriately identify and reflect the resource usage associated with Electroencephalograph telemetry the OPCS code U221 Electroencephalograph telemetry has been mapped to HRG root AA21* Intracranial Procedures Except Trauma with Other Diagnoses. Additionally, the following HRGs have been deleted: AA34C Neurophysiological Operations 19 years and over AA34D Neurophysiological Operations 18 years and under And replaced with new HRGs: AA34E Other Neurophysiological Operations 19 years and over AA34F Other Neurophysiological Operations 18 years and under Coding Quality To ensure that national coding rules and guidance continue to be supported by the Casemix classification, a review has been undertaken and amendments have been made across the HRG4 design. Those to note include: - the remapping of all.8 and.9 codes from extended categories to HRG UZ01Z Data Invalid for Grouping; and - the remapping of OPCS code X35.1 Intravenous induction of labour to UZ01Z Data Invalid for Grouping. Other Amendments In order to more appropriately represent the resource use of care in HRG output, the following HRG4 design changes have also been included: - the Procedure Hierarchy value for K51.8 Other specified diagnostic transluminal operations on coronary artery has been raised to ensure that when this activity is undertaken at the same time as more relatively minor procedures, it will take precedence in grouping terms, generating EA35Z Other Percutaneous Interventions; and 7 Copyright 2014, Health and Social Care Information Centre. All rights reserved.

- ICD-10 code T74.1 Physical abuse has been added to the orthopaedic trauma logic list to more appropriately recognise the resource impact of caring for such patients. Where this diagnosis is recorded, therefore, orthopaedic procedures will rightly be regarded as Trauma (subchapter HA) rather than non-trauma (subchapter HB). General Enhancements List and Flag descriptions have been amended for subchapters XA Neonatal Critical Care and XB Paediatric Critical Care following the introduction of new CDS6.2 admission method codes (see the Code to Group excel document Documentation Flags tab for further details). The HRG label for PET-CT has been amended to help users identify that the HRG is specifically for PET-CT scans from: - RA42Z Nuclear Medicine - category 8; to - RA42Z Nuclear Medicine - category 8 (PET-CT). 8 Copyright 2014, Health and Social Care Information Centre. All rights reserved.

Appendix A: HRG4 Distribution by Subchapter in P14/15 and LP13/14 For further details of all subchapter changes please see the supporting documentation, including the Code to Group Excel file and the Chapter summaries document available on the National Casemix Office website. Subchapter P14/15 LP13/14 Comment AA Nervous System Procedures and Disorders 65 65 Deletion of two HRGs and replacement with two HRGs to more appropriately identify and reflect the resource usage associated with Electroencephalograph telemetry, resulting in no net increase in HRG numbers in this subchapter AB Pain Management 10 10 BZ Eyes and Periorbita Procedures and Disorders CZ Mouth Head Neck and Ears Procedures and Disorders 33 33 94 94 DZ Thoracic Procedures and Disorders 99 98 Creation of a new HRG DZ54Z Complex Bronchoscopy to identify complex bronchoscopy activity leading to an increase of one HRG EA Cardiac Procedures 36 36 EB Cardiac Disorders 14 14 FZ Digestive System Procedures and Disorders GA Hepatobiliary and Pancreatic System Surgery GB Hepatobiliary and Pancreatic System Endoscopies and Radiological Procedures GC Hepatobiliary and Pancreatic System Disorders HA Orthopaedic Trauma Procedures HB Orthopaedic Non-Trauma Procedures HC Spinal Surgery and Disorders 126 125 21 21 16 16 12 12 61 61 64 64 33 33 Introduction of a new HRG FZ89Z Complex Therapeutic Endoscopic Upper or Lower GI Tract Procedures to improve identification of this complex care, leading to an increase of one HRG Logic has been added to posterior instrumented spinal instrumentations and decompressions completed for tumour and infection (OPCS codes V40.2/V40.3/V40.4) HD Musculoskeletal Disorders 21 21 HR Orthopaedic Reconstruction Procedures JA Breast Procedures and Disorders 9 9 25 25 Logic has been added to posterior instrumented spinal instrumentations and decompressions completed for tumour and infection (OPCS codes V40.2/V40.3/V40.4) 9 Copyright 2014, Health and Social Care Information Centre. All rights reserved.

Subchapter P14/15 LP13/14 Comment JB Burns Procedures and Disorders 11 11 JC Skin Surgery 36 36 JD Skin Disorders 17 17 KA Endocrine System Disorders 11 11 KB Diabetic Medicine 10 10 KC Metabolic Disorders 7 7 LA Renal Procedures and Disorders LB Urological and Male Reproductive System Procedures and Disorders 32 32 87 85 Deletion of six HRGs and replacement with eight new HRGs to better capture the increased use of laparoscopic surgery techniques leading to a net increase of two HRGs LD Renal Dialysis (NRD) 26 26 LE Renal Dialysis for Acute Kidney Injury MA Female Reproductive System Procedures MB Female Reproductive System Disorders MC Assisted Reproduction Medicine 4 0 26 26 12 12 10 10 Creation of a new subchapter LE Renal Dialysis for Acute Kidney Injury, containing four new unbundled HRGs specifically to capture dialysis for patients with acute kidney injury, resulting in an increase of four HRGs NZ Obstetric Medicine 30 30 PA Paediatric Medicine 112 112 PB Neonatal Disorders 3 3 QZ Vascular Procedures and Disorders 34 34 RA Diagnostic Imaging Procedures 39 39 HRG label for PET-CT has been amended to help users identify that the HRG is specifically for PET- CT scans RC Interventional Radiology 27 27 SA Haematological Procedures and Disorders 56 56 SB Chemotherapy 18 18 SC Radiotherapy 30 30 SD Specialist Palliative Care 10 10 UZ Undefined Groups 1 1 VA Multiple Trauma 24 24 10 Copyright 2014, Health and Social Care Information Centre. All rights reserved.

Subchapter P14/15 LP13/14 Comment VB Emergency Medicine 11 11 VC Rehabilitation 23 23 WA Immunology, infectious diseases, poisoning, shock, special examinations, screening and other healthcare contacts WD Treatment of Mental Health Patients by Non-Mental Health Service Providers 56 56 3 3 WF Non-admitted Consultations 8 8 XA Neonatal Critical Care 6 6 XB Paediatric Critical Care 8 8 XC Adult Critical Care 7 7 XD High Cost Drugs 58 50 8 new High Cost Drugs OPCS-4.7 codes have been authored resulting in eight new High Cost Drug HRGs, given the one-to-one mapping of the HRG design Total 1,592 1,576 11 Copyright 2014, Health and Social Care Information Centre. All rights reserved.

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 and grouping logic and useful links to further information The Grouper Reference 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 Roots Workbook is a spreadsheet that identifies new HRGs, deleted HRGs and changes to existing HRG Labels between each release of the classification, using an easy to follow colour-coding system The Chapter Summaries document provides an overview of the scope, composition and grouping logic of individual subchapters along with illustrative worked examples. Also included in the document are updates on the changes within subchapters 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 12 Copyright 2014, Health and Social Care Information Centre. All rights reserved.

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