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Claim Diagnosis Related Group Outlier Stay Code

DGNS_DRG_OUTLIER_CD

ON AN INSTITUTIONAL CLAIM, THE CODE THAT INDICATES THE BENEFICIARY STAY UNDER THE PROSPECTIVE PAYMENT SYSTEM WHICH, ALTHOUGH CLASSIFIED INTO A SPECIFIC DIAGNOSIS RELATED GROUP, HAS AN UNUSUALLY LONG LENGTH (DAY OUTLIER) OR EXCEPTIONALLY HIGH COST (COST OUTLIER). [NCH]

Field Metadata

FHIR Resource
ExplanationOfBenefit
FHIRPath 
ExplanationOfBenefit.supportingInfo.where(
  category.coding.where(
    system = 'https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information'
  ).exists() and
    category.coding.where(code = 'DGNS_DRG_OUTLIER_CD').exists()
).code.coding.code
Coverage / Claim Type
  • Inpatient
  • SNF
Source View
V2_MDCR_CLM_INSTNL
Source Column
DGNS_DRG_OUTLIER_CD
Reference Table
https://bluebutton.cms.gov/fhir/CodeSystem/DGNS-DRG-OUTLIER-CD
Sources
  • NCH
Profiles
  • CMS

Example 

6

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