HRG4 2016/17
Local Payment Grouper
ICD-10 5th Edition Changes
Published April 2016
HRG4 2016/17 Local Payment Grouper ICD-10 5th Edition Changes v2.0
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Author:
The National Casemix Office
Health and Social Care Information Centre
Version:
V2.0
Date of publication:
April 2016
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HRG4 2016/17 Local Payment Grouper ICD-10 5th Edition Changes v2.0
Purpose
This document outlines the changes made to the HRG4 2016/17 Local Payment Grouper for
use from 1 April 2016 due to the underlying primary classification for diagnoses being
updated to ICD-10 5th Edition, which is mandated for use from 1 April 2016.
This paper does not consider changes to the HRG4+ classification to be used in the HRG4+
2016/17 Reference Costs Grouper, which is expected to support the updated ICD-10
classification in its entirety.
Background
ICD-10 is an NHS Information Standard implemented on 1 April 1995, with subsequent
updates implemented by the NHS on 1 April 2004, referred to as ICD-10 Reprinted (with
updates and corrections) 2000, and on 1 April 2012, referred to as ICD-10 4th Edition.
The International Statistical Classification of Diseases and Related Health Problems – Tenth
Revision (ICD-10) is produced by the World Health Organisation (WHO). The changes
provided by WHO constitute updates to the classification to provide improved classification
of medical conditions. The update is referred to as ICD-10 5th Edition.
ICD-10 diagnosis codes are used in HRG grouping within the Admitted Patient Care (APC)
Commissioning Data Set (CDS).
They can be used:
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To derive HRGs for patient activity where a significant procedure is not recorded in the
patient record.
To qualify some procedures that can be used for a variety of conditions and for which
separate identification is a clinical requirement.
To recognise the presence of complications and comorbidities (CCs) within a patient
record (where it is deemed clinically relevant to differentiate HRG activity by this variable)
as a direct consequence of the resource implications of care.
In other processes as trigger codes with the output via the HRG grouper. For example,
Best Practice Tariffs (BPTs), Specialised Service Codes (SSCs) and Programme
Budgeting Codes (PBCs).
Types of changes affecting HRG design
Codes added to ICD-10 classification
For the purpose of this document, new codes are defined as those 4- or 5-digit ICD-10 codes
that do not exist in the HRG4 2014/15 Local Payment Grouper or the HRG4 2015/16 Local
Payment Grouper but will exist in the ICD-10 code set to be used by the NHS from April
2016.
Codes deleted from ICD-10 classification
Codes have been deleted from the ICD-10 4th Edition classification by the WHO to provide
an improved classification of medical conditions.
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HRG4 2016/17 Local Payment Grouper ICD-10 5th Edition Changes v2.0
ICD-10 Label changes
Code descriptions have been updated for certain ICD-10 codes, although this will have no
impact on HRG derivation.
Numbers
The following table attempts to illustrate the magnitude of the change. There are
approximately 16,000 ICD-10 codes in total.
Count
New codes
82
Deleted codes
25
Implementation within the HRG4 2016/17 Local
Payment Grouper
ICD-10 code additions
Where a new code has been added to the ICD-10 classification, Expert Working Group
(EWG) advice has been sought to ascertain the most appropriate HRG(s) to which to group
the new code and whether the new code should (or should not) be a member of certain lists
(e.g., complication and comorbidities lists). The clinical discussions centred on the ICD-10
code(s) that would have been used for the specific diagnosis prior to the introduction of the
ICD-10 update in April 2016.
Accommodating the new ICD-10 codes within the design in this way preserves the base
HRG4 2011/12 Reference Costs design, on which the underlying Reference Costs were
collected, as much as possible.
See Appendix A for the list of code additions.
ICD-10 code deletions
The HRG4 2016/17 Local Payment Grouper has implemented the code list as released by
the NHS Clinical Classifications Service. Therefore, codes that were present in previous
payment groupers but are not in the updated code set will not be valid. If used, these codes
will cause the episode (and spell) to generate HRG UZ01Z Data Invalid for Grouping.
Multi-episode spells with an admission date prior to 1 April 2016 and a discharge date after
31 March 2016 (i.e., the spell spans dates in two financial years) that contain a deleted ICD10 code will generate a spell HRG of UZ01Z Data Invalid for Grouping. The HRG4 2016/17
Local Payment Grouper will not distinguish between the two different versions of the ICD-10
classification. From analysis undertaken on SUS 2015/16 data, it is estimated that this will
affect no more than 11,500 spells nationally in 2016/17.
See Appendix B for the list of code deletions.
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HRG4 2016/17 Local Payment Grouper ICD-10 5th Edition Changes v2.0
Other grouper outputs
Code trigger lists for both Best Practice Tariffs (BPTs) and Specialised Service Codes
(SSCs) have been reviewed and updated, as appropriate, in line with any changes
necessitated by the introduction of ICD-10 5th Edition.
Programme Budgeting Categories (PBCs) have also been updated to use the updated ICD10 5th Edition code set.
Summary
The NHS Clinical Classifications Service implemented ICD-10 5th Edition on 1 April 2016.
The HRG4 2016/17 Local Payment Grouper supports this classification as it is designed to
be used with 2016/17 data.
As part of the ICD-10 update, a number of ICD-10 codes will become invalid on 1 April 2016.
Where spells span the financial year boundary and constituent 2015/16 episodes contain a
deleted code, these validly coded spells will U-group. This approach was agreed upon with
NHS England due to the relatively small number of expected affected multi-episode spells
containing a deleted code, the cost/difficulty of trying to deal with two versions of ICD codes
concurrently, and the short-lived nature of the problem. This decision has led to the design
encapsulated in the HRG4 2016/17 Local Payment Grouper.
All 82 new ICD-10 codes have been accommodated within the HRG4 classification and are
present in the HRG4 2016/17 Local Payment Grouper. This means that the new ICD-10
codes, where appropriate, will be valid and will play a part in grouping, but the base HRG4
2011/12 Reference Costs design on which the underlying Reference Costs were collected
will be preserved as much as practicable.
All 25 ICD-10 codes that become invalid from 1 April 2016, so from the year of use of the
HRG4 2016/17 Local Payment Grouper onwards, have been deleted from the HRG4 design.
This means that the use of the old ICD-10 codes will cause the episode (and spell) to group
to HRG UZ01Z Data Invalid for Grouping. This will have an impact when grouping multiepisode spells that span the year-end boundary and contain one or more deleted ICD-10
codes.
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HRG4 2016/17 Local Payment Grouper ICD-10 5th Edition Changes v2.0
Frequently asked questions
Q:
How can we group multi-episode spells that span financial years 2015/16 and 2016/17
that have a deleted ICD-10 code in the 2015/16 episode to valid HRGs using the
HRG4 2016/17 Local Payment Grouper?
A:
For multi-episode spells that end in 2016/17 but contain episodes that finished in
2015/16 (and where the episode from 2015/16 contains one of the deleted ICD-10
codes), we would advise commissioners and providers to discuss the activity and
come to a local arrangement regarding appropriate tariffs.
Q:
How can we group historic data for business planning purposes or to calculate the
marginal rate using the HRG4 2016/17 Local Payment Grouper?
A:
Historic data will U-group when run through the HRG4 2016/17 Local Payment
Grouper if it contains codes that were deleted in ICD-10 5th Edition. Where this
causes an issue for organisations locally, they may wish to use the HRG4 2015/16
Local Payment Grouper for their planning; Please note that no HRG4 2016/17
Consultation Grouper is available due to late policy changes which meant a reversal
of the previously agreed design (based on the HRG4+ 2013/14 Reference Costs
design) therefore users are advised, that any changes made between Local Payment
2015/16 and Local Payment 2016/17 would need to be considered and taken into
account as necessary. Details of these changes can be found in the summary of
changes document published as part of this documentation suite.
Further information
For further information please contact the HSCIC helpdesk on 0845 300 6016 or via
[email protected].
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HRG4 2016/17 Local Payment Grouper ICD-10 5th Edition Changes v2.0
Appendix A: code additions
A970
A971
A972
A979
G233
G835
I480
I481
I482
I483
I484
I489
I726
J9600
J9601
J9609
J9610
J9611
J9619
J9690
J9691
J9699
K025
K432
K433
K434
K435
K436
K437
K640
K641
K642
K643
K644
K645
K648
K649
L987
P917
R950
R959
Z917
Z994
U060
U061
U062
U063
U064
U065
U066
U067
U068
U069
U070
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Dengue without warning signs
Dengue with warning signs
Severe Dengue
Dengue, unspecified
Multiple system atrophy, cerebellar type [MSA-C]
Locked-in syndrome
Paroxysmal atrial fibrillation
Persistent atrial fibrillation
Chronic atrial fibrillation
Typical atrial flutter
Atypical atrial flutter
Atrial fibrillation and atrial flutter, unspecified
Aneurysm and dissection of vertebral artery
Acute respiratory failure: Type I [hypoxic]
Acute respiratory failure: Type II [hypercapnic]
Acute respiratory failure: Type unspecified
Chronic respiratory failure: Type I [hypoxic]
Chronic respiratory failure: Type II [hypercapnic]
Chronic respiratory failure: Type unspecified
Respiratory failure, unspecified: Type I [hypoxic]
Respiratory failure, unspecified: Type II [hypercapnic]
Respiratory failure, unspecified: Type unspecified
Caries with pulp exposure
Incisional hernia without obstruction or gangrene
Parastomal hernia with obstruction, without gangrene
Parastomal hernia with gangrene
Parastomal hernia without obstruction or gangrene
Other and unspecified ventral hernia with obstruction, without gangrene
Other and unspecified ventral hernia with gangrene
First degree haemorrhoids
Second degree haemorrhoids
Third degree haemorrhoids
Fourth degree haemorrhoids
Residual haemorrhoidal skin tags
Perianal venous thrombosis
Other specified haemorrhoids
Haemorrhoids, unspecified
Excessive and redundant skin and subcutaneous tissue
Acquired hydrocephalus of newborn
Sudden infant death syndrome with mention of autopsy
Sudden infant death syndrome without mention of autopsy
Personal history of female genital mutilation
Dependence on artificial heart
Emergency use of U06.0
Emergency use of U06.1
Emergency use of U06.2
Emergency use of U06.3
Emergency use of U06.4
Emergency use of U06.5
Emergency use of U06.6
Emergency use of U06.7
Emergency use of U06.8
Emergency use of U06.9
Emergency use of U07.0
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HRG4 2016/17 Local Payment Grouper ICD-10 5th Edition Changes v2.0
U071
U072
U073
U074
U075
U076
U077
U078
U079
U820
U821
U822
U828
U829
U830
U831
U832
U837
U838
U839
U840
U841
U842
U843
U847
U848
U849
U85X
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Emergency use of U07.1
Emergency use of U07.2
Emergency use of U07.3
Emergency use of U07.4
Emergency use of U07.5
Emergency use of U07.6
Emergency use of U07.7
Emergency use of U07.8
Emergency use of U07.9
Resistance to penicillin
Resistance to methicillin
Extended spectrum betalactamase (ESBL) resistance
Resistance to other betalactam antibiotics
Resistance to betalactam antibiotics, unspecified
Resistance to vancomycin
Resistance to other vancomycin related antibiotics
Resistance to quinolones
Resistance to multiple antibiotics
Resistance to other single specified antibiotic
Resistance to unspecified antibiotic
Resistance to antiparasitic drug(s)
Resistance to antifungal drug(s)
Resistance to antiviral drug(s)
Resistance to tuberculostatic drug(s)
Resistance to multiple antimicrobial drugs
Resistance to other specified antimicrobial drug
Resistance to unspecified antimicrobial drugs
Resistance to antineoplastic drugs
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HRG4 2016/17 Local Payment Grouper ICD-10 5th Edition Changes v2.0
Appendix B: code deletions
A90X
A91X
G903
I48X
I840
I841
I842
I843
I844
I845
I846
I847
I848
I849
L412
R95X
U800
U801
U808
U810
U818
U88X
U898
U899
Z225
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Dengue fever [classical dengue]
Dengue haemorrhagic fever
Multi-system degeneration
Atrial fibrillation and flutter
Internal thrombosed haemorrhoids
Internal haemorrhoids with other complications
Internal haemorrhoids without complication
External thrombosed haemorrhoids
External haemorrhoids with other complications
External haemorrhoids without complication
Residual haemorrhoidal skin tags
Unspecified thrombosed haemorrhoids
Unspecified haemorrhoids with other complications
Unspecified haemorrhoids without complication
Lymphomatoid papulosis
Sudden infant death syndrome
Penicillin resistant agent
Methicillin resistant agent
Agent resistant to other penicillin-related antibiotic
Vancomycin resistant agent
Agent resistant to other vancomycin-related antibiotic
Agent resistant to multiple antibiotics
Agent resistant to other single specified antibiotic
Agent resistant to unspecified antibiotic
Carrier of viral hepatitis
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HRG4 2016/17 Local Payment Grouper ICD-10 5th Edition Changes v2.0
The Documentation Suite - Payment
Below is a list of the various documents which are available to download from the National
Casemix Office website http://www.hscic.gov.uk/casemix/downloads.
This documentation suite provides a comprehensive resource to enable users to understand
design concepts and logic, as well as practical use of the Grouper.
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The Casemix Companion is a starting point and general reference guide for anyone
interested in learning about the casemix classification system used by the NHS in
England. The document provides an introduction to HRGs, groupers, HRG4 design
concepts and grouping logic, and it contains links to additional resources.
The Grouper User Manual provides instructions on how to prepare and group data using
the Grouper software application. Sample data with expected results is provided. This
document is updated with every grouper release.
The Summary of Changes document provides an overview of the main differences
between the current grouper design and its relevant predecessor.
The Chapter Summaries document provides an overview of the scope, composition and
relevant grouping logic of individual HRG subchapters, and it highlights significant
changes to the latest HRG design.
The Worked Examples document contains illustrations of the various concepts and
grouping logic used within the current HRG design.
The Code to Group Workbook is a spreadsheet that embodies the casemix design. It
provides details of the constituent elements that contribute to HRG grouping, and it
contains reference data such as the ICD-10 and OPCS-4 codes utilised in the design, the
procedure and diagnosis hierarchies pertinent to a specific design, and the complication
and comorbidities lists for HRG subchapters. The spreadsheet also includes information
on Programme Budgeting Category (PBC) mapping, as well as a comprehensive list of
HRG codes and labels.
The Code to Group User Manual explains how to make best use of the information
found in the Code to Group Workbook. Specifically, the manual clarifies the grouping logic
found in the workbook’s Code to Group tab.
The Specialised Service Identification Code Sets is a spreadsheet that contains details
about how the grouper allocates specific identification flags relating to specialised
services that may attract a tariff top-up.
The Best Practice Guide is a spreadsheet that contains details about how the grouper
allocates specific identification flags relating to best practice. Best Practice Flags may
result in an adjustment to the tariff. The spreadsheet also details the specific tariff
adjustments applied in the National System (SUS).
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Published by the Health and Social Care Information Centre
Part of the Government Statistical Service
This publication may be requested in large print or
other formats.
For further information
www.hscic.gov.uk
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[email protected]
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This work remains the sole and exclusive property of the Health and Social Care
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the ownership of the Health and Social Care Information Centre.
This work may be re-used by the NHS and government organisations without
permission.
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