HH Grouper Input/Output Record Layout

80.1 – HH Grouper Input/Output Record Layout (Rev. 11644, Issued: 10-13-22, Effective: 04-01-23, Implementation: 04-03-23) The required data and format for the HH Grouper input/output record for periods of care beginning on or after January 1, 2020 are shown below: File Position Format Title Description 1 - 24 X(24) Claim ID Input item: Document control number of the claim record. 25-32 X(8) From Date Input item: The Statement Covers “From” date from the claim, in format CCYYMMDD 33 9 Period Timing Input item: Set to 1 when claim From date matches Admission date or when a CWF sequence edit is received. Otherwise, set to 2. 34 - 35 9(2) Referral Source Input item: If occurrence code 61 or 62 are present on the claim, the code value is moved to this field. The occurrence date is not moved. 36 - 42 X(8) Principal Diagnosis Input item: The principal diagnosis code from the claim. File Position Format Title Description 43 - 50 X(8) Secondary Diagnosis Input item: The first secondary diagnosis code from the claim. 51 - 235 Defined above Additional Secondary Diagnosis data Input items: 23 additional occurrences of secondary diagnoses from the claim. 236-275 X(40) Filler For future use. 276 9 M1033-HOSP- RISK-HSTRY- FALLS Input item: Moved from the M1033-HSTRY- FALL field on the QIES/OASIS screen in FISS. Valid values: 0,1 277 9 M1033-HOSP- RISK- WEIGHT- LOSS Input item: Moved from the M1033-WEIGHT- LOSS field on the QIES/OASIS screen in FISS. Valid values: 0,1 278 9 M1033-HOSP- RISK-MLTPL- HOSPZTN Input item: Moved from the M1033-MLTPL- HOSPZTN field on the QIES/OASIS screen in FISS. Valid values: 0,1 279 9 M1033-HOSP- RISK-MLTPL- ED-VISIT Input item: Moved from the M1033-MLTPL-ED- VISIT field on the QIES/OASIS screen in FISS. Valid values: 0,1 280 9 M1033-HOSP- RISK-MNTL- BHV-DCLN Input item: Moved from the M1033-MNTL-BHV- DCLN on the QIES/OASIS screen in FISS. Valid values: 0,1 281 9 M1033-HOSP- RISK- COMPLIANC E Input item: Moved from the M1033- COMPLIANCE on the QIES/OASIS screen in FISS. Valid values: 0,1 282 9 M1033-HOSP- RISK-5PLUS- MDCTN Input item: Moved from the M1033-5PLUS- MDCTN on the QIES/OASIS screen in FISS. Valid values: 0,1 283 9 M1033-HOSP- RISK-CRNT- EXHSTN Input item: Moved from the M1033-CRNT- EXHSTN on the QIES/OASIS screen in FISS. Valid values: 0,1 284 9 M1033-HOSP- RISK-OTHR- RISK Input item: Moved from the M1033-OTHER- RISK on the QIES/OASIS screen in FISS. Valid values: 0,1 File Position Format Title Description 285 9 M1033-HOSP- RISK-NONE- ABOVE Input item: Moved from the M1033-NONE- ABOVE on the QIES/OASIS screen in FISS. Valid values: 0,1 286-287 9(2) M1800-CRNT- GROOMING Input item: Moved from the M1800-CRNT- GROOMING on the QIES/OASIS screen in FISS. Valid values: 00,01, 02, 03 288-289 9(2) M1810-CRNT- DRESS- UPPER Input item: Moved from the M1810-DRESS- UPPER on the QIES/OASIS screen in FISS. Valid values: 00,01, 02, 03 290-291 9(2) M1820-CRNT- DRESS- LOWER Input item: Moved from the M1820-DRESS- LOWER on the QIES/OASIS screen in FISS. Valid values: 00,01, 02, 03 292-293 9(2) M1830-CRNT- BATHG Input item: Moved from the M1830-CRNT- BATHG on the QIES/OASIS screen in FISS. Valid values: 00,01, 02, 03, 04, 05, 06 294-295 9(2) M1840-CRNT- TOILTG Input item: Moved from the M1840-CRNT- TOILTG on the QIES/OASIS screen in FISS. Valid values: 00,01, 02, 03, 04 296-297 9(2) M1850-CRNT- TRNSFRNG Input item: Moved from the M1850-CRNT- TRNSFRNG on the QIES/OASIS screen in FISS. Valid values: 00,01, 02, 03, 04, 05 298-299 9(2) M1860-CRNT- AMBLTN Input item: Moved from the M1860-CRNT- AMBLTN on the QIES/OASIS screen in FISS. Valid values: 00,01, 02, 03, 04, 05, 06 300-599 X(301) Filler For future use. 601-607 X(7) Version Used Output item: The version of the HH Grouper which grouped the current claim. Informational only. 608-612 X(5) HIPPS Code Output item: The HIPPS code determined by grouping the input items above. Moved to the HCPCS code field of revenue code 0023 line of the claim. 613-614 9(2) Validity Flag Output item: Beginning April 1, 2023, the specific diagnosis coding issue that requires a claim to be returned to the provider. File Position Format Title Description 615-616 9(2) Grouper Return Code Output item: Identified technical issues that may cause no HIPPS code to be assigned. 617-700 X(84) Filler For future use. If the return code is 05, the claim will be returned to the provider for correction because the principal diagnosis is not assigned to a clinical group. If the return code is 03, the claim will be returned to the provider for correction because of a diagnosis coding issue that is indicated by the validity flag.