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Pennsylvania DRG Grouper Version
There has been some confusion on which
DRG Grouper version to use for both ACT 44 or Workers’ Compensation Claims Use DRG Version 12 for all dates of services (change in years does not matter);
ACT 6 or Auto Insurance Claims DRG Version 12 for service dates on/after 10-01-94 and on/before 09-30-95 DRG Version 13 for service dates on/after 10-01-95 and on/before 09-30-96 DRG Version 14 for service dates on/after 10-01-96 and on/before 09-30-97 DRG Version 15 for service dates on/after 10-01-97 and on/before 09-30-98 DRG Version 16 for service dates on/after 10-01-98 and on/before 09-30-99 DRG Version 17 for service dates on/after 10-01-99 and on/before 09-30-00 DRG Version 18 for service dates on/after 10-01-00 and on/before 09-30-01 DRG Version 19 for service dates on/after 10-01-01 and on/before 09-30-02 DRG Version 20 for service dates on/after 10-01-02 and on/before 09-30-03 DRG Version 21 for service dates on/after 10-01-03 and on/before 09-30-04 DRG Version 22 for service dates on/after 10-01-04 and on/before 09-30-05 DRG Version 23 for service dates on/after 10-01-05 and on/before 09-30-06 DRG Version 24 for service dates on/after 10-01-06 and on/before 09-30-07 DRG Version 25 for service dates on/after 10-01-07 and on/before 09-30-08
REMEMBER: Act 44 is frozen on Version 12, and Act 6 changes as Medicare changes.
DRG Crosswalking
Effective for ACT 6 services on or after
October 1, 1998, several DRG numbers
were discontinued and reassigned a
new DRG Number, however for ACT 44 claims the original DRG numbers will continue
to be used. Furthermore, Grouper 25 effective for dates of
service on or after 10-01-2007 is an entirely new Grouper and is impossible to
crosswalk back to the ACT 44 grouper versions. The crosswalk of
Grouper 24
DRG numbers back to their original DRG numbers are as follows:
DISCLAIMER: The below crosswalk is our professional opinion, it may not be accurate.
ACT 6 (GRP 24 or <) ACT 44 DRG 497 DRG 214 DRG 498 DRG 215 DRG 499 DRG 214 DRG 500 DRG 215 DRG 501 DRG 221 DRG 502 DRG 222 DRG 503 DRG 222 DRG 504 DRG 458 DRG 505 DRG 457 DRG 506 DRG 458 DRG 507 DRG 458 DRG 508 DRG 459 DRG 509 DRG 460 DRG 510 DRG 459 DRG 511 DRG 460 DRG 512 DRG 191 DRG 513 DRG 191 DRG 514 DRG 104 DRG 515 DRG 105 DRG 516 DRG 112 DRG 517 DRG 112 DRG 518 DRG 112 DRG 519 DRG 214 DRG 520 DRG 215 DRG 521 DRG 434 DRG 522 DRG 436 DRG 523 DRG 435 DRG 524 DRG 15 DRG 525 DRG 116 DRG 526 DRG 112 DRG 527 DRG 112 DRG 528 DRG 7 DRG 529 DRG 110 DRG 530 DRG 111 DRG 531 DRG 4 DRG 532 DRG 4 DRG 533 DRG 5 DRG 534 DRG 5 DRG 535 DRG 104 DRG 536 DRG 104 DRG 537 DRG 231 DRG 538 DRG 231 DRG 539 DRG 400 DRG 540 DRG 400 DRG 541 DRG 483 DRG 542 DRG 483 DRG 543 DRG 1 DRG 544 DRG 209 DRG 545 DRG 209 DRG 546 DRG 4 DRG 547 DRG 106 DRG 548 DRG 106 DRG 549 DRG 107 DRG 550 DRG 107 DRG 551 DRG 115 DRG 552 DRG 116 DRG 553 DRG 478 DRG 554 DRG 478 DRG 555 DRG 112 DRG 556 DRG 112 DRG 557 DRG 112 DRG 558 DRG 112 DRG 559 DRG 14 DRG 560 DRG 20 DRG 561 DRG 20 DRG 562 DRG 24 DRG 563 DRG 25 DRG 564 DRG 25 DRG 565 DRG 475 DRG 566 DRG 475 DRG 567 DRG 154 DRG 568 DRG 154 DRG 569 DRG 148 DRG 570 DRG 148 DRG 571 DRG 182 DRG 572 DRG 182 DRG 573 DRG 303 DRG 574 DRG 395 DRG 575 DRG 416 DRG 576 DRG 416 DRG 577 DRG 112 DRG 578 DRG 415 DRG 579 DRG 415
Processing Issues
The following are processing issues for your operators of our system: - Mercy Catholic Medical Center in Philadelphia
has
two(2) divisions; the - In our provider table we
have providers with an extension “A” (see above). It - For Ambulatory Surgical Claims
(ASC)
that are processed as an - For Ambulatory Surgical Claims (ASC)
that are processed as a Part B
System Updates
We update our system on the following schedule every year: February 15th or 30 days Charge Master release whichever is later For the January 15th Charge Master release and other BWC fee schedule updates, and Medicare Physician, DME, and APC Fee Schedules. May 15th or 30 days after Charge Master release whichever is later For the April 15th Charge Master release and the Provider Table. August 15th or 30 days after Charge Master release whichever is later For the July 15th Charge Master release and the Provider Table. November 15th or 30 days after Charge Master release whichever is later For the October 15th Charge Master release, Provider Table, and new PPS calculations and data tables. Ensure that you update our system on a
timely basis as each update could have
PA Act 44 Statewide Average Weekly Wage %
Annual Overall
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