Table 1 Condition codes in claims for DPC and non-DPC hospitalizations
Type of claims for hospitalization | Description |
|---|---|
I. Claims for DPC hospitalization | |
A. DPC code | A mandatory code with 14 digits. The first 6 digits represent a group of conditions to which B-1 below belongs, followed by the 8 digits indicating whether or not the patient had surgical operation, other procedures and other relevant conditions |
B. ICD-10 codesa | ICD10 codes for 7 categories of conditions (B-1 to B-7 below) |
B-1. Greatest-resource condition | A mandatory code for a condition responsible for the greatest use of resources |
B-2. Trigger-for-hospitalization condition | A mandatory code for a condition that triggered hospitalization. |
B-3. Main condition | A mandatory code for a condition given as the main condition in the discharge summary |
B-4. Other condition | A code for a condition required to record when the DPC code indicates that the patient had a defined other relevant condition |
B-5. Second greatest-resource condition | An optional code for a condition responsible for the second greatest use of resources |
B-6. Comorbidities at the time of admission | A maximum of 4 codes for comorbidities that the patient had at the time of admission |
B-7. Conditions occurring during the hospitalization | A maximum of 4 codes for conditions occurring during the hospitalization |
II. Claims for non-DPC hospitalization | |
Condition codes | Local condition codes with 7 digits. They are officially mapped to ICD-10 codes with a few exceptions. No limitation is set to the maximum number of conditions per claim. |
Primary-condition flag | The flag indicating that the condition is the primary condition. The flag is often not given to any condition or given to two or more conditions |