HRG4+ 2020/21 Local Payment Grouper V2 (COVID-19)

Download the HRG4+ 2020/21 Local Payment Grouper Version 2 (COVID-19) application

In response to the global pandemic and following updated guidance from the WHO, updates to coding guidance from the Clinical Classifications Service have been issued in relation to the use of the following ICD codes:

U07.1 COVID-19, virus identified

Must only be assigned for laboratory confirmed cases of COVID-19 (i.e. positive test result)

U07.2 COVID-19, virus not identified

Is used when COVID-19 is diagnosed clinically or epidemiologically but laboratory testing is inconclusive or not available.

Further details can be found:

https://hscic.kahootz.com/connect.ti/t_c_home/view?objectID=19099248

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In response, the National Casemix Office has created an updated HRG4+ 2020/21 Local Payment Grouper Version 2 (COVID-19).

This re-issue of the national design subsumes and replaces the HRG4+ 2020/21 Local Payment Grouper published in March 2020, and the updated Grouper should be used for the finacial year 2020/21 from April 1 2020.

This Grouper has been updated to reflect changes in the HRG mapping of codes relating to the COVID-19 infection, and includes a new Subchapter DX COVID-19 Infection, which includes six new HRGs for patients of all ages with a primary diagnosis of either test positive or clinically-determined COVID-19, and no significant procedure(s). It has been agreed with Pricing Policy that the updated Local Payment Grouper is to be adopted as the national standard for the 2020/21 financial year and the National Reimbursement System (SUS+) will similarly be updating the Autogrouper.

We strongly advise that you read the HRG4+ 2020/21 Local Payment Grouper Version 2 (COVID-19) Summary of Changes document to become familiar with the changes introduced and also read the Chapter Summaries (especially in relation to the new DX subchapter)

The Local Payment Grouper had previously been updated to accommodate the OPCS-4.9 release, (within the March 2020 release) which came into effect from 1 April 2020.

The HRG4+ 2020/21 Local Payment Grouper Version 2 (COVID-19) should be used to:

• group data and derive HRGs
• support data quality
• conduct ‘what-if’ modelling
• assess local activity and reimbursement under the National Tariff for the 2020/21 financial year (subject to the instructions issued to the NHS by Simon Stevens)

The Local Payment Grouper should be used in conjunction with the HRG4+ 2020/21 Local Payment Grouper User Manual, which explains how data should be sorted and presented for processing by the grouper.

Summary of Changes v2 – this document replaces and subsumes the document published alongside the March 2020 release and summarises the updates to both the product and underlying design against the 2019/20 Local Payment product release. Users are strongly advised to read before using the updated Grouper.

Casemix Companion - this document is a starting point and general reference guide for anyone interested in learning about the casemix classification system used by the NHS in England. It provides an introduction to HRGs, Groupers, HRG4+ design concepts and grouping logic, and it contains links to additional resources.

Grouper User Manual - this document provides full instructions on how to prepare and group data using the updated HRG4+ Grouper software application, as well as illustrating how the revised product can be used to support users.

Chapter Summaries v2 - this document replaces and subsumes the document published alongside the March 2020 release, and provides an overview of the scope, composition and grouping logic of individual subchapters, including the update to the new HRG design.

Code to Group v2 - this workbook replaces and subsumes that published alongside the March 2020 release. This workbook provides details of constituent elements that contribute to HRG grouping. It contains reference data, such as the ICD-10 and OPCS-4 codes used in the design, procedure and diagnosis hierarchies relevant to a specific design, and the Complication and Comorbidities lists for HRG subchapters. It also includes information on Programme Budgeting Category (PBC) mapping and a comprehensive list of HRG codes and labels.

Test data and expected results – these files provide sample data to test the Grouper installation (running the sample data should result in 90% grouped, 10% ungrouped). The file format of the sample data is representative of that in the default RDFs, provided within the Grouper application. These files can easily be used as example patient data, or as a template to understand the required input to the Grouper to enable successful grouping. 

If you have any issues, ideas or feedback on the current product, please contact [email protected] or mail us at [email protected].

For more details about the National Tariffs for 2020/21, please see NHS Improvement website

Visit our archive to view downloaded historical versions of Groupers and documentation