Skip to main content

TMHP to Use Grouper Version 37.1 for Dates of Discharge on or after April 1, 2020

Last updated on 3/18/2020

Effective for dates of discharges on or after April 1, 2020, Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program will use version 37.1 of the All Patient Refined-Diagnosis Related Groups (APR-DRG) system to process inpatient claims.

In response to recent occurrences of vaping related disorders, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is implementing a new diagnosis code into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), for reporting vaping-related disorder. Grouper Version 37.0 is being updated to version 37.1 to accommodate new diagnosis code U070.

Impacts to existing DRGs are currently unknown. Any changes to relative weights, mean length of stay, day thresholds, and definitions resulting from this release will be made available on the Texas Medicaid Acute Care Hospital Reimbursement web page as soon as possible. Impacted claims with dates of discharge on or after April 1, 2020, will be reprocessed as necessary to capture APR-DRG changes resulting from this release.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.