AR-DRG Version 12.0
Date published: 29 July 2025
The Australian Refined Diagnosis Related Groups (AR-DRG) classification provides a clinically meaningful way to group together treatments and services provided for admitted acute episodes of care to enable hospitals to be funded for these services using activity based funding.
The AR-DRG classification is underpinned by the following diagnosis and intervention classifications and standards:
- International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM)
- Australian Classification of Health Interventions (ACHI)
- Australian Coding Standards (ACS); collectively known as ICD-10-AM/ACHI/ACS.
AR-DRG Version 12.0 was approved by the Pricing Authority in April 2025 and has been developed in accordance with the Governance Framework for the Development of the Admitted Care Classifications. This included consultation with clinicians and other health sector stakeholders represented on IHACPA’s technical and advisory committees. AR-DRG Version 12.0 supersedes AR-DRG Version 11.0 and is proposed to be used to price admitted acute care episodes from 1 July 2026, subject to approval by the Pricing Authority.
The Definitions Manual for AR-DRG Version 12.0 is published as a set of three volumes which contain the following products:
- Volume 1: DRGs A13A–I80Z
- Volume 2: DRGs J01A–Z66Z
- Volume 3: Appendices
The AR-DRG Version 12.0 Definitions Manual is available to purchase from the Lane Print website.
Additional resources related to AR-DRG Version 12.0 include:
- Final Report – outlines the changes made for AR-DRG Version 12.0 and details the refinement process and rationale for changes.
- Technical Specifications – details the methodology and technical specifications used in the development of AR-DRG Version 12.0, including:
- data preparation and modification
- Adjacent Diagnosis Related Group (ADRG) intervention hierarchy review
- derivation of the Episode Clinical Complexity Score (ECCS)
- ADRG splitting review.
- Descriptions – provides a full listing of long and short descriptions for Major Diagnostic Categories, Adjacent Diagnosis Related Groups and Diagnosis Related Groups.
- Definitions Manual Appendices – electronic versions of the AR-DRG Version 12.0 Definitions Manual Volume 3: Appendices:
- Appendix A: Diagnosis code/Major Diagnostic Category/Adjacent Diagnosis Related Group Index
- Appendix B: Intervention code/Major Diagnostic Category/Adjacent Diagnosis Related Group Index
- Appendix C: Diagnosis Complexity Level exclusions
- Appendix D: Age, sex and length of stay conflicts
- Appendix E: General Interventions
- Fact sheet – provides an overview of AR-DRGs and the development of Version 12.0.
Please note that the purchase and use of these products are subject to licence arrangements.
Key updates for AR-DRG V12.0 include:
- Review of MDC 14 Pregnancy, childbirth and the puerperium with refinements to improve the clinical meaningfulness and resource homogeneity within this MDC.
- Creation of ADRG A16 Posthumous organ procurement.
Development of guiding principles to inform the grouping of episodes of care to the intervention partition of the AR-DRG classification
AR-DRG education
Education on AR-DRGs is available on IHACPA Learn.
Modules are self-paced and include knowledge checks. Users can track their learning progress and download a certificate upon completion.
New users must register to access IHACPA Learn.
A list of commonly asked questions is available in the Help menu on IHACPA Learn.
Courses
Revised in 2025, this module provides an overview of AR-DRGs including:
- classification structure
- logic flow
- the complexity model
- DRG assignment.
Two modules that outline the changes for AR-DRG V12.0.
AR-DRG V12.0 Standard Refinements
This is the first of 2 modules explaining the refinements for AR-DRG V12.0. Each new version of AR-DRGs includes a standard set of refinements to maintain the currency of the classification, using the latest activity and cost data. This module covers the review of:
- ADRG intervention hierarchy
- ADRG 801 General Intervention unrelated to principal diagnosis
- ICD-10-AM codes that contribute to episode complexity
- ADRG splitting.
AR-DRG V12.0 Specific Refinements
This is the second of 2 modules outlining the refinements for AR-DRG V12.0. Each new version of AR-DRGs includes specific refinements in addition to the standard refinements. This module covers AR-DRG V12.0 refinements to:
- pregnancy, childbirth and the puerperium
- intervention type
- posthumous organ procurement.
It also includes a summary of the results from both the standard and specific refinements along with a comparison between AR-DRG V12.0 and AR-DRG V11.0.
Resources
Previous versions:
Last updated: 15 September 2025