Glossary of Healthcare Terms: D

D&C

Dilation and Curettage. A minor surgical procedure (physically, but not emotionally) to scrape the walls of the uterus. This procedure is most often used to effect an abortion and it's used as a euphemism for it.

DAW

Dispense As Written (DAW). Prescribers will sometimes add the abbreviation “DAW” to a prescription to advise pharmacists not to modify the script (e.g., not to dispense a generic drug in place of a branded drug). Also written as “Do Not Substitute” (DNS).

DCG

Diagnostic Cost Groups. They enable HCFA to modify its payments to HMOs based on the health of the Medicare beneficiaries they enroll.

For more information, see DxCG

’s site.

DDD

Drug Distribution Data. This is wholesaler distribution data aggregated by ZIP codes. Suppliers use this data to determine whether or not GPO members (e.g., hospitals) are living up to their volume commitments.

DDS

Doctor of Dental Surgery. See DMD.

DEA

Data Encryption Algorithm. Used for security purposes to scramble data, such as the Personal Identification Numbers (PINs) on credit/debit cards.

DEA Code

An identification number assigned by the Drug Enforcement Administration (DEA) to healthcare entities for purposes of drug disbursement.

This code indicates the level of control exercised by the DEA over drugs which have potential for abuse. Individuals prescribing and dispensing controlled drugs are required to register with the DEA for approval within the appropriate DEA Code category(ies). The current code list is:

Code	Description	Use	Examples
1	Schedule I	LSD, Heroin, Marijuana	Research only
2	Schedule II	Most abused	Morphine, Meperidine, Amphetamines, etc.
3	Schedule III	Less abused	Aspirin/Codeine, etc.
4	Schedule IV	Potential abuse	Valium, etc.
5	Schedule V	Controlled sale by pharmacy only
N/A	Legend	Uncontrolled substance

Deductible

A specified amount of money a member must pay out-of-pocket every year before insurance benefits begin.

DEERS

Defense Enrollment Eligibility Reporting System

Defined Contributions

A defined contribution health plan gives employees the dollars to shop for their own healthcare coverage. These kinds of health plans, are to traditional employer-sponsored plans, as a 401(k) plan is to old-styled retirement plans. The idea is to give employees $5,000 to $6,000 a year tax-free to buy their own health insurance policy.

The plan puts individuals — not insurers, employers, managed care companies or the government — in charge of their own health care decisions, with an incentive to shop around and spend their health care dollars carefully.

Delivery Time

The time normally elapsed between the time a supply requisition is issued and the time it is received.

Demand

A need for a particular item.

Denial of Claim

Refusal by an insurance company to honor a claim or request for payment for healthcare services. This may happen due to the service not being covered, failure to obtain Pre-Admission Certification, or some confusion thereof.

DES

Data Encryption Standard. The standard maintained by the American National Standards Institute (ANSI

) for Data Encryption Algorithm specifications.

DHHS

Department of Health and Human Services

DICOM

The Digital Imaging and Communications in Medicine (DICOM

) is a specification published by the American College of Radiology

and National Electrical Manufacturers Association

. NEMA also publishes specifications for medical devices

DINB

Doc-In-The-Box. This is an often-used off-handed way of referring to a physicians practice or medical group located in a remote location where they have to provide more services than they would if located in an urban center.

In particular, a DINB is more likely to dispense drugs and other medical supplies than the equivalent practice in or near an urban center.

Discharge

An event that occurs when a patient goes through the hospital's discharge process (usually associated with leaving the hospital at that time). The term does not imply any state of morbidity or mortality.

Disease Management

Refers to the management of diseases, including risk assessment, prevention, intervention and outcomes analysis. An underlying concept with disease management is to address care of diseases, usually high profile diseases, with preventive measures and specific treatment plans based on a patient's personal history and family history in an effort to provide better care and significantly reduce associated costs. See Disease State Management.

Disease State Management

See Disease Management.

DME

Durable Medical Equipment.

DMD

Doctor of Dental Medicine. See DDS.

DME

Durable Medical Equipment. Usually for home care (e.g., walker, cane).

DNR

Do Not Resuscitate.

DNS

Do Not Substitute (DNS). Prescribers will sometimes add the abbreviation “DNS” to a prescription to advise pharmacists not to modify the script (e.g., not to dispense a generic drug in place of a branded drug). Also written as “Dispense As Written” (DAW).

Doctor of Osteopathy.

DOA

Dead on Arrival. Heard often on NYPD Blue.

Dosage Form

Describes how a drug is formulated (e.g., capsule, cream, tablet, suppository, etc.).

Dose Frequency

The daily frequency, or how many times during a 24 hour period a given drug dosage is taken for a known disease state.

DOT

Surgical slang for Dead On the Table.

DOW

Died of Wounds.

DPAHC

Durable Power of Attorney for Health Care. See Advance Directive.

DRG

Diagnosis-Related Group, a patient classification system developed by 3M for the Health Care Financing Administration (Medicare, Medicaid, Child Health). This is a code that specifies the diagnosis and the treatment for a case. It groups patients (really, billable events) into predefined categories. The actual calculation of the DRG code is done by a class of software called “grouper.” An interesting fact to note is that 3M

changes the category hierarchy every year. This implies that historical DRG data is not necessarily consistent from one year to the next. Therefore, in order to analyze historical, multi-year data, the DRG codes must be recalculated with the most recent grouper to make all records consistent.

There may be a preliminary DRG (i.e., assigned at the time of admission), and an in-progress DRG, but the only one considered for billing purposes is the discharge DRG (i.e., assigned at the time of discharge or transfer to another institution).

See also APR-DRG.

In some circles, DRG stands for “Dah Revenue’s Gone.”

Drug Category Code

The Drug Category Code indicates that a drug product belongs to a category that is commonly treated as an exception in third-party plans. The current codes in use are,

CODE	DESCRIPTION
0	Unspecified
A	Anti-Anxiety Agents
B	Fertility Agents
C	Contraceptives, Oral
D	Diagnostics
E	Fluoride Preparations (excluding Vitamin Combinations)
F	Antiobesity Drugs/Amphetamines
G	Antacids
H	Hematinics
I	Insulins
J	Smoking Deterrents
K	AIDS related drugs
L	Laxatives
M	Reusable Needles (all)
N	Disposable Needles (all)
O	Reusable Syringes w/wo Needles (Non-Insulin)
P	Disposable Syringes w/wo Needles (Non-Insulin)
Q	Reusable Syringes w/wo Needles (Insulin)
R	Disposable Syringes w/WO Needles (Insulin)
S	Diabetic Supplies, Miscellaneous
T	Contraceptives, Topical
U	Products used for approved or unapproved cosmetic indications
V	Vitamins, commonly excluded
W	Contraceptives, Implantable
Y	Ostomy Supplies

Drug Class

This code classifies a drug according to its availability to the consumer per Federal specifications. The codes currently in use are,

CLASS	DESCRIPTION
O	Over-the-Counter (OTC). Contains all the proper labeling for OTC sale and no Federal Legend on the label.
F	Federal Legend present on the label; requires a prescription. Some products may not have a Federal Legend, but they may still require a prescription if they are not labeled for OTC use.

Drug Enforcement Administration (DEA) Code

The DEA Code denotes the degree of potential abuse and, thus, the level of control exercised by the DEA over drugs which according to their potential for abuse.

Individuals prescribing and dispensing controlled drugs are required to register with the DEA for approval within the appropriate DEA Code categories. The current code list is:

Code	Description	Use
0	Uncontrolled substance
1	LSD, Heroin, Marijuana	Research only
2	Morphine, Meperidine, Amphetamines, etc.	Most abused
3	Aspirin/Codeine, etc.	Less abused
4	Valium, etc.	Potential abuse
5	Controlled sale by pharmacy only

This code is subject to change by Federal regulation.

Drug Form Code

The Drug Form Code indicates the basic drug unit of measurement for performing price calculations. The current codes are:

Code	Drug Form	Unit
1	Tablets, kits, etc.	Each
2	Liquids	ml
3	Solids	gm

Drug Pricing

In addition to their therapeutic effect, drug prices are influenced by how they are marketed and even their legal status. They can be:

•	Priced as a generic; not protected by patent.
•	Priced as a brand; patent protected.
•	Patent protected, cross-licensed multi-sourced drugs can be sold under more than one brand name, but are not true generics. These are marketed as different brands, or they can be sold as brands by the NDA holder and as “generics” by a licensee or division.

Drug Strength

A description of drug potency expressed in metric units.

Drug Utilization Evaluation

This is the process by which the use of drugs throughout a hospital is continuously and formally reviewed. DUEs are performed in order to collect and analyze drug use data, to identify trends and inappropriate drug usage, and to implement programs to rectify identified problems. These evaluations are designed to address all aspects of medication use, including the prescription, preparation, dispensing, and monitoring of drugs.

Under managed care, cost has also become part of the DUE process.

DSM

Diagnostics Standards Manual, for Mental Health.

DSM

Disease state management. According to Medicine on the Net

, this is “the process of treating or maintaining the stability of a … disease using established procedures, pharmacological regimens, or lifestyle changes.” According to the same source, DSM can include the following components,

•	Case management
•	Clinical pathways
•	Clinical protocols and guidelines
•	Medication management
•	Outcomes measurement
•	Evidence-based medicine
•	Utilization review
•	Patient education

“The theory behind DSM is that if you manage a disease or condition throughout an individual's lifetime and across the care continuum, care should improve and costs should go down.”

For examples of DSM online, see the following sites,

•	University of Texas MD Anderson Cancer Center
•	TransMed Network
•	Hoechst Marion Roussel, Inc.
•	Eli Lilly's PCS Health System, Inc.

Other, disease-specific sites,

•	Eli Lilly Co.
•	Diabetes Self-Management
•	The American Association of Clinical Endocrinologists

DTC

Direct-To-Consumer. Most often used in reference to the movement by drug manufacturers to advertise prescription drugs directly to consumers, bypassing physicians. Providers and insurance companies (the organizations at risk for the cost of delivery) don't like it because it puts pressure on physicians to prescribe specific brand name drugs instead of generics or less costly brands. Drug manufacturers insist that their intention is to educate the public.

By the way, this is not an issue in Europe because the practice is not allowed. Different rules apply throughout Asia and Latin America.

DTF

Dental Treatment Facility.

DTR

Dental Treatment Room.

DUE

Drug Utilization Evaluation.

DUR

Drug Utilization Review. Same as Drug Utilization Evaluation (DUE) or Utilization Review. It is a formal program for comparing data on drug use against explicit, prospective standards and, as necessary, introducing remedial strategies to achieve some desired end. Three primary objectives of DUR are, improving quality of care, conserving drug funding resources and controlling individual expenditures, and maintaining program integrity (i.e., controlling fraud and benefit abuse).

Retrospective DUR is a systematic process that involves selection, review, analysis, and interpretation of drug use data that are collected and analyzed after events occur. Retrospective DUR is used to identify drug utilization trends that warrant further education of practitioners and patients; it also highlights areas of system abuse that might call for more extensive peer-level review and provides mechanisms for evaluation and modification of program criteria and standards.

Prospective DUR refers to systems that are designed to influence drug prescribing, dispensing, or use in a real-time environment. Implementation of such a system requires that a healthcare professional with patient care responsibilities have sufficient information regarding a patient’s medical condition, drug use profile, and history to make an informed decision regarding new or renewed drug use.

Shorthand for “diagnosis.” See also, Fx, Hx, Mx, Px, Rx, Sx, Tx.

Dynamic Order Quantity

See Economic Order Quantity.