Case 2011-MDC05-01 Cardiac arrest
|Target version:||Expert Group 2011|
|MDC:||MDC05||Owner / responsible:|
|Target Grouper:||COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE||Old forum status:||CLOSITEM - Closed item|
Last updated: 2011-04-20
Status: CLOSITEM - Closed item
By: Barbro Ohde [email@example.com]/NPK, Sweden
Expert Network 2011-03-17 - Change recommended
Board 2011-04-04 - Recommendation accepted
CPK ID 358
The initiator pointed out that a case with the principal diagnos I46.0 (Cardiac arrest with successful resuscitation) is grouped to DRG 129 (Cardiac arrest, unexplained) with the weight 1,5004 but if a coronary angiography (AF037) is performed the case is grouped to DRG 124 (Diagnostic percutan cardiac procedure w circulatory complex dx) with the weight 1,0678. Thus the addition of a procedure results in a DRG with lower weight and there is an economic incitement to avoid reporting procedures which can lead to incorrect medical registers.
Analysis by NPK
We first tackled this as a hierarchy problem for DRG 129 and 124 and considered a change in the Drglocic table so that the rule for DRG 129 is placed between the rules for DRG 126 and 120 according to the Swedish weights for 2011. See table below.
We tested that solution on the Swedish Patient register and found that some cases in DRG 121, 123 and 124, totally 140 cases, were transferred to DRG 129 according to the table below.
Is such a transferral wanted in a medical perspective? Is it really more important to describe that the patients have a cardiac arrest (DRG 129) than that they have a myocardial infarction (DRG 121 & 123) or that they have had an intervention (DRG 124)? These questions made us look at the content in DRG 129. According to the definition tables the following diagnosis codes are grouped to DRG 129, if registered as principal diagnosis.
It is obviously wrong that R960 and R961 are grouped to DRG 129 because R96 excludes cardiac death. R96 should be handled like R98 (Unattended death).
The remaining codes (I46) are probably associated with cardiac infarction in most cases and the reason why the cases with these codes not are grouped to the infarction groups (DRG 121-123) is probably depending on under coding. We find it especially strange that patients that have survived the cardiac arrest (the I460 cases) not have got a more precise diagnosis.
The average costs for the patients in DRG 129 are presented in the table below.
We suggest that the DRG 129 is deleted. The cases with R96 should be handled like R98 cases. The rest (I46 cases) can be handled like cardiac infarction cases and be grouped to DRG 121-125 depending on outcome (death within 3 days = DRG 123) or procedures (DRG 124/125 or 121/122).
With the suggested solution we also want the expert network to discuss if some kind of validation rule should be introduced to force the clinicians to be more precise in coding. It is unbelievable that patients with cardiac interventions or more than 3 days of hospital stay don’t have a more precise diagnosis than “cardiac arrest”.
The technical changes to achieve the suggested grouping changes can be specified later.
Expert Network 2011-03-17
The meeting recommended acceptance of that the diagnosis R96.0 and R96.1 should be grouped to MDC 23 and should have the same properties as R 98.
The case will be postponed for further investigation of the diagnosis I46.xx by Sweden.
Technical change 2011-03-28
Dx R96.0 ’Instantaneous death’ and R96.1 ‘Death occurring less than 24 hours from onset of symptoms, not otherwise explained’ are assigned to diagnosis category 23M99 ‘Other factors influencing health status’. The property 05M05 ‘Cardiac arrest’ is removed.
DRG change 2011-03-28
Cases with R96 code as principal dx are assigned to MDC 23 DRG’s.