Case #167

Case 2010-MDC03-01 Hierarchy problem in MDC 03

Added by Anonymous about 7 years ago.

Status:AcceptedStart date:2014-01-13
Priority:NormalSpent time:-
Assignee:-
Category:-
Target version:Expert Group 2010
Initiator:Sweden Target year:2011
MDC:MDC03 Owner / responsible:
Target Grouper:COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE Old forum status:CLOSITEM - Closed item

Description

Last updated: 2010-04-09
Status:CLOSITEM - Closed item
Initiated: 2010-01-14
By: /CPK, Sweden
Expert Network 2010-03-12 - Change recommended
Board 2010-04-09 - Recommendation accepted

BACKGROUND

CPK ID 331

Problem

An adenoidectomy or tonsillectomy in outpatient care is allocated to DRG 060O (Operations on tonsils or adenois, short therapy) with the weight 0,1909 (Sweden 2010). If an excision of a lesion of the lip (EAA10) is done in the same session the case is allocated to DRG 169O (Mouth procedures, short therapy) with the weight 0,1111. Thus, the addition of a secondary procedure results in a DRG with lesser weight. This is undesirable because we have a risk for underreporting of procedures, which will lead to incorrect medical registers.

Analysis

The weights in question are based on a large number of observations and seem to be OK. The problem is caused by a hierarchy problem in the outpatient part of MDC 03.

Suggestion

The rule for DRG169O with ORD 103D0100 should be moved to below the last rule for DRG 060O.

COMMENTS

Expert Network 2010-03-12

The meeting recommended accepting the proposal to move the rule for DRG169O with ORD 103D0100.

CHANGES

Technical change

The rule for DRG 169O (currently ORD 103D0100) is moved to ORD 103D15900 (after DRG 060O).

DRG change

Cases with both procedures for DRG 060O and 169O are assigned to DRG 060O.

Introduction

2011

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