Case #180

Case 2009-MDC10-01 Diabetes in MDC 01, 02, 05 and 11

Added by Anonymous almost 8 years ago.

Status:AcceptedStart date:2014-01-15
Priority:NormalSpent time:-
Assignee:-
Category:-
Target version:Expert Group 2009
Initiator:Sweden Target year:2010
MDC:MDC10 Owner / responsible:
Target Grouper:COMMON Old forum status:CLOSITEM - Closed item

Description

Last updated: 2009-06-22
Status: CLOSITEM - Closed item
Initiated: 2008-02-19
By: Olafr Steinum, Barbro Ohde and Ann Liljeström/CPK, Sweden
Expert Network 2009-02-26 - Change recommended
Board 2009-03-20 - Recommendation accepted

BACKGROUND

CPK ID 262

Problem

The experts of Primary Classifiations have noticed that today E10-E14 with .2-.5 will in the DRG classification go to MDC 01, 02, 05 or 11. They suggest that they instead should go to where they clinical belong, to MDC 10 and in outpatient care go to DRG 836O or DRG 836P.

Analysis

See tables Diabetes In-patients and Diabetes Out-patients

In-Patients:

There is no serious problem to accept the suggested changes looking at the overall figures for costs but there are four groups that cost quite a lot more than the rest. These are the Diabetes patients over 35 yrs in DRG 130, 131 (peripheral vascular disorders w cc or w/o cc) and DRG 331 (Other kidney and urinary tract diagnoses) and Diabetes patients in DRG 295 (Diabetes 0-35). These groups cost substantially more then the other groups and that has to be taken into consideration.

Out-patients:

There is no serious economical problem to accept the suggested changes.

Suggestion

CPK supports the suggested changes but there might be necessary to make one more DRG in MDC 10 for complicated Diabetes >35 yrs. Cases with vascular disorders (diabetes cases in DRG 130 and 131) or kidney disorders (diabetes cases in DRG 331) should be included in that group but other complicated cases could of course also be included in the future.



COMMENTS

Martti Virtanen 2009-02-20

Den essentiella frågan är, behandlas dessa patienter för diabetes eller för organkomplikation. Det att enskilda patienter kan med hänsyn till resursförbruk flyttas till en annan grupp, ger ingen information om detta. Frågan är vilken gruppering beskriver den kliniska verksamheten bäst.

Jag ser två möjligheter att analysera detta problem:

  1. I vilka enheter behandlades dessa patienter? Om det var i endokrina eller diabetes avdelningar, talar det för att det kanske var mera diabetes och mindre behandling av organkomplikation.
  2. Vilka åtgärder har man gjort åt dessa patienter? Finns det patienter som skulle hamna i DRG 468/477 på grund av denna förändring.

Den rätta kodningen för dessa fall, när man behandlar organkomplikationer, är en dagger-asterisk kombination, där asterisk-koden styr patienten i NordDRG ändå till MDC och DRG för organet i fråga. Därför är förslaget i princip helt rätt. Om man enbart anger diabeteskoden, grupperas patienten till diabetesgrupper.

Jag önskar, att alla länder skulle ta ställning till denna fråga. Eftersom saken inte är brådskande är det väl skäl att begära att alla är eniga om detta ärende.

Expert Network 2009-02-26

The meeting recommended that all diabetes codes E10-14 should be moved to MDC 10. An asterix-dagger code should be used in treatment of organ complications but to compensate for incorrect coding (and to prevent from more cases in DRG 477/477O and serious economic side effects by the change) special rules will be constructed so that procedures in MDC 01, 02, 05 or 11 for diabetic conditions still are grouped to the same DRGs as before the change.

CHANGES

Technical changes

Following new principal diagnosis properties are created:

  • 01P05 ‘Diabetes complicating nervous system’
  • 02P02 ‘Diabetes complicating eye’
  • 05P02 ‘Diabetes complicating circulatory system’
  • 11P01 ‘Diabetes complicationg urinary system’
  • All codes of type E1x.2 ‘xxxx diabetes mellitus with neurological complications’ are moved from diagnosis category 11M99 ‘Other kidney and urinary tract diagnoses’ to diagnosis category 10M01 ‘Diabetes’ and these codes are given the new property 11P01.
  • All codes of type E1x.3 ‘xxx diabetes mellitus with ophthalmic complications’ are moved from diagnosis category 02M99 ‘Other disorders of the eye’ to diagnosis category’ to 10M01 and these codes are given the new property 02P02.
  • All codes of type E1x.4 ‘xxx diabetes mellitus with neurological complications’ are moved from diagnosis category 01M08 ‘Cranial and peripheral nerve disorders’ to 10M01 and these codes are given the new property 01P05.
  • All codes of type E1x.5 ‘xxx diabetes mellitus with peripheral circulatory complications’ are moved from diagnosis category 05M06 ‘Peripheral vascular diseases’ to 10M01 and these codes are given the new property 05P02.

New rules are created in the NordDRGlogic:

  • A copy of current rule 401D051(DRG 005X ‘Extracranial vascular procedures’) is placed after the current rule. From MDC 01 is removed and Pdgprop is given value 01P05.
  • A copy of current rule 401D0712 (DRG 007X ‘Periph & cranial nerve & other nerv sys proc w cc’) is placed after the current rule. From MDC 01 is removed and Pdgprop is given value 01P05.
  • A copy of current rule 401D0722 (DRG 008X ‘Periph & cranial nerve & other nerv sys proc w/o cc’) is placed after the current rule. From MDC 01 is removed and Pdgprop is given value 01P05.
  • A copy of current rule 402D035(DRG 036A ‘Other retinal procedures’) is placed after the current rule. From MDC 02 is removed and Pdgprop is given value 02P02.
  • A copy of current rule 402D05110 (DRG 039X ‘Lens procedures with or without vitrectomy’) is placed after the current rule. From MDC 02 is removed and Pdgprop is given value 02P02.
  • Copies of current rules 405D13011 (DRG 478X ‘Other vascular procedures w cc’) and 405D13012 (479X ‘Other vascular procedures w/o cc’) is placed after the current rules. From MDC 05 is removed and Pdgprop is given value 05P02.
  • A copy of current rule 411D1410 (DRG 315X ‘Other kidney & urinary tract o. r. procedures’) is placed after the current rule 411D1411. From MDC 11 is removed and Pdgprop is given value 11P01.
  • A copy of current rule 411D291 (DRG 317X ‘Admit for renal dialysis’) is placed after the current rule. From MDC 11 is removed and Pdgprop is given value 11P01.

DRG changes

Patients with diabetes as principal diagnosis are always assigned to diabetes DRG’s except cases where a intervention related to the localizing diabetes diagnosis is performed. Cases with specific operations for specific problems do not follow this principle – in these cases a correct diagnosis is demanded for correct DRG assignment.

Introduction

2010

2009-MDC10_01_1.jpg (204 KB) Anonymous, 2014-01-15 10:47

2009-MDC10_01_2.jpg (132 KB) Anonymous, 2014-01-15 10:47

2009-MDC10_01_3.jpg (197 KB) Anonymous, 2014-01-15 10:47

2009-MDC10_01_4.jpg (122 KB) Anonymous, 2014-01-15 10:47

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