Case 2010-MDC18-01 Grouping of B02 Zoster (Herpes Zoster)
|Target version:||Expert Group 2010|
|MDC:||MDC18||Owner / responsible:|
|Target Grouper:||COMMON||Old forum status:||CLOSITEM - Closed item|
Last updated: 2010-04-09
Status: CLOSITEM - Closed item
By: Irene Bohlin, Göteborg/CPK, Sweden
Expert Network 2010-03-12 - Change recommended
Board 2010-04-09 - Recommendation accepted
CPK ID 335
B02.8 (Zoster with other complications) is allocated to DRG 421 (Virusinfection >17) with the weight 0,4634 (Sweden 2010). B02.9 (Zoster without complication or Zoster NOS) goes to DRG 272/273 (Major skin disorders with/without cc) with the weights 1,499/0,7117.
In a clinical perspective it is incorrect that a diagnosis with “complications” groups to a DRG with lower weight than a diagnosis “without complications”. In a classification perspective it is also wrong that unspecified information is paid better than more specified information.
Swedish cost data show that cases with B02.9 in DRG 272/273 are 18-20 % less expensive than the average for these DRGs (see table below). The cases with B02.9 fit better in DRG 283/284 (Minor skin disorders with/without cc).
A change so that B02.9 is grouped to DRG 283/284 will not solve the problem, however. The weights for these DRGs are also higher than the weight for DRG 421 (see table below).
The easiest way to solve the problem is to let B02.9 be grouped in the same way as B02.8 to DRG 421/422 but B02.9 must not have any COMPL value.
Expert Network 2010-03-12
In the group B02 Zoster [herpes zoster] the anatomically defined groups (B02.0-B02.3) list the important anatomically defined manifestations. Especially B02.2+ as a manifestation code (dagger code) makes it possible to code all specific organ manifestations of herpes zoster. Therefore the undefined herpes zoster (B02.7-B02.9) indicates a problem manifested mostly as skin disease which is the basic manifestation the disease. The meeting therefore recommended that dx B02.7 ’ Disseminated zoster’ and B02.8 ’ Zoster with other complications’ should be regarded as major skin disorder (09M03) and dx B02.9 as minor skin disorder (09M99).
Dx B02.7 (Disseminated zoster) and B02.8 (Zoster with other complications) are moved to diagnosis category 09M03 ’Major skin disorders’ (from dgcat 18M04 ‘Viral illness’) and dx B02.9 (Zoster without complication or Zoster NOS) to dgcat 09M99 ’Minor skin disorders’ (from 09M03).