Case #199

Case 2009-MDC15-01 Treatment of jaundice in newborns grouped to DRG 470

Added by Anonymous over 6 years ago.

Status:RejectedStart date:2014-01-20
Priority:NormalSpent time:-
Assignee:-
Category:-
Target version:Expert Group 2009
Initiator:Sweden Target year:
Case type:Major Owner / responsible:
MDC:MDC15 Old forum status:CLOSITEM - Closed item
Target Grouper:

Description

Last updated: 2009-03-20
Status: CLOSITEM - Closed item
Initiated: 2008-09-30
By: Barbro Ohde, SLL/CPK, Sweden
Expert Network 2009-02-26 - Proposal rejected
Board 2009-03-20 - Recommendation accepted

BACKGROUND

CPK ID 274

Problem

A newborn child with jaundice (diagnosis code P599) is grouped to DRG 391 if no procedures are registered but with the procedure codes DP018 (Umbilikal venkateter på nyfödda) or DR050 (Utbytestransfusion, erytrocyter och plasma, allogen) the case is grouped to DRG 469 (Unspecified or invalid discharge information).

(The text has been shortened and translated by Mats Fernström at CPK.)

Comments by CPK

In NordDRG 2009 the DRG will be 470 instead of 469. The problem depends on that P599 has the property 15M02 (Normal newborn) and the mentioned procedure codes have the property 15S02 (Neonatal intensive care procedure) and according to a validation rule (ord 015D80002) this combination leads to DRG 470 (previously DRG 469). The thought with this rule, we assume, is that the combination of “normal” and “intensive care” indicates wrong primary coding. In this case, however, the primary coding seems to be correct.
One way to solve the problem is to omit the validation rule (ord 015D80002). Another way is to withdraw the property 15M02 from the diagnosis code P599. If so, it should be considered to withdraw 15M02 (Normal newborn) from the following codes as well.

This medical judgement is probably best done by Martti Virtanen who is a paediatrician.

COMMENTS

Martti Virtanen 2009-02-19

The coding is not correct. P59.9 is the code for ‘Physiological’ jaundice and similar situations. Even if it would be prolonged or intense a blood exchange may never be performed with that indication. The correct code for a jaundice necessitating this risky therapy is P59.8 ‘Neonatal jaundice from other specified causes’. Although the difference is difficult the determine in some cases, this model keeps a part two distinct problems.

Expert Network 2009-02-26

The meeting recommended not to accept the proposal. The case will be closed.

2009-MDC15-01.jpg (66.7 KB) Anonymous, 2014-01-20 14:53

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