Case 2009-MDC14-06 Supervision of pregnancy
|Priority:||Error correction||Spent time:||-|
|Target version:||Expert Group 2010|
|MDC:||MDC14||Owner / responsible:||Nordic Casemix Centre|
|Target Grouper:||COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE||Old forum status:||CLOSITEM - Closed item|
Last updated: 2010-04-09
Status: CLOSITEM - Closed item
Error corrected by Nordic Centre
By: Eva Petersson, Blekinge and Denise Olsson, Skåne/CPK, Sweden
Expert Network 2009-02-26 - Change recommended
Board 2009-03-20 - Recommendation accepted
Expert Network 2010-03-12 - Correction recommended
Board 2010-04-09 - Recommendation accepted
CPK ID 293
Supervision of high-risk pregnancy (Z35) is grouped to DRG 384 (Other antepartum diagnoses w/o medical complications) in MDC 14 with the weight 0,3780 but supervision of normal pregnancy (Z34) is grouped to DRG 467 (Other factors influencing health status) in MDC 23 with the weight 0,4485.
It is peculiar that normal pregnancy is grouped to MDC 23 instead of MDC 14 and it is un-logical that “normal” is grouped to a DRG with higher weight than “high-risk”.
Comment and suggestion by CPK
Z35 has dgcat 14M99 (Obstetrical problem) but Z34 has dgcat 23M99 (Other factors influencing health status) which explains the grouping result mentioned above. The thought with dgcat 23M99 was probably that something else than the pregnancy is the main problem if a patient with normal pregnancy is admitted for in-patient care. Nevertheless, we agree that it is un-logical that “normal” patients are grouped to a DRG with a higher weight than for “high-risk” patients. This negative effect is present also for out-patient visits, se table 1.
According to Swedish cost data 2007 (se table 2), the patients in DRG 467 with the principal diagnosis Z34 (normal pregnancy) are almost 30 % less expensive than the other patients in DRG 467. They are also less expensive than the patients in DRG 384 but still they fit better in DRG 384 than in DRG 467 (they are not many enough to form a separate DRG).
On the last row in table 2 we can se the result if we add the patients in DRG 467 with the principal diagnosis Z34 to the patients in DRG 384. The number of patients is small and the economic effects are minimal. For logical reasons we therefore suggest a change in the grouping logic so Z34 is grouped similar to Z35. This can be achieved by changing the dgcat for Z34 from 23M99 to 14M99.
Expert Network 2009-02-26
The meeting recommended to accept the proposal to change the dg.cat for Z34 from 23M99 to 14M99.
The diagnosis category of all group Z34 (Supervision of normal pregnancy) codes is changed from 23M99 to 14M99.
Patients with principal diagnosis from group Z34 are assigned to obstetrical DRG’s.
Martti Virtanen 2009-07-22
Because of the change of MDC the group 23M99 does not include any obstetrics related codes any more. Therefore the rule 423D0625 becomes obsolete and has to be deleted.
Expert Network 2010-03-12
The meeting recommended accepting the correction.
Rule 423D0625 is deleted from all versions of NordDRG.
No change of correctly coded cases.