Case 2009-MDC14-04 Gynaecological surgery during pregnancy
|Target version:||Expert Group 2009|
|Case type:||Major||Owner / responsible:|
|MDC:||MDC14||Old forum status:||CLOSITEM - Closed item|
|Target Grouper:||COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE|
Last updated: 2009-08-18
Status: CLOSITEM - Closed item
By: Nina Bonnedahl , Barbro Odhe/CPK, Sweden
Expert Network 2009-02-26 - Change recommended
Board 2009-03-20 - Recommendation accepted
CPK ID 285
Main diagnosis O348B (Maternal care for other abnormalities of pelvic organ.) and KVÅ-code LAE10 (Unilateral oophorectomy) groups to DRG 477. Main diagnosis O348B alone groups to DRG 348.
Comments and suggestion by CPK
There is no rule in DRG-logic that can handle this combination with pregnancy and operation on ovary. This type of patient goes under the general validation rule with ord 499D001900 at the second last line in DRG-logic which leads to DRG 477. In the Swedish discharge register for 2007 we found several similar problems. See table below.
Now we concentrate on the 84 discharges with a gynaecological or obstetric procedure with OR 1. All of them had a principal diagnosis with the property 14X99. For description it should be better if these cases were grouped to another DRG than 477. We suggest that they are grouped to the surgical rest group in MDC 14, that is DRG 377 (Postpartum & post abortion diagnoses w o. r. procedure). If so, the text should be altered to “Pre- & postpartum & post abortion diagnoses w o. r. procedure”.
Technically the change can be done by addition of a rule where dgprop 14X99 combined with OR 1 leads to DRG 377 (possibly the three present rules for DRG 377 then will be unnecessary). The same changes can be done for DRG 377O.
The economic perspective is not very important since the number of cases affected by the suggested change is rather small.
Martti Virtanen 2009-02-19
I have asked from Finland how these cases are coded there.
The proposed model is unnecessary complicated. 14X99 is a property that is generated automatically to all dx with MDC 14. Thus we are talking about patients with principal diagnosis in MDC 14 and OR=1. That would create a rest group that could be called ‘Obstetrical problem with other o.r. procedure’. This would make the current rules for DRG 377 unnecessary and also cover all cases with general anaesthesia in obstetrical problems and thus make the obstetric rule for DRG 530 unnecessary.
Another option is that we would use the procedure property 14S90 ‘Significant operation for obstetrical patient’ to limit the procedures accepted in this respect. That would leave anaesthesia out and group them to DRG 530.
Expert Network 2009-02-26
The meeting recommended to accept the proposal. DRG 377 should be changed to DRG 377N and the name to Obstetrical problem with other o.r. procedure. The rule for DRG 530 in MDC 14 will disappear.
DRG 377X is changed to 377N ‘Obstetrical problem with other o.r. procedure’
From current rule 414D121 (DRG 377X) the Dxprop1 14X05 is removed and DRG is changed to 377N
From current rule 114D03900 the Dxprop1 14X05 is removed.
Current rules 414D122, 414D123, 414D125 and 414D3701 are removed together with rules 114D03901 and 114D03902.
Cases obstetrical principal diagnosis and with OR=1 procedures are assigned to DRG 377X if no previous rule applies. DRG 530 disappears.