Case #204

Case 2009-MDC14-02 Caesarean sections and complications – Bad coding or bad logic?

Added by Anonymous about 7 years ago.

Status:RejectedStart date:2014-01-21
Priority:NormalSpent time:-
Assignee:-
Category:-
Target version:Expert Group 2009
Initiator:Norway Target year:
MDC:MDC14 Owner / responsible:
Target Grouper: Old forum status:CLOSITEM - Closed item

Description

Last updated: 2009-03-20
Status: CLOSITEM - Closed item
Initiated: 2009-02-03
By: Norway
Expert Network 2009-02-26 - Proposal rejected
Board 2009-03-20 - Recommendation accepted

BACKGROUND

The DRGs 370/371 for caesarean section with and without CC are rather large groups. During the first eight months the total amount of cases in Norwegian hospital data are about 2900 and 4000, respectively. There is an ongoing discussion in Norway regarding complicating properties of conditions within this DRG pair (which conditions should be regarded as complications, and which should not). The main purpose of this case is to prepare a discussion on this subject in the expert group so that experiences and points of view on this matter can be shared across countries. A simple LOS analysis from Norway for the two DRGs is provided. Similar analysis from the other countries, and eventually cost analysis, would be helpful to evaluate if the Norwegian data solely is caused by inconsistent coding, or if there are weaknesses in the DRG model itself.

Examples of codes with complicating properties that occur frequently within DRG 370:

  • O99.0 Anemi som kompl svangerskap, fødsel og barseltid
  • O67.8 Annen spesifisert blødning under fødsel
  • O67.9 Uspesifisert blødning under fødsel
  • O14.1 Alvorlig preeklampsi
  • O14.0 Moderat preeklampsi
  • O24.4 Diabetes mellitus som oppstår under svangerskap
  • O36.5 Omsorg for og beh av mor ved langsom fostervekst
  • MAE20 Forsøk på vakuumekstraksjon
  • MAF20 Forsøk på tangforløsning ved hodeleie

Proposal

Based upon the Norwegian LOS analysis alone, it could be argued that a merger of DRG 370 and 371 would be correct. Simple LOS analysis and cost analysis from other Nordic countries would be valuable for the further discussion and handling of this matter. Based upon the discussion in the group, either coding rules in Norway must be enforced, or the DRG logic regarding complications of sections must be further evaluated.

COMMENTS

Expert Network 2009-02-26

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

2009-MDC14-02.jpg (23.8 KB) Anonymous, 2014-01-21 13:23

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