Case #205

Case 2009-MDC14-01 Case of severe eclampsia necessitating medical abortion is grouped to DRG 380 – Error of coding or need for change in grouping logic?

Added by Anonymous over 6 years ago.

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

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

A woman in week 18 of pregnancy developed severe eclampsia with HELLP syndrome, and multi-organ failure. She received intensive care, and an abortion had to be performed to save the woman’s life. The abortion was achieved medically. She received no surgical treatment. She was discharged alive. The grouping result was 380 ’Abortion w/o d&c’, which does not seem meaningful. This example illustrates several cases where information about an abortion overrides more important information regarding the total treatment.

Relevant codes

Codes of the example case:

Main condition:

O15.0 Eklampsi under svangerskap

Additional conditions:

1 O14.2 HELLP
2 O99.8 Andre spesifiserte sykdommer og tilstander som kompliserer svangerskap, fødsel og barseltid + N17.9 Uspesifisert akutt nyresvikt
3 O99.5 Sykdommer i åndedrettssystemet som kompliserer svangerskap, fødsel og barseltid + J15.2 Pneumoni som skyldes Staphylococcus
4 O99.3 Psykiske lidelser og sykdommer i nervesystemet som kompliserer svangerskap, fødsel og barseltid + G93.6 Hjerneødem
5 O04.9 Legal abort, komplett eller uspesifisert, uten komplikasjoner

Procedures:

TG6 01 Respiratorbehandling
MAGM00 Medikamentell svangerskapsavbrytelse + ATC G02A D06 Misoprostol
MBA 30 Manuell uthenting av placenta

DGPROP 14X31 of O04.9 is of importance for the grouping result in this case. Either the coding of O04.9 in this case is wrong, or it is wrong that the DRG 380 rule involving DGPROP 14X31 disregards the more important information that is provided.

Proposal

If the provided coding is considered correct, the case should be grouped to DRG 383, unless a new DRG were to be made.

COMMENTS

Expert Network 2009-02-26

The meeting proposed not to accept the proposal. The grouping result depends on how long the pregnancy is, it is not a wrong coding. The case will be closed.

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