Case 2009-MDC08-02 One surgical procedure gives more weight than two
|Target version:||Expert Group 2009|
|MDC:||MDC08||Owner / responsible:|
|Target Grouper:||COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE||Old forum status:||CLOSITEM - Closed item|
Last updated: 2009-03-20
Status: CLOSITEM - Closed item
By: Irene Brohlin, SU VGR/CPK, Sweden
Expert Network 2009-02-26 - Change recommended
Board 2009-03-20 - Recommendation accepted
CPK ID 290
An In-patient gets vascular ischemic problems in left lower leg. A transtibial amputation is done (NGQ19). This groups to DRG 213 (Amputation for musculoskeletal system & conn tissue disorder) weight 2,7885. Because of necrosis a re-amputation is preformed (NFW99+NFQ19). This groups to DRG 210 (operation on hip and femur except on bigger joint, >17 yrs, cc) weight 1,7592. (All weights are from Sweden 2009.)
Comments and suggestion by CPK
As a principle, addition of a secondary procedure should almost never result in a DRG with lesser weight. This is important because otherwise we have a risk for underreporting of procedures, which will lead to incorrect medical registers.
In this particular case it is obvious that two surgical procedures, in this case a transtibial amputation and a re-amputation are more expensive than one single amputation and therefore an economic analysis is not necessary.
The Swedish weight for DRG 210 is based on 5425 cases but the weight for DRG 213 is based on only 163 cases and therefore perhaps not very solid. If the weight for DRG 213 is higher than the weight for DRG 210 in Finland as well, however, we suggest that the rule for DRG 213 in Drglogic is moved to a position ahead to the DRG 210 rules.
Martti Virtanen, 2009-02-12
The trimmed weight of DRG 210 is 9,51, of DRG 213 is 11.25. Untrimmed values are similar.
The difference in the Finnish data is less than the Swedish difference. Thus I think that Finland would support this proposal.
Expert Network 2009-02-26
The meeting recommended to change the hierarki. The DRG 213 will be moved before DRG 210.
The current rule for DRG 213X 408D081 is moved before current rule 408D0521.
Cases with amputation combined to procedures from DRG 210-211 are assigned to DRG 213.