Case 2009-MDC04-02 CPAP and BiPAP in DRG 475
|Target version:||Expert Group 2009|
|MDC:||MDC04||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: Olafr Steinum/CPK, Sweden
Expert Network 2009-02-26 - Change recommended
Board 2009-03-20 - Recommendation accepted
CPK ID 292
DRG 475 (Respiratory system diagnosis with ventilator support) includes treatment with CPAP/BiPAP and respirator treatment. Treatment with CPAP/BiPAP can be performed on almost any ward but respirator treatment is a typical intensive care procedure.
Analysis by CPK
The following procedures (Swedish codes) are included in DRG 475:
In the Swedish cost data base (2007) we analysed the content of DRG 475 and divided the patients into three groups, one with CPAP/BiPAP treatment (DG001/DG007 in the table below), one with conventional respirator treatment (DG021 in the table below) and one group without DG001, DG007 or DG021 (others in the table below).
As seen in the table, the patients treated with CPAP/BiPAP are far less expensive than the other patients in DRG 475.
We suggest a split of DRG 475 into DRG 475A and 475B where the less expensive cases with CPAP/BiPAP treatment are grouped to 475B.
Expert Network 2009-02-26
The meeting recommended acceptance of the proposal and the case will be closed. Sweden and Finland shall analyse the possibility to withdraw DRG 475B in the future and instead add CC property to the CPAP/BiPAP codes which will be a new case.
- Addition of a new procedure property: 04S04 ‘Positive airway pressure therapy’.
- The new property is given to WAA722 Positive end-expiratory pressure (PEEP) therapy.
- Procedure property 04S03 ‘Mechanical ventilation’ is removed from this code.
- The propertychanges are automatically inherited to national codes mapped to WAA722.
Two new DRG’s is added the Drgnames-table:
- 475A Respiratory system diagnosis with respirator therapy
- 475B Respiratory system diagnosis with PEEP support
In the DRGlogic table a new rule is added after current rule 404D031. The new rule is a copy of current rule 404D031 but procpro1 is changed to 04S04 and DRG to 475B.
In the current rule 404D031 DRG is changed to 475A.
Int the DRGlogic table a new rule is added after current rule 104D030. The new rule is a copy of current rule 404D031 but procpro1 is changed to 04S04. The new rule results in the same DRG as the old 475O.
Cases with light respiratory support (PEEP) are assigned to DRG 475B and cases with more heavy support in DRT 475A in MDC 04. No change in short therapy cases.