Task #11: Delivery of minor update proposals for NordDRG 2015
Impossible anesthesia rules
|Target version:||Expert Group 2014|
|Case type:||Owner / responsible:||Nordic Casemix Centre|
|MDC:||Old forum status:|
National ID: CPK ID 532
Initiator: NPK, Sweden
The Swedish National Board of Health and Welfare (SOS) makes own definition tables parallel to the process at the Nordic Casemix Centre (NCC) and the current problem was discovered during routine comparison between SWE2014CC-SOS-PR02 (SOS version) and SWE2014PR0F (NCC version) in the autumn 2013.
As decided in the Forum [[http://documents.norddrg.net/issues/101]]a lot of anesthesia rules were constructed. The purpose of these rules is that cases with a surgical procedure property but without OR 1 shall be grouped to a surgical DRG if greater anesthesia is present. In the updating process for NordDRG 2014 Martti noticed that some of these rules were ”impossible”, meaning that no cases could be grouped according to them because all cases without OR=1 are assigned to conservative DRG's within their MDC according to rules higher up in the Drglogic table. Therefore the rules were deleted in the NCC version (but not in the SOS version). The rules are listed below (the empty fields MDC, DGCAT, AGELIM, SEX, DGPROP3, DGPROP4, SECPROC, DISCH and DUR have been omitted to save space in the figure).
The rule with ORD 490D06004 is not an anesthesia rule (OR 1 is demanded but not 00X10) and we think that it is possible because we can’t find any previous rule with the same demands (the diagnosis codes with 08P03 belong to MDC 09). This rule should be reinserted in the NCC version.
For the rest of the listed rules Martti is right but we mustn’t delete the rules. The rules are correct but not correctly placed in Drglogic. They should be reinserted in the NCC version but with ORD values that places them before the rules for the conservative DRGs within their MDC. This order change has to be done also in the SOS version.
#3 Updated by Martti Virtanen over 6 years ago
- Description updated (diff)
2014-03-14 Martti Virtanen
The ORD 490D06004 is still included in the SWE logic table. May be in some intermediate version it was by error reported to be removed. However, we agree on this point.
The other rules are unnecessary in the current position.
The proposal would move these postMDC rules from postMDC area (490D...) inside the MDC's. Within the MDC's there already exists a rule for the DRG's at issue and since all interventions in the groups listed here the cases with these interventions with usual principal dx from the MDC at issue will be assigned to the correct DRG based on the dx and the procedure.
These rules have been created for situations where the principal dx is not from the usual MDC for the interventions at issue. Before these rules any possible other intervention(s) in combination with the principal dx that is used, will be concidered. Then the rest of the cases are assigned to a DRG that does not correspond to the MDC of the principal dx with the form of these rules that is not using anaesthesia property.
If for example the rule for DRG B09C is moved to a location within MDC 2 the cases with 02S01 interventions with coded anaesthesia would be assinged to this DRG irrespectively which other interventions were performed and what was the principal dx. The same situation without using anesthesia codes would only be assigned to DRG B09C iv no other MDC based rule applies to the case.
I think it is obvious that rules using anaesthesia property must remain attached to the corresponding rule with OR=S and that these rules are really unnecessary and shall be removed.
#4 Updated by Martti Virtanen over 6 years ago
- Description updated (diff)
Mats Fernström, NPK, Sweden, 2014-03-19
First a minor correction: the national ID of this case is CPK ID 532 – not 531.
This is a tricky case that demands a thorough analysis of the definition tables. I see now that the rules with suggested ORD 409D1323 and 409D1324 (leading to DRG H44) really are unnecessary. All diagnosis codes with 08P03 also have 09M01 and all procedure codes with 08S12 (but without OR 1) also have 09S01. This means that all these cases with greater anesthesia (00X10) are grouped to DRG J01 according to the existing rules with ORD 409D04101 and 409D04201.
I have also noticed that the other suggested anesthesia rules are about rather small inventions (even if they are done in greater anesthesia) and I agree with Martti that post-MDC rules for such procedures mustn’t overrule MDC rules for greater procedures.
Thus we withdraw all suggestions with the exception for that the rule with ORD 490D06004 must be included in the logic table.