Task #11: Delivery of minor update proposals for NordDRG 2015
|Target version:||Expert Group 2014|
|Case type:||Owner / responsible:||Nordic Casemix Centre|
|MDC:||Old forum status:|
|Target Grouper:||COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE|
National ID: NPK ID 535
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.
The J37 diagnosis codes (Chronic laryngitis and laryngotracheitis) have had DGCAT 03M05 for at least 10 years in the Swedish versions of NordDRG. Late in the updating process for version 2014 Martti wanted to change DGCAT to 03M08 for the J370 codes (including the Swedish subcodes) with the motivation that it was an “adjustment between the Nordic versions, must be the same in all versions”. We did not accept the change in the SOS version.
We agree that the codes should have the same DGCAT in all versions but it has never been discussed weather 03M05 or 03M08 is the best property.
DGCAT 03M05 leads to DRG C35 (DRG 70 in Common) with the text “Otitis media and upper respiratory infections” and DGCAT 03M08 leads to DRG C48/C49 (DRG 73/74 in Common) with the text “Other ear, nose, mouth & throat diagnoses”. In a medical descriptive perspective we think that DRG C35/70 is a better alternative, especially since DRG C48/C49/73/74 are heterogeneous rest groups.
We have done an economic analysis (see table below).
According to this the mean cost for the J37 cases is somewhat closer to the mean cost for all DRG C35E than for the mean costs for DRG C48/C49.
Thus we think that DRG C35/70 is a better alternative for the J37 cases, also in an economic perspective and therefore DGCAT 03M05 is better than 03M08 for the J370 codes.
NPK, Sweden – 2014-01-29
Based on the analysis above we suggest that the DGCAT value is changed from 03M08 to 03M05 in all versions of NordDRG. See .
#7 Updated by Martti Virtanen over 4 years ago
2014-09-11 Martti Virtanen Nordic Casemix Centre
A further additional detail to this discussion:
J381B 'Reinke's edema'
J381D 'Oedema of vocal cords'
are linked to J3700 'Chronic laryngitis' and not to J3810 'Polyp of vocal cord and larynx' in ICD+. .
The linkage is reasonable since J381D does indicate any polyp and J381B is a condition with chonic inflammatory changes resembling polyps. The question is, are inflammatory polyps, polyps or chronic inflammation.
J3810 belongs to diangosis catogery 03M09 but due to this decission J381B and J381D will be moved to diagnosis category 03M05.
#9 Updated by Ralph Dahlgren about 4 years ago
The ICD-codes J381B Reinkeödem ('Reinke's edema' ) and J381D Randstående stämbandsödem ('Oedema of vocal cords' ) are not infections.
This means that the codes should not have the DGCAT 03M05 Otitis media and upper respiratory infection. Instead it should have the DGCAT 03M08 Other ear, nose, mouth and throat diagnoses. This means that the code has to be linked to another ICD+ code than J3700
#11 Updated by Martti Virtanen about 4 years ago
2015-03-26 Martti Virtanen
This problem basically illustrates the fact that chronic laryngitis is actually not an infectious disease but an inflammation.
However to solve the problem I propose that we link J381B and J381D to J38700