Case #262

Task #10: Delivery of major update proposals for NordDRG 2015

Gallbladder surgery during Pregnancy

Added by Anonymous over 5 years ago. Updated over 4 years ago.

Status:AcceptedStart date:2014-02-21
Priority:MajorSpent time:-
Assignee:Ralph Dahlgren
Category:-
Target version:Expert Group 2014
Initiator:Sweden Target year:2015
Case type: Owner / responsible:Nordic Casemix Centre
MDC: Old forum status:
Target Grouper:COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE

Description

National ID: CPK ID 404
Initiated: 2014-01-29

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Problem

See Case #157: Case 2011-MDC07-01 Revision of rules for the cholecystectomy DRGs [[http://documents.norddrg.net/issues/157]].

Pregnant patient with primary diagnosis O996 Sjukdomar i matsmältningsorganen hos modern som komplicerar graviditet, förlossning och barnsängstid (Diseases of the digestive system of the mother complicating pregnancy, childbirth, and puerperium) and secondary diagnosis K802 (Gallstones without cholecystitis) undergoing a laparoscopic operation, JKA21 (Laparoscopic cholecystectomy) falls into the DRG Z60N Annan sällsynt, eller felaktig, kombination av huvuddiagnos och åtgärd (Former DRG 477 Other rare or incorrect combination of primary diagnosis and measure).

Analysis

Sweden think that the problem is that the diagnosis code O99.6 refers to all diagnos codes in Chapter XI (Digestive Diseases) while in the DRG world has divided the codes in Chapter XI in three MDC (Major Diagnostic Category). Thus it has been decided that all the codes in section K00-K14 should belong MDC 03, the codes in section K70-K87 to MDC 07 and the other codes in the chapter to MDC 06.

Since a majority of the codes in Chapter XI belongs to the MDC 06 NordDRG has chosen that O99.6 should belong to MDC 06. And this is the reason why the case ends up in DRG Z60 Annan sällsynt, eller felaktig, kombination av huvuddiagnos och åtgärd, öppenvård (Former DRG 477 Other rare or incorrect combination of primary diagnosis and measure)
There are not so many cases in PAR. In clinical reality this happens not too seldom. The reason it´s not found is because people change their primary coding when DRG outcome is wrong.

Suggestion

The Swedish National Board of Health and Welfare and their Swedish collaboration partners 2014-01-29

We suggest that O99.6 should get a new PDGPROP. Can´t get DGCAT since it already has one. Our suggestion is a PDGPROP in MDC 07. For example 07P14 (where 07 stands for MDC 07 "Diseases of the liver, biliary tract and pancreas," and 14 stands for "Pregnancy, childbirth and the puerperium" ) and the text can be for 07P14 "Diseases and disorders of the hepatobiliary system intra-or postpartum.

This described above and additionally new rules I DRGlogic for involved DRG for incare/daycare.

The involved DRG are listed below:

Decided changes

The Swedish National Board of Health and Welfare 2014-01-29

These changes should be done to the definitions tables for 2015

DRG change

Some cases vid main diagnose O996 will go from DRG Z60 and to the other DRG mentioned above.

Technical change

ICD code O99.6 get a new PDGPROP 07P14 Diseases and disorders of the hepatobiliary system intra-or postpartum.
New rules I DRGlogic for involved DRG for incare/daycare: G06A (193M), G06C (193C), G06E (194X), G10C (195C), G10E (196X), G11A (197M), G11C (197C), G11E (198X), G12A (493M), G12C (493C), G12E (494X, G13O (494O), G29C (201C), G29E (201N)
G29O (201O)

Introduction

NordDRG [2015] [SWE]

2014-CPK-ID-404.jpg (75.8 KB) Anonymous, 2014-02-21 13:55

CPK ID 404 Suggestion.xlsx (23.3 KB) Anonymous, 2014-02-21 13:59

History

#1 Updated by Anonymous over 5 years ago

  • Description updated (diff)
  • Parent task changed from #157 to #10

#2 Updated by Martti Virtanen over 5 years ago

20014-03-19 Martti Virtanen
The proposal is technically OK. It solves the problem caused by bad code structure and instructions from WHO. It does not solve the problem of concervative cases.

#3 Updated by Anonymous over 5 years ago

  • Target Grouper COMMON, DEN, EST, FIN, ICE, LAT, NOR added

Comment Expert Group 2014-03-24

The suggestion is ok but it causes many new lines.
Swedish proposal accepted.

#4 Updated by Martti Virtanen over 5 years ago

2014-03-27 Martti Virtanen

A better solution for the problem would be to add subcodes for hepatobilirary and gastrointestina problems during pregnancy. However, since this has not proven to be possible we need to create an alternative solution.
The problem does not solve grouping of conservative cases, that will still be assigned to MDC 06 DRG’s
The problem affects mainly Sweden, because other countries seem not to follow the WHO coding instructions in this area.

Technical change

A new PDGPROP 07P14 ‘Potential hepatobiliary problem during pregnancy’
This property is given to dx O9960 ‘Diseases of the digestive system complicating pregnancy, childbirth and the puerperium’
To each surgical DRG’s of MDC 07 (MDC 07 and OR=S or DGPROP1 =00X10) is created a copy in Drglogic table. Each copy is placed immediately after the original rule. In each copy MDC removed and PDGPROP is given value 07P14.

DRG change

Patient cases with O9960 and a hepatobiliary intervention and no gastrointestinal interventions will be assigned to hepatobiliary DRG’s.

#5 Updated by Ralph Dahlgren over 5 years ago

Sweden suggest that the new PDGPROP 07P14 should be called ‘Hepatobiliary problem during pregnancy’. The word Potential in the beginning is unnecessary.
MVH Ralph

#6 Updated by Martti Virtanen over 5 years ago

Martti Virtanen 2014-04-15
The names of the properties obviously do not affect the DRG assignment, so this is not essential in any way.
'Potential' refers to the fact that not all cases with this dx have a hepatobiliary problem. However the name can as well be shortened.

07P14 will have the name '‘Hepatobiliary problem during pregnancy’'

#7 Updated by Anonymous over 4 years ago

  • Status changed from Active to Accepted

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