Case #264

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

Surgery on malrotation of the gut and appendectomy

Added by Anonymous over 5 years ago. Updated about 3 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: C413
Initiated: 2014-02-14

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Problem

The NordDRG users have asked a question why while doing surgery of a congenital malformation of the intestine bracket (Q43.3) with surgery for malrotation (JAM10) the case is grouped to DRG F35E Andra operationer i mage tarm, ej komplicerat (Old DRG 171 Other operations on stomach bowel, not complicated).
If the surgeon do another procedure like JEA00 appendectomy, this to prevent later surgery for the patient, the case will group to F30E Appendektomi, ej komplicerat. (Old DRG 167 appendectomy, not complicated).

Analysis

The hierarchy is such in the F-DRG´s that when adding to a major surgery code a smaller surgery code , for example a small surgery like appendectomy, the grouping of the case will end up there instead of the DRG that belongs to the bigger surgery.
This also means that if the surgeon do an extra measure to save the patient from a new surgery the result for the surgeon is the opposite.
The DRG system should not not support that a addition of a procedure code makes the case fall into a lower resource DRG.
The F-DRG´s has been checked with Swedish cost data. The order in DRG logic is done with the non-complicated DRG as base for each different DRG.

See Appendix C413 to Forum.

Suggestion

The Swedish National Board of Health and Welfare 2014-02-14

The suggestion is that the DRGlogic changes are done so that the order of the non complicated DRG that begins with FxxE are put into an order with the DRG that use the most resources are at the top and then downward as the resuoce use decrease.

Decided changes

The Swedish National Board of Health and Welfare 2014-02-14

Since this might be a concern only for the Swedish DRGlogic Sweden wants it to be introduced for the 2015 version in Sweden.

DRG change

Cases in DRG F12E, C Andra operationer på magsäck, matstrupe och tolvfingertarm (Former DRG 155N) can be grouped to F05E, C, A Större tunn- och tjocktarmsoperationer (Former DRG 149), or to F01E, C Rektal resektion och exstirpation( Former DRG 147X) or to DRG F07E Adherenslösning och delning av brid, ej komplicerat (Former DRG 151).

F35E, C, A Andra operationer i mage och tarm (Former DRG 171) will get cases from DRG F20E, C Operationer av andra bråck än inguinala och femorala, >17 år Former DRG ), or get cases from DRG F26E, C Bråckoperationer, 0-17 år (Former DRG 163), or get cases from F30E, C Appendektomi (Former DRG 166C), or get cases from DRG F23E, C Operationer av inguinala och femorala bråck, >17 år (Former DRG 162 ), or get cases from DRG F15E, C, A Operationer i analregionen, stomirevisioner och andra mindre tarmingrepp (Former DRG 162).

DRG F30E, C Appendektomi (Former DRG 166C) will lose cases to F35E, C, A Andra operationer i mage och tarm (Former DRG 171) and to DRG F26E, C Bråckoperationer, 0-17 år (Former DRG 163).

DRG F23E, C Operationer av inguinala och femorala bråck, >17 år (Former DRG 162 ) will lose cases to DRG F30E, C Appendektomi (Former DRG 166C). to DRG F26E, C Bråckoperationer, 0-17 år (Former DRG 163) and to DRG F35E, C, A Andra operationer i mage och tarm (Former DRG 171).

DRG F15E, C, A Operationer i analregionen, stomirevisioner och andra mindre tarmingrepp (Former DRG 162) will lose cases to DRG DRG F23E, C Operationer av inguinala och femorala bråck, >17 år (Former DRG 162 ), to DRG F30E, C Appendektomi (Former DRG 166C). to DRG F26E, C Bråckoperationer, 0-17 år (Former DRG 163) and to DRG F35E, C, A Andra operationer i mage och tarm (Former DRG 171).

Technical change

  • DRG F12E, C Andra operationer på magsäck, matstrupe och tolvfingertarm (Former DRG 155N) will be moved down below DRG F07E Adherenslösning och delning av brid, ej komplicerat (Former DRG 151)
  • F35E, C, A Andra operationer i mage och tarm (Former DRG 171) will be moved up below DRG F09E Mindre tunn- och tjocktarmsoperationer (Former DRG 153)
  • F30E, C Appendektomi (Former DRG 167N) are moved down below F26E Bråckoperationer, 0-17 år (Former DRG 163)
  • DRG F23E, C Operationer av inguinala och femorala bråck, >17 år (Former DRG 162) are moved below F30E, C Appendektomi (Former DRG 167N)
  • DRG F15E, A, C Operationer i analregionen, stomirevisioner och andra mindre tarmingrepp (Former DRG 158) are moved below DRG F23E, C Operationer av inguinala och femorala bråck, >17 år (Former DRG 162)
  • DRG F43E Inflammatorisk tarmsjukdom (Former DRG 179) are moved upwards below DRG F39E Maligna tumörer i matsmältningsorganen (Former DRG 173)

Introduction

NordDRG [2015] [SWE]

Appendix C413 to Forum.xlsx (39.8 KB) Anonymous, 2014-02-25 13:16

C413 Decision to Forum.xlsx (19 KB) Anonymous, 2014-02-25 15:40

Case 264 - logic order changes.pptx (93 KB) Martti Virtanen, 2014-03-19 10:30

History

#1 Updated by Anonymous over 5 years ago

#2 Updated by Anonymous over 5 years ago

  • Description updated (diff)
  • Parent task set to #10

#3 Updated by Martti Virtanen over 5 years ago

2014-03-19 Martti Virtanen
Changes according to the technical description in the Excel ® file:
1) Rules for group F12 DRG (155) are moved below groups F01 (146-147), F05 (148-149) and F07 (150-151) that are not included in table of the changes. The order of 155N (F12E) and 155C (F12C) has been switched – by mistake?
2) Rules for group F35 (170-171) are moved above group F30 (166-167) and simultaneously over groups F23 (161-162) and F15 (157-158) as well as groups F20 (159-160) and F26 (163) that are not included in the table of changes.
3) Rules for group F23 (161-162) are moved above group F15 (157-158)
4) Rules for group F43 (179) remain lowest of the discussed rules. They are moved above group F40 (174-175) that are not included in the table of changes
Change 1)
The switch is a clear mistake. In Finish data DRG’s 146-151 have all higher weight than 155N (155B) but lower and 155C (155A) the CC-DRG.
Change 2)
The most radical change. In Finnish data the bypassed DRG’s have all lower weight than 170 (CC-DRG) whereas only 157, 158, 162 and 163 (4/9) have lower weight than DRG 171 (non-CC-DRG). Thus there is no problem with regard to the CC-DRG whereas the non-CC-DRG is somewhat problematic.
Change 3)
Minor change only affecting the two groups. In Finnish data 161 (CC-DRG) has higher weight than 157 (and 158) and 162 (non-CC-DRG) has higher weight than 158 (non-CC-DRG). Thus the figures support the proposed change
Change 4)
This is unnecessary change since the grouping is based on principal dx and since each case only has one principal dx the order of the rules does not affect the DRG assignment

#5 Updated by Anonymous over 5 years ago

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

Comment Expert Group 2014-03-24

Marttis proposal for changes of rules for grouping is accepted.

#6 Updated by Martti Virtanen over 5 years ago

2014-03-27 Martti Virtanen

Technical change

Following changes will be performed
1) Rules for group F12 DRG (154B, 155B and 156X) are moved below groups F01 (146-147), F05 (148-149) and F07 (150-151) that are not included in table of the changes. 155B (155N/F12E) must remain after 154B (155/CF12C). 156X is neither included in the table of changes but it mus remain after 155B.
2) Rules for group F35 (170-171) are moved above group F30 (166-167) and simultaneously over groups F23 (161-162) and F15 (157-158) as well as groups F20 (159-160) and F26 (163) that are not included in the table of changes.
3) Rules for group F23 (161-162) are moved above group F15 (157-158)
All changes are performed by changing ORD-values of the rules.

DRG change

In patient cases with several interventions on the same hospital stay the patient casess will be assigned to more resource needing DRG’s.

#7 Updated by Martti Virtanen over 5 years ago

2014-06-11 Martti Virtanen
The work with testdata revealed that there is an error in this case. The rule for DRG 156X, that does not exist in Swedish version, remains at its current position. As a result all cases for 154B and 155B (F12)will be assigned to DRG 156X (childrens DRG).
The rule for DRG 156X needs to be moved together with the rules for 154B and 155B.
I have modified the technical changes accordingly.

#8 Updated by Mats Fernström about 5 years ago

2014-08-21 Mats Fernström
The ORD change has made the rules for DRG F23 ‘Operationer av inguinala och femorala bråck, >17 år’ (former DRG 161 & 162) impossible. All cases that should be grouped to DRG F23 are incorrectly grouped to DRG F26 ‘Bråckoperationer, 0-17 år’ (former DRG 163). This is an error that must be corrected already in the production version for 2015. One way for correction is to change places for the rules for DRG F23 and F26 but this will cause another problem – grownup cases with both appendectomy and hernia repair during the same hospital stay will be grouped to the less expensive hernia repair DRG (Swedish weight for F23E = 0,7636) instead of the more expensive appendectomy DRG (Swedish weight for DRG F30E = 0,896). There are probably not many cases with combined hernia repair and appendectomy but the profession is always very upset when addition of another procedure code causes a DRG with lesser weight. Therefore we want another way to make the rules for DRG F23 possible, namely by adding an age limit (<6575) in the rules for DRG F26.

#9 Updated by Martti Virtanen about 5 years ago

2014-08-21 Martti Virtanen
Yes, this is an obvious error. The problem is the rule 406D101005 for DRG F26C/163C in SWE version. In common version the problem does not exist because there is no division to pediatric cases (this was introduced with the CC-Project).
The simple solution is that we introduce an upper limit for age to rule 406D101005 i.e. age '<6575'. This type of rule has usually not been used, because childrens groups are expected to more resource needing than adult groups. Here this is not the case, and we must use the opposite setting.
Sorry for not noticing this in first phase.

#10 Updated by Martti Virtanen almost 5 years ago

2014-10-20 Martti Virtanen
An additional note. The age limits (>6574) for DRG's 161X (F23C) and 162X (F23E) actually become obsolete because of this change and shall be removed. They do not cause any error in in DRG assignment.
Please note that without the change all cases would end in the child group and no cases to 161-162.

#11 Updated by Anonymous over 4 years ago

  • Status changed from Active to Further active

#12 Updated by Martti Virtanen over 4 years ago

2015-05-05 Martti Virtanen
Finland noted that in the NordDRG 2016 version children with hernia operations are assiged to adult DRG's although the child DRG exists.
This case has only been introduced to NordDRG Swe and therefore the corrections for age limits (M.F. 2014-08-21) do not apply.
We will now retain the old version in other NorDRG's and therefor also retain the old age limits.
However, if the case will be used in other versions (as I think was decided in 2014) all corrections need to be done in similar way as in Swe version.

#13 Updated by Martti Virtanen over 3 years ago

2016-03-15 Expert group (MV)
The additional corrections were accepted without further discussion.

#14 Updated by Anonymous about 3 years ago

  • Status changed from Further active to Accepted

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