Case #265

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

Inconsistent CC-MCC grading

Added by Anonymous about 5 years ago. Updated over 2 years ago.

Status:AcceptedStart date:2015-02-11
Priority:MinorSpent time:-
Assignee:Ralph Dahlgren
Category:-
Target version:Expert Group 2014
Initiator:Sweden Target year:2015
Case type: Owner / responsible:Nordic Casemix Centre
MDC:CC Old forum status:
Target Grouper:COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE

Description

Forum ID: Case 2013-CC-02 (continuation of case last year)
National ID: CPK ID 502 (last year CPK ID 464)


Problem

This case is a continuation of the #66 Case 2013-CC-02 - Inconsistent CC grading which deals with the inconsistentency in the CC-MCC grading.

When the CC-grouper was developed there turned out to be some inconsistency in the CC-MCC grading due to the fact that it was machine done.
It turned out that some codes in xxx.9 (unspecific) have higher CC-level than the more specific codes. This error support poor coding, the users will tend to add an unspecified code to get a higher reimbursement.

Last year a few of the problems were dealt with. This year Sweden has worked with the case and divided it into three parts. Part 1, Part 2, Part 3.
Part 4 is not included in the case this year and will be postponed to next year.

Analysis

See Appendix CPK ID 502 to Forum.xls.

The comments are to make it easier to go through the material. Note that some of the suggested changes in Part 1 are handled in Case #253 (CPK ID 537) "MCC or CC for S42, S52 and S82" that has been sent to NordDRG Forum previously (2014-02-13).

They are still in the “Appendix” (marked with red text) but they are not included in the suggestion file.

Suggestion

The National Board of Health and Welfare, Sweden, 2014-02-20

The suggestions for changes are in the Excel-file Suggestion CPK ID 502 to Forum.

Technical change

The National Board of Health and Welfare Sweden

attach technical changes in an Excel-file Suggestion CPK ID 502 to Forum.

The changes are such that most ICD-codes will go from “no CC” to “CC”, some goes from “no CC” to “MCC”, some from “MCC” to “CC” and some from “CC” to “no CC”.

The changes will naturally be that some cases will go from non CC-DRG to CC-DRG or MCC-DRG if there are som.
There have been necessary to develop 8 new compl. Cat. See Suggestion CPK ID 502 to Forum.xls.

Introduction

NordDRG [year] [version]

Appendix CPK ID 502 to Forum.xls (132 KB) Anonymous, 2014-02-25 16:02

Suggestion CPK ID 502 to Forum.xls (128 KB) Anonymous, 2014-02-25 16:03

Case 265 CC-changes.xlsx - Updated list of changes (38.1 KB) Martti Virtanen, 2014-04-03 08:06

Case 265 CC-changes - 2014-05-20.xlsx (38.3 KB) Martti Virtanen, 2014-05-20 15:08


Subtasks

Case #393: Inconsistent CC-MCC grading case393AcceptedMats Fernström

History

#1 Updated by Anonymous about 5 years ago

  • Description updated (diff)
  • Parent task changed from #66 to #10

#2 Updated by Anonymous about 5 years ago

  • Description updated (diff)

Comment Expert Group 2014-03-24

This case is extensive and will be discussed on day 2 of meeting.

#3 Updated by Anonymous about 5 years ago

  • Description updated (diff)
  • Target Grouper COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE added

Comment Expert Group 2014-03-25

The cases are few and the codes are rare so the impact on the system is small.
Data from one year is minimal. It is not essential for all countries to analyze the data because the coding is poor.

Proposal is accepted by all countries.

#4 Updated by Martti Virtanen about 5 years ago

2014-03-04 Martti Virtanen
I have missed this case when going trough the cases after expert meeting.
The exculsions need to be defined for all changes. In doing that I made a few minor changes that are included in the new table (Case 26 CC-changes). The items that have been changed are marked with red.

Chronic liver dysfunction exclusions would need some discussion, but that is the case for a number of other exclusions.

Technical change

The COMPL-value changes of the Dg-table are listed in the table Case 26 CC-changes. The changes from G-level to C-level in CC-category or vice versa will not affect the Komplex-table. All new CC-diagnoses must be included on the exclusion list of the defined CC-category in the Komplex-table, if they are not already there.
None of the dx that loose their CC-category will be taken out from the Komplex-list.
All other exclusions any dx has, are not affected.

DRG change

Some but probably very few cases are expected to change assignmet between CC (and MCC) and no-CC.

#5 Updated by Ralph Dahlgren about 5 years ago

B452 is a skin disease, should not have 18C08, we suggest Compl "09C09 Skin mucosis" as a new property instead. Look at the other B45- codes.
The rest of Marttis suggestions we accept also.

#6 Updated by Martti Virtanen about 5 years ago

Martti Virtanen 2014-04-15
I see your point.
Actually this demonstrates a problem of the CC-system. The idea is that all diagnoses in B45-group indicate a quite severe condition with increased resource need for the patient. However, now you can code as principa dx B4590 or even worse B4580 or B4570 (all belong to 18C08) and add any off the B4500-B4530 (after addition 09C09 to B4520) and get a complicated group. Or the order of codes can be converted with the same result. Correct coding would be using just B4570 'Disseminated cryptococcosis' not resulting in assignment to CC group.
This is not a real problem, since Cryptococcosis is very rare, but illustrates the principal problem of the system.

For the time beeing, B4520 shall belong to Compl 09C09 .

#7 Updated by Mats Fernström about 5 years ago

Mats Fernström, NPK, Sweden 2014-04-23
Marttis comment reminds us that we have to make exclusion criteria for 09C09. Without exclusions it is possible to get a CC DRG if you register the code B452 twice. We suggest that all B45 diagnosis codes are includ-ed in the compl.excl table under complication category 09C09.

#8 Updated by Martti Virtanen almost 5 years ago

2014-04-29 Martti Virtanen
Any dx with complication category will automatically get exclusion for that category (xxCxx). Thus in this case B452 will have exclusion for B452.
However, it seems logical to have other exclusions for B452. Skin mucosis should not be able to complicate for example systemic mucosis?

#9 Updated by Martti Virtanen almost 5 years ago

2014-05-20 Martti Virtanen
I found an obvious error in the table. Codes S9241, S9251, S927, S9270 and S9271 were given different exclusions when they were obviously meant to have the same exclusion 21C16.
I have corrected the table, see the new version

#10 Updated by Martti Virtanen over 4 years ago

2014-09-04
There were a number of code pairs starting with I398 - unspcified endocarditis, that had been defined for different 05Cxx complication categories. The only corrrect one is 05C02 'Acute or subacute endocarditis' as stated in text. The codes are wrong. None of the pairs needs to be defined separately. The other properties had by mistake been modified and are now returned to the original.

#11 Updated by Anonymous about 4 years ago

  • Status changed from Active to Further active

#12 Updated by Martti Virtanen about 3 years ago

  • Status changed from Further active to Accepted

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