Case #270

Task #11: Delivery of minor update proposals for NordDRG 2015

Subgaleal hemorrhage in the newborn

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

Status:AcceptedStart date:2014-02-24
Priority:MinorSpent time:-
Assignee:-
Category:-
Target version:Expert Group 2014
Initiator:Norway 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: HD-0058
Initiated: 2014-02-21
Initiator: Oslo University hospital


Problem

Subgaleal hemorrhage in the newborn is a serious adverse event. Even if the condition is rare, it may require intensive care. This condition is coded with P12.2 “Epicranial subaponeurotic hemorrhage due to birth injury”. P12.2 is now categorized as 15M02 ‘normal newborn’ in the NordDRG system. If this condition is treated with intensive care where the relevant intensive care procedures (procedure property 15S02 - Neonatal intensive care procedure) are registered, the case will be assessed to DRG 470.

Analysis

Norwegian directorate of health – 2014-02-21

We only find a handful of such cases in the Norwegian national data. This might be because of removing the procedure codes from the data.

Suggestion

Norwegian directorate of health – 2014-02-21

We suggest that dx code P12.2 is given the property 15X37 ‘Neonatal hematologic problem’ or alternatively the property 15X32 ‘Neonatal CNS problem’.

Decided changes

DRG change

The cases with P12.2 as the main dx and one of neonatal intensive care procedures will move from DRG 470 to DRG’s in MDC 15.

Technical change

Introduction

NordDRG [year] [version]

History

#1 Updated by Anonymous over 5 years ago

  • Parent task set to #11

#2 Updated by Martti Virtanen over 5 years ago

2014-03-17 Martti Virtanen
The problem in this case is attached with the terminology that is not used in any standard way. In group P12 the dx listed by WHO may be mostly seen as synonyms but they include very differen clinical situations.

Within P12 'Birth injury to scalp'

P12.1 'Chignon'
P12.3 'Bruising of scalp'

Seem to be most clearly related with a minor problems

P12.0 'Cephalhaematoma'
P12.2 'Epicranial subaponeurotic haemorrhage'

Can indicate a very large, even life treathing condition but may also be quite minor hematomas.

P12.4, P12.8 and P12.9 do not indicate what kind of problem exists.

The question is highly relevant - most severe situations are clinically and for resource use highly relevant problems.

#3 Updated by Martti Virtanen over 5 years ago

  • Description updated (diff)

#4 Updated by Martti Virtanen over 5 years ago

Mats Fernström, NPK, Sweden, 2014-03-19
There are not many cases with P122 as the principal diagnosis in Sweden either (only 14 cases 2012) but they are rather expensive (mean cost = 45 064 SEK) and we agree that they shouldn’t be grouped to DRG 470 (or Z78 in Sweden).
The suggested technical change will not solve the problem, however. In addition, the Dgcat value 15M02 must be exchanged to 15M99, otherwise the cases will still be grouped to DRG 470/Z78 according to the rules with ORD 015D800020 or 015D800021 which are situated early in the grouping logic.

#5 Updated by Anonymous over 5 years ago

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

Comment Expert Group 2014-03-25

Proposal is accepted with addition with swedish comment.

#6 Updated by Anonymous over 5 years ago

Beata Tana wrote:

Comment Expert Group 2014-03-25

Norwegian proposal is accepted with addition with swedish comment.

#7 Updated by Martti Virtanen over 5 years ago

2014-03-27 Martti Virtanen

Technical change

P1220 is given the DDGPROP 15X98 ‘Other significant problem of neonate’ and changed to DGCAT 15M99 from 15M02

DRG change

Cases with P1220 will not bll not be assigned to DRG 391X ‘Normal newborn’ and in case of interventions the cases will not be assigned to DRG 470

#8 Updated by Anonymous over 4 years ago

  • Status changed from Active to Accepted

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