Case #276

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

Impossible day surgery

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

Status:AcceptedStart date:2014-02-25
Priority:MinorSpent time:-
Assignee:Mats Fernström
Category:-
Target version:Expert Group 2014
Initiator:Sweden Target year:2015
Case type: Owner / responsible:Nordic Casemix Centre
MDC:OR Old forum status:
Target Grouper:COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE

Description

National ID: CPK ID 550
Initiated: 2013-05-22
Initiator: NPK, Sweden

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Problem

When we many years ago constructed the day surgery DRGs we had a principle of parallelism – for every inpatient surgical DRG we constructed a corresponding outpatient DRG (but without division into CC and not CC). We knew already then that we constructed DRGs for procedures that are impossible to perform on outpatients, for example organ transplantations, but the hypothesis was that the operation could be done in one clinic and the aftercare in another clinic. In the operating clinic's perspective it is then an outpatient. Now we can see that such a division of the care is very rare. The few cases with procedure codes for organ transplantations in the table below are obviously miscoded. They had a reported cost of about 3000-4000 SEK and it is of course impossible to perform such procedures with such low costs. (We have noticed a misunderstanding about how to code control visits – in some hospitals they think that they shall code for the procedure that was done during the previous contact.)

In NordDRG 2015 we want the DRGs in the table above to be deleted and that outpatient cases with such procedures are grouped to a new DRG (Z81O) with the text “Impossible day surgery”.
(For NordDRG 2016 we plan to add more procedures to the “Impossible day surgery” list.)

Suggestion

NPK, Sweden – 2014-02-25

In NordDRG 2015 we want the DRGs in the table above to be deleted and that outpatient cases with such procedures are grouped to a new DRG (Z81O) with the text “Impossible day surgery”.
The easiest technical change to achieve that for now is to replace the present DRG code in the rules for these DRGs with the new DRG code Z81O.

See "Suggestion CPK ID 550.xls".

(If there will be many procedures judged as impossible on outpatients in the future we can then introduce a new procedure property with the meaning “impossible outpatient procedure” and replace all rules for DRG Z81O with one single rule based on that procedure property.)

2014-CPK-ID-550.jpg (14.5 KB) Anonymous, 2014-02-27 14:24

Suggestion CPK ID 550.xls (46 KB) Anonymous, 2014-02-27 14:27

History

#1 Updated by Anonymous about 5 years ago

  • Parent task set to #11

#2 Updated by Martti Virtanen about 5 years ago

  • Description updated (diff)

2013-04-17 Martti Virtanen
I support this proposal. Would the new DRG be regarded as type of subgroup to old DRG 470 and thus not usable for reimbursement?

#3 Updated by Anonymous about 5 years ago

  • Assignee set to Mats Fernström
  • MDC OR added

Comment Expert Group 2014-03-25

The answer to Marttis question is yes.
Proposal is accepted.

#4 Updated by Anonymous about 4 years ago

  • Status changed from Active to Accepted

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