Case #297

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

Case #295: Difference in the properties of corresponding dx’s in different countries

Vincent’s infections

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

Status:AcceptedStart date:2014-03-11
Priority:MinorSpent time:-
Assignee:Martti Virtanen
Category:-
Target version:Expert Group 2014
Initiator:Nordic Casemix Centre 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

This is a very rare infection caused by certain type spirochetal bacteria originally described during first world war. It may occur as a mouth disease or a tonsillo-pharyngitis. WHO has reserved two codes for these diseases:

A69.0 Necrotizing ulcerative stomatitis

Cancrum oris
Fusospirochaetal gangrene
Noma
Stomatitis gangrenosa

A69.1 Other Vincent's infections

Fusospirochaetal pharyngitis
Necrotizing ulcerative (acute):

  • gingivitis
  • gingivostomatitis

Spirochaetal stomatitis
Trench mouth
Vincent's:

  • angina
  • gingivitis

The stomatitis cases are divided between the two codes and pharyngitis occurs only in the latter. Finland, Sweden and Denmark have added subcodes that make distinction of the two areas possible.

ICD-10 plus has only two codes:
  • A691A Vincent's tonsillo-pharyngitis
  • A691X Other Vincent's infections

The latter includes stomatitis and gingivitis. All codes that include stomatitis or gingivitis in text or inclusion are mapped to A691X as well as all codes that do not define the location.

Technical change

All codes mapped to A691A will have DGCAT 03M08 ‘Other ear, nose, mouth and throat diagnoses’.
All codes mapped to A691X will have DGCAT 03M99 ‘Dental and oral diseases’.
DGCAT 03M05 ‘Otitis media and upper respiratory infection’ and 18M99 ‘Other infectious and parasitic disease diagnosis’ are not used with these diagnosis nor PDRGPRO 08P11 ‘Face, mouth or neck diagnosis’.
DGPROP 15X90 is no more in use and will be removed from all versions.

DRG change

Since the occurrence of these codes is extremely low, not significant effect is expected. The mouth infection cases are assigned to mouth DRG’s

Case 297 comment.xlsx - Swedish cost data (9.81 KB) Martti Virtanen, 2014-03-23 22:48

History

#1 Updated by Martti Virtanen over 5 years ago

2014-03-17 Martti Virtanen
This is the same case as case #291.
See also case #117

#2 Updated by Martti Virtanen over 5 years ago

Mats Fernström, NPK, Sweden, 2014-03-19
No, this is not exactly the same case as case #291. There are two differences.
1. In case 291 (CPK ID 545) we state that 691A (Vincent's tonsillo-pharyngitis) in a medical perspective is similar to other tonsillitis conditions (codes beginning with J03) and therefore the code shall have DGCAT 03M05 (Otitis media and upper respiratory infection) leading to DRG C35/68, 69 & 70 (Otitis media & uri) instead of DGCAT 03M08 (Other ear, nose, mouth and throat diagnoses) leading to the heterogeneous rest DRGs C48/73 & 74 (Other ear, nose, mouth & throat diagnoses). The code A691A was introduced in Sweden 2014 so we cannot find it yet in our KPP database but tonsillitis (J03) fits better in DRG C35 than in DRG C48. See table on Swedish cost data.
2. In case 291 (CPK ID 545) we also suggested that the COMPL value 18C90 is deleted from A691 and A691W in the NCC version and added to A691B in the SOS version. See case 291 for motivation.

#3 Updated by Martti Virtanen over 5 years ago

2014-03-23 Martti Virtanen

This is the same case as #291 and they must result in the same result. It is true that the Swedish proposal and my proposal are not exactly the same. This needs to be decided.

1. A691A 'Vincent's angina' must belong to either 03M05 or 03M08.
2. A691X 'Other Vincent's infection' must either belong to COMPL 18C90 or not.

This will affect all linked codes including Swedish. Which of the options is selected is not important. The codes are and will (hopefully) remain very rare.

#4 Updated by Anonymous over 5 years ago

  • Owner / responsible deleted (National organisations)
  • Target Grouper COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE added

Comment Expert Group 2014-03-25

Recommends that the properties in all versions will be according to the linkage to common version. A691A shall have property 03M05 and A691X shall belong to COMPL 18C90.

#5 Updated by Martti Virtanen over 5 years ago

2014-03-26 Martti Virtanen

Technical change

All codes mapped to A691A will have DGCAT 03M05 ‘Otitis media and upper respiratory infection’.
All codes mapped to A691X will have DGCAT 03M99 ‘Dental and oral diseases’.

DGCAT 03M08 ‘Other ear, nose, mouth and throat diagnoses’ and 18M99 ‘Other infectious and parasitic disease diagnosis’ as well as PDRGPRO 08P11 ‘Face, mouth or neck diagnosis’ are removed from all these diagnosis.
DGPROP 15X90 is no more in use and will be removed from all versions.
A691X will also belong to COMPL 18C90.

DRG change

Cases with A691A or any linked national code as principal dx will be assigned to DRG’s 068-070 (C35x) ‘Otitis media & uri’ depending on CC and age.

Cases with A691X or any linked national code as principal dx will be assigned to 186-187 (SWE C55x-C56x FIN 580x) depending on CC and interventions.

In addition to A691A also A691X and all linked national codes as secondary dx will be potentially complicating factors

#6 Updated by Anonymous over 4 years ago

  • Status changed from Active to Accepted

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