DRG's 482 and 483 are not usable in Estonian NordDRG due to incomplete coding
|Priority:||Error correction||Spent time:||-|
|Target version:||Expert Group 2015|
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|MDC:||Old forum status:|
DRGs 482 'Tracheostomy for face, mouth & neck diagnoses'and 483 'Tracheostomy except for face, mouth & neck diagnoses' are dependent on registration of tracheostomy at hospital level. In Estonia the Estonian Health Insurance Fund (EHIF) noted that the the interventions are poorly coded by the hospitals and as a result the DRG's are not homgenous and a random number of cases gets grouped to other DRG's. After analysis by EHIF it was decided that DRG's 482 and 483 must be inactivated in the Estonian version of NordDRG.
This was done for NordDRG EST 2014 by inactivating the rules in the common version logic. However, since the logic for other users was not supposed to be changed, the rules were reactivated next year.
To make this change (removal of DRG 482 and 483) possible Estonian DRG needs it's one logic. This means that the logic changes to Estonian logic need to be done and checked separately since common version changes do not get automatically applied in Estonian NordDRG.
As long as there are no other differences, the logic may be copied each year from the common version and the rules for DRG 482X and 483X (but 483B) are inactivated after creation of the separate file.
The change will be done for 2014 (afterwords) and 2015 version of NordDRG Est.
Cases that in other versions of NordDRG are assigned to DRG's 482 and 483 will be assigned to DRG's based on the principal dx and other interventions than tracheostomy.
#1 Updated by Martti Virtanen over 5 years ago
2014-11-26 Martti Virtanen
Estonia has noticed that some of the cases where tracheostomia is properly registered in the patient documentation now end up in DRG 470 which is not acceptable.
This is an obvious consequence since the interventions have OR=1 and now other intervention properties than tracheostomy. If no other intervention is registered or if only additional codes (Z-codes) are registered, the case doesn't fit anywhere and ends up in DRG 470.
The problem is that you cannot get both. The DRG'¨s cannot not be removed totally if the interventions are partly in use. It is not possible to remove the internvention codes at issue from the data afterwards, because then one needs to remove the additional codes also - otherwise the result is again DRG 470.
After discussions we agreed with Kristiina Kahur to do following:
In the Estonian logic the logic rule for DRG 483X (current rule 400D30080) is retained but placed at end of postMDC group (f.ex. at 499D999999). The rules for DRG 482X are inactivated. The name of the DRG should be just 'Tracheostomy' because it will include all types tracheostomies if no other significant intervention is performed. If other significant interventions are performed, the cases will be assigned to different DRG's based on those interventions and reimbursed accoringly.
Estonia will still not have any weight nor price for this DRG and it is not usefull to create them since the quality of the data is very poor. Thus all cases must be regarded as outliers and reimbursed based on intermediate level intervention cost (more less fee for service model).