Case #378

Correction of DRGlogic for empty values on columng ICD (Doctors team visit)

Added by Anonymous almost 5 years ago. Updated over 3 years ago.

Status:RejectedStart date:2015-02-09
Priority:MinorSpent time:-
Assignee:Ralph Dahlgren
Category:-
Target version:Expert Group 2015
Initiator:Sweden Target year:2016
Case type:Minor Owner / responsible:National organisations
MDC:GEN Old forum status:
Target Grouper:SWE

Description

National ID: 428
Initiated: 2014-12-08
Initiator: Ralph Dahlgren

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Problem
When the DRG Y99Y 'Medical contact in group or group with team of care providors' (Läkarbesök i grupp el gruppteam - Old DRG 953O) was created in MDC 50 'Caregiver dependant groupd' (Vårdgivarberoende grupper i öppenvård) - an unspecific MDC used by the NordDRG Swe version. This due to the fact that there were not enough visits in the group to make one group for each MDC. Going through DRG Y99Y with cost data (KPP) for 2013 there are still not enough information to make new DRG groups, particularly when it comes to cost data. As far as cost data are concerned there will always be a problem getting it correct.
But when looking through DRG logic the Swedish National Board of Health and Welfare noticed that the DRGlogic row for this kind of doctor visit does not demand a diagnose code. This must be an error since all doctors’ visits in Sweden must have a ICD diagnosis.
Analysis
The Swedish National Board of Health and Welfare – 2014-12-08
No analysis is needed.
Suggestion
The Swedish National Board of Health and Welfare – 2014-12-08
Add the demand for diagnosis to the DRG logic row for DRG Y99Y
The Swedish National Board of Health and Welfare – 2014-12-08
This is something that Sweden wants to have introduced for 2016

DRG change
There should be no changes of DRG
Technical change
In NordDRG SWE for 2016 Sweden wants in the row for DRGlogic ord 200D213 that has to do with DRG Y99Y Läkarbesök i grupp el gruppteam to have a “+” added in the column ICD.
Se Excell-file:Decision, Technical changes, NPK C428

C428 to Forum.docx (15.8 KB) Anonymous, 2015-02-09 09:49

C428 Decision Technical changes NPK C428.xls (40 KB) Anonymous, 2015-02-09 09:49

History

#1 Updated by Martti Virtanen almost 5 years ago

  • Subject changed from Correction of DRGlogic for Doctors team visit to Correction of DRGlogic for empty values on columng ICD (Doctors team visit)
  • Description updated (diff)

2015-02-09 Martti Virtanen
The DRG for 'Doctor team visits' is not a problem. The NordDRG logic SWE starts with 3 lines demanding a valid principal dx for all doctor contacts (ord 000D000004), all team contacts (ord 000D000005)and all inpatient contacts (ord 000D00001). Additionally all deaths (that are assigned to inpatient DRG's) also demand a valid principal dx (ord 000D000030). These rules all result in assingment to group 470 DRG's (group Z70 according to Swedish coding). The same is truth for common version but there are only two rules (ord 000D00000 and ord 000D00001).

After these rules all '+'-signs of the icd column have no practical meaning and that icd is empty does neither mean anything nor affect the DRG assignment. To make the table easier to read, the icd should never be left empty, but all icd-column empty values should be substituted with '+'.

But there is one exception in the NordDRG SWE. The rule for DRG 470L 'Unplanned hospitalisation from planned visit' (Z82O 'Besök med oplanerad inskrivning')is placed as the first rule of the logic and is empty on icd. I would suggest that this case is also given '+' since it is difficult to understand that a patient would be assinged without any working dx. Otherwise we need to have to rules for this DRG. One with '-' and one with '+' for ICD.

#2 Updated by Ralph Dahlgren over 4 years ago

If we understand it correctly we can´t agree that all DRGs should have “+” in the DRGlogic column “icd”. This due to the fact that according to the Swedish primary classification rules we can only demand that incare patients and specialist outpatient doctor visits must have a ICD-10 diagnose.
So we do not want all other DRGs to have “+”. We are quite happy with the rest being empty since not all other DRGs must include doctor involvement. That include also the rule for DRG 470L 'Unplanned hospitalisation from planned visit' (Z82O 'Besök med oplanerad inskrivning') that is placed as the first rule of the DRGlogic and is empty on icd. The reason for “icd” beeing empty is that all that is required to get grouped to this DRG is that you use procedure code XS100 Oplanerad inskrivning till sluten vård with grouping property DGPROP 00X90 just like we intended.

#3 Updated by Martti Virtanen over 4 years ago

2015-03-05 Martti Virtanen
After a second checkup I partly agree with Ralph. At the outpatient contacts with other healthcare professionals than doctos, there is no demand for diagnosis in NordDRG SWE.
This does not affect the original problem of this case, because the demand exist for all outpatient doctor contacts as well as for outpatient team care as reflected in the rules for DRG Z70O/470O (rules ord=000D000004 and ord=000D000005). The same is true for all inpatient care as reflect in the rule for DRG Z70N/470X (ord=000D000030).

Sweden has also invented the code U9990 'Diagnostic information missing' (U99.9 ‘Diagnosinformation saknas’) which is meant to be used by other healthcare professionals than doctos in situations where no diagnosis has been set (by a doctor) - see Case #395.

Shouldn't the use of this code be demanded in all cases where no other dx can be used?
This could be performed simply by removing Procpro1='99V35' from the rule for DRG Z70O/470O (ord 000D000004). Then the other rule for Z70O/470O (ord 000D000005) could be inactivated.

If this is not acceptable we also need to adapt the VAGS based NDMS to the fact that there are several rules that may be without the demand for valid principal dx.

#4 Updated by Ralph Dahlgren over 4 years ago

Sweden has done a check up again. We want this casse to be withdrawn and closed. No Changes done concerning this matter.

#5 Updated by Martti Virtanen over 4 years ago

2015-03-13 Expert group/MV
At the meeting Sweden withdraw the proposal.
I think the problem is actually valid and might need some consideration. My proposal would be the make empty diagnosis equivalent to U999 'No diagnostic information' what it basically is.
The simple way to do this, is to add empty diagnosis to the national diagnosis list for DRG. It can be mapped to U9990 and thus get the same properties. Then 'empty' diagnosis would be assigned to group Z71 DRG's.
The rules 000D000004, 000D000005, 000D00001 and 000D000030 (group Z70 DRG's) would then be used only in cases with miscoded dx's.
This would solve the problem of empty values in NordDRG ICD-column. The 'empty' dx would be a valid dx and they could have value '+'. This would solve or probelm with VAGS based new NDMS.
The original problem of medical doctor contacts without dx would be solved since according to case #395 these patient cases would be assigned to DRG Z71.

#6 Updated by Anonymous over 4 years ago

Mats Fernström
NPK, Sweden, 2015-03-24
We do not accept the changes suggested by Martti after the Expert meeting. Either close the case without any changes or postpone it until next year.

#7 Updated by Anonymous almost 4 years ago

  • Target version changed from Minor-Proposals-for-2016 to Expert Group 2015

#8 Updated by Martti Virtanen over 3 years ago

  • Status changed from Active to Rejected

2016-03-15 Expert group (MV)
There was no further interest do discuss the case and it was closed.

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