Administrative intervention code results in assignment to an administrative DRG in a clinical situation (Arthropathy code (M-chapter in ICD-10) together with procedure code lead to an administrative DRG)
|Target version:||Expert Group 2015|
|MDC:||GEN||Owner / responsible:||National organisations|
|Target Grouper:||SWE||Old forum status:|
National ID: CPK ID C446
Initiator: Ralph Dahlgren, The Swedish National Board of Health and Welfare
Addition of a procedure code for certificate writing, for example GD003 Intyg, omfattande (Certificate, extensive) or XS013 Avstämningsmöte med försäkringskassan (Status meeting with the social insurance) leads to an administrative DRG-group, X63O/926V Vårdadministrativa åtgärder, öppenvård (Administration of care, short therapy) which has a lower weight (and possibly lower reimbursement) than many visits without the procedure codes, and many clinics may therefore skip the reporting of these procedure codes.
In general terms, addition of a procedure code should not lower the weight of a DRG group in Nord-DRG. We do not want to diminish the reporting to our health registers.
As for now the grouping property that goes to DRG X63O/926V is procpro 40V39. The following codes have that property:
The Swedish Expert group (SWEX) wants the cases that group to DRG X63O/926V also should have the proper ICD-10 code. After consulting with KLT at the Swedish National Board of Health and Welfare it has been established that one of the following codes should be the main diagnosis:
It is then required that the ICD-codes mentioned before get a new property that leads to DRG X63O/926V. The suggestion is to give these codes a new PDGPRO 23P05 Issue of certificate.
A new PDGPROP 23P05 'Issue of certificate' is added to the codes': Z027, Z027A, Z027B, Z027C.
In DRGlogic in the rule for DRG X63O/926V 23P05 is added to the pdgprop column.
Should not be so much difference, some of the present cases in DRG X63O might be grouped to more diagnose specific DRGs.
Se Excell file: Technical changes, Decision NPK C446
#2 Updated by Martti Virtanen over 6 years ago
- Description updated (diff)
2015-03-04 Martti Virtanen
Obviously, if a usual visit to a doctor is more resource intensive than issuing a certificate, it is wrong that the latter takes over the first. To me it seems also peculiar that the rule for this DRG is placed between diffrent medical visits. For example it does not affect the grouping to neurological visits but it affects grouping to orthopaedic visits.
This rule does not demand a doctors visit although a certificate is always issued by a doctor. Is the idea, that this DRG should apply for issuing the certificate when the patient is not present?
An alternative and clearly more simple solution is to move the rule below the rules for doctor visits, after rule for DRG W99Z/884T (current ord 200D1955) without any other change in the rule. Then it would not run over any medical visit and still catch the cases where a certificate is issued without medical visit.
#3 Updated by Ralph Dahlgren over 6 years ago
Some of the listed certificates can be issued by others than doctors.
DRG X63O Is for a patient visit with the main purpose to get a certificate issued and that is why we demand a diagnosis indicating the purpose (Issuing a certificate).
We are not intrested in having this DRG moved since we in Another case on forum want a new DRG (Z63O)for issuing of certificates without patient visits.
#4 Updated by Martti Virtanen over 6 years ago
2015-03-13 Expert group/MV
At the expert group Sweden expressed clearly that they prefer the model with specific properties for the dx indicating issueing medical certificate (listed above) combined with intervention codes also listed above. The rule should be at the place previously stated. Sweden also indicated that the rule should remain at the place where it currently is located.
#5 Updated by Martti Virtanen over 6 years ago
2015-03-19 Martti Virtanen
This case has still some problems that I propose Sweden would consider before the case is closed.
As indicated by Ralph Dahlgren some of the statements may be written by others than medical doctors. This is very much true for the interventions listed but more difficult with the dx's. As stated in case #395 other staff is not demanded to set a diagnosis. Is it now necessary to code with a diagnosis code 'Issue of ...'. This demands at least a list of dx that may and must be registered by nurses or other staff than medical doctors.
The new rule demands that one both codes 'Issue of ...certificate' + the intervention at issue. The question is which of statements stands for 'death certificate' or are all 'medical certificates' represented in the list of interventions? And also 'plan of rehabilitation' is hardly a 'medical certificate', neither 'specialist consultation' even 'with written report'
Since the strong rule demanding both dx and intervention from selected categories can be place anywhere in the system I would propose following change:
The new property 23P05 would be created as proposed.
The new property would be given to the listed dx codes but additionally to U9990 and possibly also to empty dx '_______ - No diagnosis'
The rule for DRG X63O/926V would be moved before the rule for DRG Z71O/470U (currently 000D0040) with the proposed change demanding the new PDGPRO 23P05.
Now all patient cases with the listed interventions with specified 'Issue of ... certificate' and cases with no diagnosis specified but with any of the listed interventions would be assigned to DRG X63O/926V. This would apply both to medical doctors and other staff without a demand for diagnosis. All situations where a treatment of a problem had taken place cannot not have any of the 23P05 dx's as principal dx, since that would be obviously wrong coding.
At the new place the rule would be more understandable - after the modification it will anyway be a very strong rule. The name of the property 23P05 might need to be reconsidered.
If the empty dx is to be included some modifications to the 470/Z70 rules are needed. That can be discussed if this option is interesting for Sweden.
#7 Updated by Ralph Dahlgren over 6 years ago
The suggestion by Martti have been discussed in the team.
After internal discussions, considerations we have decided that we do not want U99.9 to get PDGPRO 23P05. We still want the changes to be done according to the original proposal,including no change of ord.
#8 Updated by Martti Virtanen over 6 years ago
- File Case #379 Technical changes.xlsx added
- Subject changed from Arthropathy code (M-chapter in ICD-10) together with procedure code lead to an administrative DRG to Administrative intervention code results in assignment to an administrative DRG in a clinical situation (Arthropathy code (M-chapter in ICD-10) together with procedure code lead to an administrative DRG)
2015-04-07 Martti Virtanen
The cases has been modified accordingly.