Case #381

Coding of sleep distubances (other and unspecified G4780 and G4790) and sleep apnoe investigations - what is correct DRG?

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

Status:AcceptedStart date:2015-02-09
Priority:MinorSpent time:-
Assignee:Ralph Dahlgren
Category:-
Target version:Expert Group 2015
Initiator:Iceland, Latvia, Norway, Sweden Target year:2016
Case type:Minor Owner / responsible:National organisations
MDC:MDC03, MDC19 Old forum status:
Target Grouper:ICE, LAT, NOR, SWE

Description

National ID: C454
Initiated: 2014-12-08
Initiator: Ralph Dahlgren

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Problem
The initiator pointed out that a with principal dx G4780 'Other sleep disorders' (Andra specificerade sömnstörningar) or G4790 'Sleep disorder, unspecified' (Sömnstörning, ospecificerad) are assigned to DRG T49N/432C 'Other unspecific mental disorders' (Ospecificerade psykiska besvär).
Cases with R0650 'Mouth breathing ' (Munandning och snarkning) and G4730 'Sleep apnoea' (Sömnapnésyndrom) are assigned to DRG C37C-E/520N-C 'Obstructive sleep apnoe syndrom/w CC' (Obstruktivt sömnapnésyndrom, ej kompliserad/kompliserad). According to the initiator the investigation of the problems are the same.

Analysis
The Swedish National Board of Health and Welfare 2014-12-08
The Swedish cost data (KPP) shows little difference between the cost for ICD-10 codes G478 and G479 in DRG T49N/432C and the cases in DRG C37C-E/520N-C.
Assigning cases with the two codes to DRG C37C-E/520N-C would also result in a more homogeneous distribution of the DRG's

Suggestion
The Swedish National Board of Health and Welfare 2014-12-08

We cannot move G4780 and G4790 to a diagnosis category in MDC 03 because these unspecific codes may be used for other problems than apnoe that are treated in psychiatric care.
Using a new principal diagnosis property 03P05 ‘Sleep apnea' it is possible to construct rules that bypass this problem.
Cases with G4780 or G4790 as principal dx continue to be assigned to DRG T49N/432C if no sleep apnoe investigation (interventions with procedure property 03V02) is performed:

If any of the interventions is performed the cases should be assigned to DRG C37O-E-C/520O-N-C.

The rule for DRG C37O/520O (outpatient rule only used in NordDRG SWE) already uses both proc1 (99V20 'Outpatient visit') and secproc (99V35 'Medical doctor') leaving no place for PROCPRO 03V02 thus demanding another solution.

Sweden wants this change to be introduced in the NordDRG SWE 2016

Technical change

A new principal diagnosis property 03P05 'Sleep apnoe' is created. This property is given to dx G4780 and G4790 and to all linked national codes.

A new diagnosis property DGPROP 03X05 ‘Sleep apnoe examination‘ is given to all the procedure codes with procedure property 03V02

Three new rules are added to the Drglogic-table for DRG C37O-E-C/520O-N-C. They are copies of the current rules but MDC 03 is removed, PDGPROP has value 03P05 and Dgprop1 03X05.

The text on the DRG C37E/C will have a name change to “Sömnstörningsutredning” ( Investigation of sleep Disturbance), C37O will have a name change to “Läkarbesök vid sömnstörningar” ( Doctor's appointment of sleep disorders ).

DRG change
Some outpatient cases (doctor visits) will be grouped to DRG C37O instead of DRG C76O/767V 'Sleep apnoe examination, short therapy' and T99O/880V 'Other medical contact for psychiatric problem, short therapy'. The remaining cases in DRG C76O/767V will be visits at other personal categories than doctors. For inpatients some will be moved from DRG T49N/432C to DRG C37E-C/520O-N-C.

For more details see the Excell-file “Decision, technical changes, NPK C454”

C454 Decision Technical changes NPK C454.xls (77 KB) Anonymous, 2015-02-09 10:00

C454 to Forum.docx (17.4 KB) Anonymous, 2015-02-09 10:00

Sleep_apnoe_interventions.xlsx (9.77 KB) Martti Virtanen, 2015-03-04 07:54

Sleep_apnoe_interventions.jpg (93.3 KB) Martti Virtanen, 2015-03-04 07:54

Sleep_disturbances.xlsx (10.1 KB) Martti Virtanen, 2015-03-04 09:28

Sleep_disturbances.jpg (250 KB) Martti Virtanen, 2015-03-04 09:29

Case #381 Technical changes.xlsx - Updated 2015-04-24 (24.5 KB) Martti Virtanen, 2015-04-24 18:42

History

#1 Updated by Martti Virtanen over 4 years ago

2015-03-03 Martti Virtanen
In this case the question is basically what is correct coding. As the added codes in Denmark illustrate (in ICD+) the conditions that may be coded with these dx's are not typically sleep apnoes, not at least in the Danish thinking. It seems, however that this is the case in Sweden. To avoid the proplem presented by Sweden we must adapt the system.

The Swedish proposal is basically good, but I would change two details.
1)The new rule for DRG C37O/520O does not need to retain the property 99V20. Duration <1 is enough to mark that this is outpatient visit. Thus we can use the property 03V02 and need no new diagnosis property.
2)The change of the name is misleading, because the DRG's will still only contain cases with apnoe (or suspected apnoe) and other sleep distubances are not included. The word 'obstructive' could be omitted since it is not certain that all have obstruction of airways.

The argument is valid for all versions. However, as seen from the list of interventions, only Swedish, Norwegian, Icelandic and Latvian CSP versions have codes for the interventions at issue. I propose that the new rules are added to all versions but they will have practical effect only if the intervention codes exist (or are added).

#2 Updated by Martti Virtanen over 4 years ago

  • File deleted (Sleep_disturbances.xlsx)

#3 Updated by Martti Virtanen over 4 years ago

  • File deleted (Sleep_disturbances.jpg)

#5 Updated by Martti Virtanen over 4 years ago

  • Subject changed from G479 Sömnstörning and G478 Andra specificerade sömnstörningara are grouped wrong. to Coding of sleep distubances (other and unspecified G4780 and G4790) and sleep apnoe investigations - what is correct DRG?

#6 Updated by Ralph Dahlgren over 4 years ago

We accept the proposal to remove 03X05 and use the 03V02.
We do not accept Martti's suggestion for change of DRG names due to the fact that a couple of the procedures with 03V02 also can be used for other sleep disorders other than sleep apnea.

#7 Updated by Martti Virtanen over 4 years ago

  • File Case #381 Technical changes.xlsx added
  • Target Grouper ICE, LAT, NOR added
  • MDC MDC19 added
  • Initiator Iceland, Latvia, Norway added

2015-03-13 Expert group/MV
The case was accepted with the modification.
Further discussion is necessary about the nature of the dx for sleep disturbances and apnoe. This will be a new case.

Technical change
A new principal dx property 03P05 'Sleep apnoe' is created
The dx G4780 and G4790 are given the new PDGPRO 03P05.
New rules are created for DRG's 037O (after current rule 200D16919 - only SWE), 037C (after current rule 403D280005 - only SWE) and 037E/520X (after ord 403D280009 - for all versions). The rules are copies of current versions but MDC will be empty, PDGPRO 03P05 and procpro1 03V02.

DRG changed
The dx G4780 and G4790 will be accepted as apnoe dx when an apnoe examination is performed and assigned to DRG's for examination of sleep disturbances (520/C37) in MDC 03.
NOTE:
In interventions for obstructive apnoe (521/C17) these dx's are still not accpeted.

#9 Updated by Martti Virtanen over 4 years ago

  • File deleted (Case #381 Technical changes.xlsx)

#10 Updated by Anonymous almost 4 years ago

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

#11 Updated by Martti Virtanen over 3 years ago

  • Status changed from Active to Accepted

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