Case #395

Grouping of U9990 'Diagnostic information missing '

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

Status:AcceptedStart date:2015-02-11
Priority:MinorSpent time:-
Assignee:Mats Fernström
Category:-
Target version:Expert Group 2016
Initiator:Sweden Target year:2017
Case type:Minor Owner / responsible:National organisations
MDC:GEN Old forum status:
Target Grouper:SWE

Description

National ID: C522
Initiated: 2013-11-04
Initiator: Veronica Myrelid, Västerås, Sweden

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Problem
The ICD code U9990 'Diagnostic information missing' (only available in Sweden as U99.9 ‘Diagnosinformation saknas’) is intended to be used 1) in non-doctor visits when diagnostic information is not available and 2)in doctor visits that result in an unplanned inpatient care. Any other use shall result in a Z-DRG indicating an incorrect coding. However, under certain circumstances it is possible to register U999 without getting a Z DRG, both in inpatient and outpatient care. There are grouping rules where the fields Dgcat, Pdgpro and Dgprop all are empty and the only diagnostic requirement is the plus sign in the field ICD, which is fulfilled by U999.
To counteract this misuse, we cannot use the existing Dgcat 99M00 ‘Code not acceptable as principal diagnosis' because then we will get DRG Z71 'Main diagnosis invalid' also when U999 is used properly by other professionals than doctors.

Suggestion
NPK, Sweden – 2015-02-04
Therefore, we propose that U999 gets a new DGCAT (99M02 'Code allowed only for visits with unplanned admission and non-doctor visits') and that two new rules for DRG Z71 'Main diagnosis invalid' are introduced (one for visits and one for inpatient care) based on this DGCAT. The new rules are copies of the existing rules with ORD 000D0040 and 000D0041 but 99M00 is changed to 99M02 and in the rule for visits 99V35 ‘Medical doctor’ is inserted in the field Proc1. The new rules are placed immediately after the existing rules with ORD 000D0040 and 000D0041.
Sweden wants this to be introduced in NordDRG 2016.
DRG change
Minor. Some cases with U99.9 as principal diagnosis will be grouped to DRG Z71 instead of the previous group.
Technical change
A new DGCAT 99M02 'Code allowed only for visits with unplanned admission and non-doctor visits' is introduced in the dg categ table.
U999 gets this new DGCAT and U999 is then moved from the dg 0 table to the dg 1 table.
Two new rules for DRG Z71 are inserted in the Drglogic table. These rules are copies of the existing rules with ORD 000D0040 and 000D0041 but 99M00 is changed to 99M02 and in the rule for visits 99V35 ‘Medical doctor’ is inserted in the field Proc1. The new rules are placed immediately after the existing rules with ORD 000D0040 and 000D0041.

See “Decision C522.xlsx”.

C522 Decision C522.xlsx (20 KB) Anonymous, 2015-02-11 12:44

C522 to Forum.docx (16.5 KB) Anonymous, 2015-02-11 12:44

Decision C522.xlsx (18.8 KB) Ralph Dahlgren, 2015-03-24 15:50

Case #395 Technical changes.xlsx - Updated version (21.7 KB) Martti Virtanen, 2015-03-31 12:04

Decision 2016 #395.xlsx (13.3 KB) Mats Fernström, 2016-02-03 16:58

History

#1 Updated by Martti Virtanen over 4 years ago

  • Subject changed from Grouping of U99.9 'Diagnostic information missing' to Grouping of U9990 'Diagnostic information missing '
  • Description updated (diff)

2015-02-24 Martti
The point is valid and the proposed modificiation should not have any problems.
An in a way more simple alternative is to put U9990 to dgcat 99M00 and add to the rules for DRG Z71 procpro 99V35. Since other professionals than medical doctors are not demanded to code any diagnosis (other than U9990) why should we check that they are not using invalid codes (from the category 99M00)?

#2 Updated by Ralph Dahlgren over 4 years ago

Sweden supports Marttis idea.

#3 Updated by Martti Virtanen over 4 years ago

  • File Case #396 Technical changes.xlsx added

2015-03-13 Expert group/MV
The modified proposal was accepted.

Technical change
U9990 will get property 99M00
The rules for DRG Z71/470E&U ord 000D0040 and 000D0041 are modified by adding procpro 99V35.

DRG change
When medical doctors (indicated by 99V35) code U9990 the cases are assigned to DRG Z71 (NordDRG SWE)

#4 Updated by Martti Virtanen over 4 years ago

  • File deleted (Case #396 Technical changes.xlsx)

#5 Updated by Martti Virtanen over 4 years ago

  • File Case #395 Technical changes.xlsx added

#6 Updated by Ralph Dahlgren over 4 years ago

The change should only be done for outpatients visits. For inpatients we want the rule for DRG Z71N to be unchanged. Otherwise inpatients with U99.9 will be accepted. The code for doctors visits has procpro 99V35 and is never used for inpatient care.

#7 Updated by Ralph Dahlgren over 4 years ago

#8 Updated by Martti Virtanen over 4 years ago

2015-03-31 Martti Virtanen
True, the Technical changes is modified accordingly.

#9 Updated by Martti Virtanen over 4 years ago

  • File deleted (Case #395 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 Mats Fernström almost 4 years ago

  • File Decision 2016 #395.xlsx added
  • Target version changed from Expert Group 2015 to Expert Group 2016
  • Target year 2017 added

Mats Fernström, NPK, Sweden, 2016-02-03
The decision that was taken on the Expert network meeting in March 2015 caused that all non-doctor outpatient visits are grouped to DRG Z71N ‘Huvuddiagnos ogiltig’ (Invalid principal diagnosis) which is obviously wrong. The reason for this grouping result is the rule with ORD 000D004100. The rule is intended only for inpatients but all cases with 99M00 are affected. The problem is solved by adding >0 in the column DUR. Technical changes are specified in Decision 2016 #395.xlsx.

#12 Updated by Martti Virtanen over 3 years ago

  • Status changed from Active to Accepted

2016-03-15 Expert group(MV)
The additional correction was accepted.

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