Case #397

Compl value for urinary tract infection N39

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

Status:AcceptedStart date:2015-02-11
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:MDC11 Old forum status:
Target Grouper:SWE

Description

National ID: C578
Initiated: 2014-12-10
Initiator: Ralph Dahlgren

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Problem
During the review of the case with incongruence of compl values, we found that the code N390A ‘Asymptomatic urinary tract infection’ has the compl value 11C12 ‘Urinary tract infection NOS’. N390A means that the patient has bacteria in the urine, no symptoms and should not be treated with antibiotics according to all Swedish guidelines. Since this is the case the code cannot complicate an inpatient.
The problem is that the other codes on N390 Urinary tract infection, without a specific localization N390X Urinary tract infection NOS have CC as well.
The system should not reward bad coding, so if the compl value for N390A is removed, all codes on N390 have to have their compl values removed.
Medical there is no problem since pyelonephritis is coded on the N10. 9 and acute cystitis is coded at N30.0 And both diseases are easy to clinically separate.

Analysis
The Swedish National Board of Health and Welfare 2014-12-10
When the CC-grouper was constructed the selection of codes which should have CC-level (complication – level) or MCC-level (major complication-level) were done by cost control in cost-data (Swedish KPP) and those who there were insecure were controlled manually.
Unfortunately these codes passed without being recognized getting the compl even if they should not have compl.
This is a medical decision.

Suggestion
The Swedish National Board of Health and Welfare 2014-12-10
Suggests that the codes below:

All the above should loose COMPL 11C12 Urinary tract infection NOS

Sweden suggest that these changes are introduced 2016

DRG change
Some patients will group from a complicated DRG to a non complicated DRG. This is very correct medical vise.

Technical change
The codes N390, N390A, N390X loose COMPL 11C12 Urinary tract infection NOS
For specific details se Excell-file “Decision, Technical changes, NPK C578”

NPK C578 Decision Technical changes NPK C578.xlsx (15.2 KB) Anonymous, 2015-02-11 13:07

NPK C578 to Forum.docx (16.3 KB) Anonymous, 2015-02-11 13:07

Urinary_tract_inf_asympt.jpg (76.7 KB) Martti Virtanen, 2015-02-23 14:48

Case #397 Technical changes.xlsx (11 KB) Martti Virtanen, 2015-03-18 12:22

History

#1 Updated by Anonymous almost 5 years ago

  • Parent task deleted (#245)

#2 Updated by Martti Virtanen over 4 years ago

  • File Urinary_tract_inf_asympt.jpg added
  • Description updated (diff)

2015-02-23 Martti Virtanen
It is obvious that asymptomaitic urinary tract infection should not be regarded as complicating factor.
11C12 'Urinary tract infection NOS' is a very specific complication category. The only dx belonging to it is N3900 'Urinary tract infection, site not specified'. The exclusion list is a broad range of more or less related diagnosis in several chapters of ICD-10.
It is perhaps more correct to state, that N390A ‘Asymptomatic urinary tract infection’is misplace in ICD-10. ICD-10 has dx R8270 'Abnormal findings on microbiological examination of urine' that also exist in the Swedish ICD-10 (as well as all other versions). If N390A means that the patient has bacteria in the urine without any symptoms, it is almoust identical with R8270.
A more correct linkage would thus be with R8270 and not with U3900. This would solve the problem since R82700 does not belong to any complication category. Moreover it belongs to diagnosis category 11M06 (instead of 11M04) This would result in assignment to DRG 326-325/M50E-C (instead of 320N/C/M-M40E/C/A) for inpatients and 326O/M50O (instead of 321O/M40O)for outpatients.

Further analysis
The other issue is, whether N3900 should be a complicating dx. As noticed abouve N1000 (N10.9) and N3000 are complicating diagnosis. The necessary analysis for this case is, whether the use of N3900 as secondary dx indicates similar additional resource demand than N1000 or N3000 and to which extent this N3900 is used.
The solution should be common because the change will affect all versions of NordDRG.
Thus all countries should analyse the matter.

#3 Updated by Martti Virtanen over 4 years ago

  • File deleted (Urinary_tract_inf_asympt.jpg)

#4 Updated by Martti Virtanen over 4 years ago

  • File Urinary_tract_inf_asympt.jpg added

#5 Updated by Martti Virtanen over 4 years ago

  • File deleted (Urinary_tract_inf_asympt.jpg)

#7 Updated by Ralph Dahlgren over 4 years ago

In Sweden the use of the different codes N39.0 Urinary tract infection, site not specified is found for inpatients 37 846 times in 530 different DRGs. The code N10.9 Pyelonephritis = Infection in the kidney is found for inpatients 11 813 times in 298 different DRGs. N30.9 Cystitis unspecified is found 3 192 times in 309 different DRGs.
Clinically for adult the differentiation between N10.9 and N30.- is clear somewhere between 95-97 % and in Sweden the rest will be investigated to secure the diagnose since the treatment differs.
In Sweden the current way of coding gives very little clinical information. With removal of the Complication value from N39.0 the coding and clinical information would increase rapidly.

#8 Updated by Martti Virtanen over 4 years ago

2015-03-13 Expert group/MV
The change of mapping of N390A to R8270 was accepted.
The discussion about properties of N3900 was postponed and will be opened as new case.
The rules will not change, only mapping of N390A (Swe dx). The properties will change automatically after uppdate of ICD+ for PR-versions.

#9 Updated by Anonymous almost 4 years ago

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

#10 Updated by Martti Virtanen over 3 years ago

  • Status changed from Active to Accepted

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