Case #403

Normal newborn, birth weight over 2500 g, with other significant problem

Added by Anonymous over 4 years ago. Updated about 3 years ago.

Status:AcceptedStart date:2015-02-26
Priority:MinorSpent time:-
Assignee:Kristin Dahlen
Category:-
Target version:Expert Group 2015
Initiator:Norway Target year:2016
Case type:Minor Owner / responsible:National organisations
MDC:MDC15 Old forum status:
Target Grouper:NOR

Description

National ID: HD-0092, HD-0110 and HD-0117
Initiated: 2015-02-25
Initiator: Norwegian Directorate of Health
Responsible at National organization: Ruth Foseide Flenning and Kristin Dahlen
Sent to NordDRG Forum: 2015-02-25
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Problem
A plurality of diagnosis can lead to DRG 390X/Q55N 'Neonate, birthweight 2500 g or more, with other significant problem', and we question if it is correct that they all classify as “significant problems” for a newborn. As can be seen in preliminary data from Norway 2014, 72% of the babies are assigned to DRG 391X/Q60N 'Normal newborn', while 17% of the newborns are assigned to DRG 390X/Q55N.

In addition we have registered different coding practice mainly in the area of P codes. This is misleading when it comes to medical statistics, and has also represented problems according to the activity based payment.

Based on this we have studied the list of P codes diagnoses leading to DRG 390X/Q55N.

We have following comments:

  • Some codes are descriptive of the mothers condition (P00-P04). This information represents a potential link between a mothers and child’s condition and is obviously important in a medical and statistic point of view, but is it correct to route these codes into DRG 390 independently of a healthy newborn or not?
  • For the following codes, analysis has revealed a difference in code practice between the hospitals:

P9220 'Slow feeding of newborn' - would it be better to rephrase the code to make the difference between a normal and pathological more clear? i.e. loss of more than 10% of birth weight and need of additional nutrition? Is it necessary to differentiate between newborns <8 days and older and only route those babyes >8 days into DRG 390?
P8310 'Neonatal erythema toxicum' - a common harmless skin rash that affects healthy newborn and clears up without any treatment.
P0340 'Fetus and newborn affected by caesarean delivery' F – frequently coded in some hospitals

  • For the following codes we question if it is correct to route them directly to DRG 390:

P9250 'Neonatal difficulty in feeding at breast
P9280 'Other feeding problems of newborn'
P9290 'Feeding problem of newborn, unspecified'

From how many days of age and under which conditions is it correct to assess these groups of nutritional challenges as a “significant problem”?

Analysis
No economic analysis available

Suggestion
Norwegian directorate of health – 2015-02-25

We suggest to remove the property 15X98 “other significant problem of neonate” from the following ICD-10 codes:

P0000 'Fetus and newborn affected by maternal hypertensive disorders'
P0010 'Fetus and newborn affected by maternal renal and urinary tract diseases'
P0020 'Fetus and newborn affected by maternal infectious and parasitic diseases'
P0030 'Fetus and newborn affected by other maternal circulatory and respiratory diseases'
P0040 'Fetus and newborn affected by maternal nutritional disorders'
P0050 'Fetus and newborn affected by maternal injury'
P0060 'Fetus and newborn affected by surgical procedure on mother'
P0070 'Fetus and newborn affected by other medical procedures on mother, not elsewhere classified'
P0080 'Fetus and newborn affected by other maternal conditions'
P0090 'Fetus and newborn affected by unspecified maternal condition'
P0100 'Fetus and newborn affected by incompetent cervix'
P0110 'Fetus and newborn affected by premature rupture of membranes'
P0120 'Fetus and newborn affected by oligohydramnios'
P0130 'Fetus and newborn affected by polyhydramnios'
P0140 'Fetus and newborn affected by ectopic pregnancy'
P0150 'Fetus and newborn affected by multiple pregnancy'
P0160 'Fetus and newborn affected by maternal death'
P0170 'Fetus and newborn affected by malpresentation before labour'
P0180 'Fetus and newborn affected by other maternal complications of pregnancy'
P0190 'Fetus and newborn affected by maternal complication of pregnancy, unspecified '
P0200 'Fetus and newborn affected by placenta praevia'
P0210 'Fetus and newborn affected by other forms of placental separation and haemorrhage'
P0220 'Fetus and newborn affected by other and unspecified morphological and functional abnormalities of placenta'
P0230 'Fetus and newborn affected by placental transfusion syndromes'
P0240 'Fetus and newborn affected by prolapsed cord'
P0250 'Fetus and newborn affected by other compression of umbilical cord'
P0260 'Fetus and newborn affected by other and unspecified conditions of umbilical cord'
P0270 'Fetus and newborn affected by chorioamnionitis'
P0280 'Fetus and newborn affected by other abnormalities of membranes'
P0290 'Fetus and newborn affected by abnormality of membranes, unspecified'
P0300 'Fetus and newborn affected by breech delivery and extraction'
P0310 'Fetus and newborn affected by other malpresentation, malposition and disproportion during labour and delivery'
P0320 'Fetus and newborn affected by forceps delivery'
P0330 'Fetus and newborn affected by delivery by vacuum extractor [ventouse]'
P0340 'Fetus and newborn affected by caesarean delivery'
P0350 'Fetus and newborn affected by precipitate delivery'
P0360 'Fetus and newborn affected by abnormal uterine contractions'
P0380 'Fetus and newborn affected by other specified complications of labour and delivery'
P0390 'Fetus and newborn affected by complication of labour and delivery, unspecified'
P0400 'etus and newborn affected by maternal anaesthesia and analgesia in pregnancy, labour and delivery'
P0410 'Fetus and newborn affected by other maternal medication'
P0420 'Fetus and newborn affected by maternal use of tobacco'
P0430 'Fetus and newborn affected by maternal use of alcohol'
P0440 'Fetus and newborn affected by maternal use of drugs of addiction'
P0450 'Fetus and newborn affected by maternal use of nutritional chemical substances'
P0460 'Fetus and newborn affected by maternal exposure to environmental chemical substances'
P0480 'Fetus and newborn affected by other maternal noxious influences'
P0490 'Fetus and newborn affected by maternal noxious influence, unspecified'
P8310 'Neonatal erythema toxicum'
P9220 'Slow feeding of newborn'
P9250 'Neonatal difficulty in feeding at breast
P9280 'Other feeding problems of newborn'
P9290 'Feeding problem of newborn, unspecified'

403RalphDahlgenComment.jpg (34.8 KB) Anonymous, 2015-03-12 11:43

SWE-Comment-#403-22Jan2016.docx (18.7 KB) Anonymous, 2016-01-25 11:49

Technical changes #403.xlsx (17.1 KB) Mats Fernström, 2016-03-16 17:54

Technical changes case #403.xls (73 KB) Martti Virtanen, 2016-04-14 11:29

History

#1 Updated by Kristiina Kahur over 4 years ago

2015-03-03 Kristiina Kahur
This case should be discussed and handled in light of the case submitted By Finland two years ago http://documents.norddrg.net/issues/1
Some of the diagnosis have lost the diagnosis property 15X98 (Other significant problem of neonate)in Finnish version in 2014 already.

#3 Updated by Anonymous over 4 years ago

#4 Updated by Martti Virtanen over 4 years ago

  • Description updated (diff)

#5 Updated by Martti Virtanen over 4 years ago

  • Status changed from Active to Further active
  • MDC MDC15 added

2015-03-13 Expert group/MV
The expert group was in favour to make a separate solution for Finland and Norway.
However, the changes Kristiina Kahur refers to, is actually 6 codes out of the 43 listed above that do not have property 15X98 currently. This is valid also for Sweden.
To remove the property 15X98 from the rest of the codes affects all versions, which is not supported by Sweden.

It is possible that the analysis performed in a very short time in Sweden is not complete. The analyse should be only about cases that have one of the dx listed above and no other dx with 15Xxx properties (except for 15X99 which does not count).

We must therefore postpone the case for further analysis.

#6 Updated by Anonymous almost 4 years ago

Susan Berggren has sent to Nordic Casemix Centre Sweden´s comment to this case.
Please open the document attached (SWE-Comment-#403-22Jan2016) to see the comment.

#7 Updated by Anonymous almost 4 years ago

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

#8 Updated by Mats Fernström over 3 years ago

Mats Fernström, NPK, Sweden, 2016-03-16
This case was discussed at the Expert Network meeting 2016-03-14 – 15. Swedish cost data support the Norwegian proposal and it was decided to be implemented. The file Technical changes #403.xlsx (attached) includes also the Swedish sub codes to the codes in the original suggestion.

#9 Updated by Martti Virtanen over 3 years ago

  • File Technical changes case #403.xls added

2016-03-+15 Expert group (MV)
As already stated by Mats Fernström the case was accepted.
The technical changes document shows which codes in national versions are affected by the change (ICD+ sheet)

#10 Updated by Martti Virtanen over 3 years ago

  • File deleted (Technical changes case #403.xls)

#12 Updated by Anonymous about 3 years ago

  • Status changed from Further active to Accepted

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