Case #407

Normal birth without procedure

Added by Anonymous over 6 years ago. Updated over 5 years ago.

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


National ID: HD-0105
Initiated: 2015-02-25
Initiator: Norwegian Directorate of Health
Responsible at National organization: Kristin Dahlen
Sent to NordDRG Forum: 2015-02-25
Norwegian coding rules states that all normal births shall be coded with diagnosis code Z37.- “outcome of delivery”, and a procedure code indicating birth. This might be TMA20 “ manuell fødselshjelp ved normal fødsel”.

Cases without procedure code will group to DRG 376 “Postpartum & post abortion diagnoses w/o operation”. This is obviously wrong DRG even though a procedure code is missing.

Norwegian directorate of health – 2015-02-25

We suggest DGPROP 14X03 “delivery this admission” to diagnosis codes Z37.-.

Z37-group.jpg (89.9 KB) Martti Virtanen, 2015-03-05 14:53

Case #407 - Technical changes.xlsx (11.2 KB) Martti Virtanen, 2015-03-17 12:14


#1 Updated by Martti Virtanen over 6 years ago

2015-03-05 Martti Virtanen

It is obvious that the usage in Norway is acceptable and there is now need for additional code for interventions.

These codes indicate that a delivery has taken place and they should therefore have the property 14X03 'Delivery this admission'. The codes are in principal not allowed to be used (alone) in Sweden and are rarely used in other NordDRG collaboration countries (possibly with the exception of Denmark). Thus the addition of the property to these codes will not cause any change in DRG assignment in any other country.

(missunderstanding corrected 16.3.2015)

#2 Updated by Ralph Dahlgren over 6 years ago

In Sweden the Swedish association for obstetrics and gynecology has decided that all cases with child delivery must be registered with a code in the interval O80-O84 as the principal diagnosis so it seems a bit peculiar to us that Norway is using additional codes from the Z chapter as the principal diagnosis. You say that “a procedure code indicating birth” also must be used but the suggestion is that diagnosis codes Z37 alone shall be grouped to a delivery DRG. Isn’t it better that Z37 without a procedure code indicating birth is grouped to DRG 470? That will learn the obstetricians to code according to your principles.
Nevertheless, we don’t oppose that the Z37 codes are given the diagnosis property 14X03 (Delivery this admission). It will hardly change anything in Sweden. But we don’t want the Z38 codes to have 14X03 if they are used for neonatal registration as Martti says. Neonates must not be grouped to a delivery DRG.

#3 Updated by Martti Virtanen over 6 years ago

  • File deleted (Z38-group.jpg)

#4 Updated by Martti Virtanen over 6 years ago

2015-16-03 Martti Virtanen
I have corrected my previous misunderstanding.
We should note that WHO instructions do not indicate that Z-codes of ICD-10 should not be used as principal diangosis. Actually vice versa: they indicate that patient is healthy and they can only rarely be combined with disease codes. Thus using Z37-group codes for normal delivery is actually correct. In Norway one obviously omits the usage of O8000/O80.0 'Spontaneous vertex delivery'. Of course since it basically indates 'normal delivery', it does not add any substantion information to Z37-group. Z37-group on the other hand gives more exact information on multiple births than O80-O84 group.

#5 Updated by Martti Virtanen over 6 years ago

2015-03-13 Expert group/MV
The Norwegian proposal was accepted by all countries.

Technincal change
The diagnoses in the group Z37 are given the property 14X03.
DRG change
Cases with group Z37 will be assigned to DRG 374X/P05E-C-A 'Vaginal delivery w sterilization &/or d&c' instead of DRG 376X/P15C-E 'Postpartum & post abortion diagnoses w/o operation'

#6 Updated by Anonymous over 5 years ago

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

#7 Updated by Martti Virtanen over 5 years ago

  • Status changed from Active to Accepted

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