Case 2007-MDC04-01 Respiratory failure
|Case type:||Owner / responsible:|
|MDC:||MDC04||Old forum status:||CLOSITEM - Closed item|
Last updated: 2009-03-20
CLOSITEM - Closed item
Initiated - 2007-03-09
By: Mats Fernström, CPK, Sweden
Expert Network 2007-03-28 - Change recommended
Steering Group 2007-04-11 - Recommendation accepted
Expert Network 2008-03-06 - Correction accepted
Steering group 2008-03-31 - Recommendation accepted
Expert Network 2009-02-26 - Correction recommended
Board 2009-03-20 - Recommendation accepted
CPK ID 228
The Swedish Association for Respiratory Medicine (SLMF) has decided that respiratory failure (code J96) in association with chronic obstructive pulmonary disease (COPD, code J44) always shall be coded with the underlying problem, i.e. COPD, as the principal diagnosis (and the respiratory failure as a secondary diagnosis). The coding will then be J44 + J96.
With the present DRG logic there will be a problem. The more resource consuming cases with respiratory failure will be grouped to the “lighter” DRG 088 (Chronic obstructive pulmonary disease) instead of the “heavier” DRG 087 (Pulmonary edema & respiratory failure). Therefore SLMF suggests a change in the NordDRG logic so that J96 will lead to DRG 087 even though it is registered as a secondary diagnosis.
CPK has made an economical analysis on this proposal (se table) and it seems quite OK to move the cases with J44+J96 from DRG 088 to DRG 087.
DRG 087, all cases
DRG 088, all cases
J44 + J96
Expert Network 2007-03-28
Changes recommended that the cases with J44+J96 will be moved from DRG 088 to DRG 087.
Two new diagnosis properties 04X03 ‘Respiratory failure’ and 04X04 ‘Obstructive pulmonary disease’ are created. 04X03 is given to J96 and 04X04 is given to J44.
A new rule is created in the logic table before current rule 404D15. The new rule sill be a copy of the rule 404D15 DRG is changed to 087X, column dgcat1 is cleared and dgprop1 is given value 04X03 and dgprop2 value 04X04.
Cases with J96 and J44 diagnosis are assigned to DRG 087 independent of the order of the diagnoses.
Kristin Dahlen 2007-08-22
Cases with other principal dx than J44 or J96 are now assigned to DRG 087. This is because the grouper uses diagnosis properties form all diagnosis so that J44 and J96 may both be secondary diagnoses. (short cut by Nordic Centre)
Martti Virtanen 2007-08-22
This is true. It is probable that cases with obstructive pulmonary disease and respiratory failure are more resource intensive than cases with pneumonia (J15.9) or ‘Unspecified acute lower respiratory infection’ (J22.0) only (for example). Therefore it might be correct to assign these cases to DRG 087. However, this was not what was decided. Therefore the changes will be modified as follows.
Expert Network 2008-03-06
The meeting accepted the correction. Error corrected. The case will be closed.
Expert Network 2009-02-26
The meeting accepted the change. Error corrected. The case will be closed
A new principal diagnosis property 04P01 ‘Respiratory failure’ is created and given to J96.
The new rule is modified so that column pdgprop is given value 04P01, column dgprop1 is given value 04X04 and dgprop2 cleared.
Cases with J96 and J44 diagnosis are assigned to DRG 087 independent of the order of the diagnoses. No other cases change DRG.
A new principal diagnosis property 04P01 ‘Respiratory failure’ is created and given to J44.
The new rule is modified so that column pdgprop is given value 04P01, column dgprop1 is retains value 04X03 and dgprop2 cleared.
Cases with J96 and J44 diagnosis are assigned to DRG 087 if J96 is principal dx. No other cases change DRG.