Case #461

Day surgery DRGs for doctors only

Added by Mats Fernström almost 4 years ago. Updated about 3 years ago.

Status:AcceptedStart date:2016-01-28
Priority:MinorSpent time:-
Assignee:Mats Fernström
Category:-
Target version:Expert Group 2016
Initiator:Sweden Target year:2017
Case type:Minor Owner / responsible:
MDC:GEN Old forum status:
Target Grouper:SWE

Description

Problem
We have noticed that some health personal don’t know the national rules for coding of control visits. They register the procedure that was performed during the previous contact instead of the diagnosis that is controlled. Thus we have, for example, outpatient physiotherapist visits with hip replacements in our medical registers, which of course is totally wrong.
Analysis
NPK ID C384, Sweden – 2016-01-28
We have discussed different ways to solve the problem. One way is to delete day surgery DRGs that are impossible and this has been done for a few DRGs (see NCC Case #276).
Another way to diminish the problem is to add that it must be a doctor visit to get a day surgery DRG. This demands a very thorough and time consuming analysis, however, since it becomes more frequent that specially trained nurses are doing OR procedures. Therefore, to begin with, we have chosen to restrict some DRGs to doctor visits:

In the Drglogic table, the rules for day surgery DRGs that demand a procpro value denoted as “extensive” in the proc prop table are restricted to doctor visits by adding a new diagnosis property, 99X35 (Medical doctor) in the first empty dgprop field. (The existing procedure property 99V35 ‘Medical doctor’ cannot be used since the secproc field already is occupied in some rules.)

This can be seen as a first step to reduce the problem and in the future we can perhaps analyze the other day surgery groups.
Suggestion
NPK, Sweden – 2016-01-28
To reduce the number of erroneous day surgery registrations we suggest that day surgery DRG rules with procedures defined as “extensive” are restricted to doctor visits in NordDRG 2017. Then 44 rules in the Drglogic table has to be changed by adding a new diagnosis property, 99X35 (Medical doctor) in the first empty dgprop field. See Suggestion CPK ID 384.xls for details. The DRG change will be minor.

Suggestion CPK ID C384.xls (75.5 KB) Mats Fernström, 2016-01-28 13:32

Decision CPK ID C384.xls (77.5 KB) Mats Fernström, 2016-03-17 10:14

History

#1 Updated by Anonymous almost 4 years ago

  • Target version changed from Expert Network Meeting to Expert Group 2016

Target version changed to Expert Group 2016.

#2 Updated by Anonymous almost 4 years ago

  • Target year 2017 added

#3 Updated by Kristiina Kahur over 3 years ago

Finnish National DRG-Centre 2016-2-25

The proposed change cannot be applied in Finland since the coding of doc/nurse visits with specific code is not reliable and coherent as there are no nationwide guidelines for that.

#4 Updated by Martti Virtanen over 3 years ago

2016-03-09 Nordcase - Martti Virtanen
The proposal would obviously only apply for the Swedish version, creating another bulk of differences to the logic.
The falsely coded cases would end up in the group 477O/Z60O which is not acceptable for the hospitals and they would certainly improve their coding. This fact makes this yet another example of trying to learn people to code through DRG, which we do not have a good record on.
Otherwise the proposal can be performed for the Swedish version.

#5 Updated by Mats Fernström over 3 years ago

Mats Fernström, NPK, Sweden, 2016-03-17
This case was discussed at the Expert Network meeting 2016-03-14 – 15 and accepted for change in SWE version but the ORD value for the new rules must not be the same as the deleted rules. This is now fixed in the attached file Decision CPK ID C384.xls.

#6 Updated by Martti Virtanen over 3 years ago

2016-03-15 Expert group (MV)
This case was accepted by the expert group for Swedish use. The information about doctors participation is not available in other countries and this type of rule is therefore not applicable.
Since other version will retain the old rules the new rules should have different coding as shown int the latest version of the proposal.
The document from Sweden is vali as technical changes documentation. The correspond code for medical doctor in NCSP+ is ZZ2221.

#7 Updated by Anonymous about 3 years ago

  • Status changed from Active to Accepted

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