Case #494

Cardiac arrest, ICD-codes I46.0 and I46.9

Added by Tiina Pasanen 10 months ago. Updated 6 months ago.

Status:ActiveStart date:2016-12-16
Priority:MinorSpent time:-
Assignee:Veronika Stemme
Category:-
Target version:Expert Group 2017
Initiator:Sweden Target year:2018
Case type:Minor Owner / responsible:National organisations
MDC:MDC05 Old forum status:
Target Grouper:SWE

Description

Description:

National ID: CPK ID647
Initiated: 2016-05-02
Initiator: Veronika Stemme, National Board of Health and Welfare, Sweden

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Problem
The ICD-10 code I46.0 'Cardiac arrest with successful resuscitation' is grouped to DRG Z60N 'Other rare or incorrect combination of principal diagnosis and procedure' but the ICD-10 code I46.9 'Cardiac arrest, unspecified' is grouped to DRG E48E Cardiac arrest, unexplained, uncomplicated. The least specific code is in this way favored. Both I46.0 and I46.9 should be OK to use if the time in hospital is less than 2 days.
See also case #217

Analysis
National Board of Health and Welfare – 2016-12-02
This is a matter of medical description, economical analysis is not needed.

Suggestion
National Board of Health and Welfare – 2016-12-02
We suggest that the ICD-code I46.0 is accepted if the time in hospital is less than 2 days, the cases should go to DRG E48 Cardiac arrest, unexplained.

Decided changes
National Board of Health and Welfare – 2016-12-02
Sweden wants this change to be implemented in the Swedish NordDRG 2018.

DRG change
The ICD-code I46.0 is now grouped to DRG Z60N. Instead we want I46.0 to be grouped to DRG E48E if the time in hospital is less than 2 days.

Technical change
'Duration >1' is added to the rule in DRG-logic with PDGPROP 00P03 (Rare or incorrect principal diagnosis), only valid for the diagnosis code I46.0
Se file Technical changes CPK ID 647.xlsx

Technical changes CPK ID 647.xlsx (13.8 KB) Tiina Pasanen, 2016-12-16 10:47

Technical changes case #494.xlsx (21.7 KB) Martti Virtanen, 2017-05-08 22:49

History

#1 Updated by Martti Virtanen 8 months ago

  • Description updated (diff)

#2 Updated by Kristiina Kahur 8 months ago

Finnish National DRG-centre 2017-3-9

Both codes, I46.0 and I46.9 have exactly the same properties in Finnish grouping logic and the most used DRG in inpatient setting is DRG 129 (E48E-> 129, Cardiac arrest, unexplained) if any of those codes is coded as primary diagnosis.
DRG 477 is used three times and DRG 468 four times in case I46.0 is coded as main dx. LOS in case of DRG 477 is 3,3 days and in case of DRG 468 is 7,5 days.
While checking the 477 and 468 cases in detail, the problem seems to be wrong coding (sequence of dx codes) rather than LOS and therefore the suggested change would not make sense in Finland.
Is it possible that the properties and grouping rules are different in SWE and FIN?

#3 Updated by Veronika Stemme 8 months ago

Veronika Stemme, Sweden:
In Sweden the ICD-10-code I46.0, 'Cardiac arrest with successful resuscitation' but not I46.9 'Cardiac arrest, unspecified', has pdgprop 00P03 ‘Rare or incorrect principal diagnosis’. Otherwise the two codes have the same properties.
The reason that I46.0 has the pdgprop 00P03 is that if a patient is successfully resuscitated, we think that you should be able to find a reason for the cardiac arrest and set a more specific diagnosis.

#4 Updated by Martti Virtanen 6 months ago

2017-03-13 Expert group
Expert group accepted the change for NordDRG Swe. Other version are not affected.

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