Case #544

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

Added by Kristin Dahlen over 4 years ago. Updated over 3 years ago.

Status:AcceptedStart date:2017-02-22
Priority:MinorSpent time:-
Assignee:Kristin Dahlen
Category:-
Target version:Target version 2018
Initiator:Norway Target year:2018
MDC:MDC15 Owner / responsible:National organisations
Target Grouper:COMMON Old forum status:

Description

Problem
A large number of diagnoses can lead to DRG 390 Normal newborn, birth weight over 2500 g, with other significant problem. As described in our case #403 (2015-02-25) we have registered different coding practice mainly in the area of P codes. This is misleading when it comes to medicial statistics, and will also represent problems according to the activity based payment. A change in properties for a number of diagnoses was done according to this case.

Based on further analysis, and suggestions from the Norwegian “Avregningsutvalget”, an advisory committee which assists the Directorate of Health on issues related to coding practice and quality of the data used in activity based funding, we suggests that dgprop 15X98 is withdrawn from the following codes:

P05.0 Lett i forhold til svangerskapslengde/ Light for gestational age
P05.1 Liten i forhold til svangerskapslengde/ Small for gestational age
P05.2 Feilernæring hos foster uten opplysning om lett eller liten i forhold til svangerskapslengde/ Fetal malnutrition without mention of light or small for gestational age and
P05.9 Uspesifisert langsom fostervekst/ Slow fetal growth, unspecified.

These codes have been mentioned by Finland in case #1, with reference to the fact that these diagnoses do not indicate any need for additional intervention and neonates without any other significant dx should be regarded as normal newborns.

Suggestion
The Norwegian Directorate of Health – 2017-02-22
The following codes shall loose dgprop 15X98, and be given dg category 15M02 Normal newborn:

P05.0 Lett i forhold til svangerskapslengde/ Light for gestational age
P05.1 Liten i forhold til svangerskapslengde/ Small for gestational age
P05.2 Feilernæring hos foster uten opplysning om lett eller liten i forhold til svangerskapslengde/ Fetal malnutrition without mention of light or small for gestational age and
P05.9 Uspesifisert langsom fostervekst/ Slow fetal growth, unspecified.

Technical changes case _544.xls (41.5 KB) Kristin Dahlen, 2017-02-27 13:45

Technical changes case _544.xlsx (14.3 KB) Martti Virtanen, 2017-03-08 11:26

Swedish data#544.xlsx (11.8 KB) Veronika Stemme, 2017-03-09 12:57

Swedish data#544_2.xlsx .xlsx (10.9 KB) Mats Fernström, 2017-03-11 10:42

Technical changes case #544.xlsx (19.1 KB) Martti Virtanen, 2017-04-05 13:37

History

#1 Updated by Kristin Dahlen over 4 years ago

  • Target Grouper COMMON added

#4 Updated by Veronika Stemme over 4 years ago

Veronika Stemme, Sweden:
Sweden does not want this change since, in Swedish KPP, the mean costs for the mentioned diagnosis are significantly higher than the mean cost of DRG Q60N Normal newborn. Please see file ‘Swedish data #544.xslx’

#5 Updated by Kristin Dahlen over 4 years ago

According to the Swedish data presented, we wonder if the cases only have the mentioned codes or if there are any other conditions or procedures registred? In our opinion these codes alone does not describe what or if there are any significant problems with the newborn.

#6 Updated by Kristiina Kahur over 4 years ago

Finnish National DRG-centre 2017-3-10

In Finnish data the cost of DRG 391 (Normal newborn) is 2896 EUR.
The cases with main dx P05.x are grouped to different DRGs.
In inpatient settings there are in total 20 cases, mean cost 20 565 EUR:

1) seven cases in DRG 388B Neonate, birthweight 1500-2499 g or other immaturity w/o multiple problems, mean cost 22 174 EUR.
2) six cases in DRG DRG 385A Neonate, died within 2 days or transferred to other unit within 5 days, mean cost 5004 EUR
3) the rest of the cases in DRGs 385B (# 2), 389B (# 2), 388A (# 1), 390 (# 1), 468 (# 1)

Similarly to Swedish data, the cases with main dx P05.x are way more expensive compared to the mean cost of DRG 391 Normal newborn.
All 20 cases with main dx P05.x have other conditions coded same time. There are no single case with P05.x diagnosis only.
As for procedures, the main ones are different diagnostic procedures (ultrasound (brain, abdomen, heart), MRI, x-ray). Some have. Very few cases with laparoscopic diagnostic procedure.

In summary, based on the Finnish cost data the suggested change is not supported.

#7 Updated by Kristin Dahlen over 4 years ago

According to the cost data analyses done by Finland, there seems to be few (e,g, none) of the cases in the material analysed corresponding to the cases we describe. This might be the case also in Sweden. The cases in other DRGs than DRG 390 in the Norwegian material do have other conditions or procedures with properties leading to these DRGs (e.g the low birth weight). In Norway we have approximately 1100 case (per 2 tert 2016) with one of the P05.- codes in combination with the code Z380 single birth in hospital. No other codes or significant procedures are present. Please note that all newborns, also the healthy ones, are registered in the Norwegian database.

The criteria for P05.- given by WHO is birthweight <10-percentile for GA. This should then correspond to 9.9 percent of the Norwegian newborns, and will be the case for ethnical Norwegian babies < 3000 g. Most of these babies are considered to be healthy (from the yearly report from the Norwegian “avregningsutvalget”).

In our opinion the property 15X98 can be withdrawn from the mentioned codes. The cases where the babies have other symptoms or signs will be coded with other codes, for example the birth weight code and the cases will be grouped to a DRG different from 390/ 391 anyway.

#8 Updated by Mats Fernström over 4 years ago

Mats Fernström, NPK, Sweden 2017-03-11
To get a more ”clean” analysis we now included only the cases with P05 in DRG Q55/390. See Swedish data#544_2.xlsx. They are still too expensive to fit in DRG Q60N/391.

#9 Updated by Martti Virtanen over 4 years ago

2017-03-13 Expert group
The problem is, that Norway, registrating all newborns and billing child and maternal care separately, has a very different use of the codes in the P05 group. Most of the newborns with only these codes are in Norway quite healthy. In other countries the codes are used only in cases where the child needs separate care and becomes therefore billed separately. The less affected children are included in the price for the care of the mother.
Thus for Norway a change is a must, for other countries it is impossible.
The Norwegian use is the original intent of the code. The problem must be solved by separate codes in ICD+.
Norwegian (and English) version codes will be linked to the original codes (P05x). In other versions the group P05 codes will be linked to new ICD+ codes:
P05xA 'Admission for' + the original text.
The P05xA codes will retain current properties. The original codes will loose the propety 15X98 as proposed by Norway.

#11 Updated by Martti Virtanen over 3 years ago

  • Status changed from Active to Accepted

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