Case #554

Dental care vs ENM mouth care

Added by Martti Virtanen about 3 years ago. Updated over 1 year ago.

Status:AcceptedStart date:2017-07-05
Priority:MinorSpent time:-
Target version:Target version 2018
Initiator:Finland Target year:2018
Case type: Owner / responsible:Nordic Casemix Centre
MDC:MDC03 Old forum status:
Target Grouper:FIN


NordDRG Fin has a number special groups for dental care since 2013. This is based on the case 'Dental care DRG's for NordDRG' that is now copied to this new Forum (Case #553)
The rules developed in 2012 have a serious problem that needs attention. The differentiation between dental and ENM mouth problems does not work and a large proportion of obvious dental cases are assigned to ENM mouth DRG's.
The problems treated in dental care are often the same as in ENM care. The tumors, anomalies and traumas cause often dental problems and it is natural to use the same codes in both situations.
The interventions are often not exclusively dental. Same interventions are performed (and at leat same codes are used) in both dental and ENM care. The codes have thereofre proerties for bot dental and ENM care.
In the logic the rules for ENM care precede the rules for dental care. Thus most cases of obvious dental care are assigned to ENM care. The rules for dental care exist only for NordDRG Fin but the ENM care rules are common.
Possible solution
The sitinction of dental care and ENM care must be defined by the principal dx. Dental care is a part of ENM care and thus both belong to MDC 03.
The ICD-10 has an area of codes that is obviously intended to be used for dental and related problems. That are groups K00-K09. This area hs codes for Inflammatory and infectious conditions, for tumor and trauma related problems of the area. In addition the conditions coded with S025 'Fracture of tooth' and it's subcodes as well as Z012 'Dental examination' indicate obviously a dental problem. Other codes may be uased for patients with dental problems.
The proposal is that all cases primarily treated for dental problems should have as pricipal dx a code from this group. In addition a secondary dx of a syndrome or other code for the more complex sitaioation may be used as secondary dx.
These codes would get a principal dx property (03P01 'Potential mouth problem', existing property). The MDC 03 diagnosis category is retained.
In the logic new rules based on the 03P01 are placed before the ENM mouth rule (DRG's 055O, 049A and 052X). The current rules using special dental procedure proerties (03S4x) and MDC 03 only are retained. The postMDC rules with 03P01 become obsolete and are inactivated.

Changes in DRG assignment
if this is done, the cases with dental problem as principal dx will be assigned to dental DRG's. The cases with MDC 03 principal dx and interventions with dental properties (03S4x) and without other MDC 03 procedure proberties are also assigned to dental DRG's. Other cases with MDC 03 principal dx are assigned to ENM DRG's based on the the other MDC 03 procedure properties.

What next
The coding practise possibly does not follow this proposal. The ICD-10 is not logical within this area. The codes for conditions related to dental area problems do not indicate that there are codes in the K00-K09 area that could also be used. What should be primary coding is neither indicated.
This model would however add cases to the dental groups if the dental codes are used. At least all cases with only dental dx would be assigned to the dental DRG's. The cases with interventions without other MDC 03 procedure properties would also be assigned to dental DRG's (the only ones that now are assigned there). Possibly the coding practise would gradually improve and result in even better DRG assignment.

The change affects only NordDRG Fin so basically the Finish team must decide whether this model is acceptable. The model actually gets more logical and might become more interesting for ohter countries.

Technical changes #554.xlsx (75.7 KB) Martti Virtanen, 2017-08-28 13:52

Technical changes #554-2.xlsx (76.3 KB) Martti Virtanen, 2017-11-20 13:07

Technical changes #554-3.xlsx (76.2 KB) Martti Virtanen, 2017-12-01 13:44

Technical changes #554-4.xlsx (78.2 KB) Martti Virtanen, 2017-12-05 13:56


#1 Updated by Martti Virtanen about 3 years ago

  • File Technical chnages #554.xlsx added

#2 Updated by Martti Virtanen about 3 years ago

  • File deleted (Technical chnages #554.xlsx)

#3 Updated by Kristiina Kahur about 3 years ago

Finnish National DRG-centre/Kristiina Kahur 5-7-2017

Thanks Martti for that suggestion. We will have a closer look at it after summer holidays. If I got you correct you suggest the change would be introduced in 2018 version already? It might become complicated to introduce it since it is after all quite a big change and may need proper analysis and some discussions.

#4 Updated by Kristiina Kahur almost 3 years ago

Finnish National DRG-centre 2017-8-4

We have now checked the case and did some analysis. The data of 2015 from five university hospitals was used (FIN2017F grouper).
99,3% of the cases with main diagnosis K00-K00 currently group to dental care DRGs (580-series DRGs).
Respective share for cases with main diagnosis S025 is 99,5% and with main diagnosis Z012 99,1%.
From that perspective the change would affect only very few number of cases (ca 350) but from clinical point of view the change would assure the working model initially desired for dental care cases.
Thus, it seems reasonable to make this change in 2018 grouper in case it can be handled as error correction. If not, the case can be postponed to 2019. Based on the data, the delay would not make the situation worse because the number of cases involved is small.

#5 Updated by Kristiina Kahur almost 3 years ago

Correction: 99,3% of the cases with main diagnosis K00-K09 currently group to dental care DRGs (580-series DRGs).

#6 Updated by Martti Virtanen almost 3 years ago

2017-08-28 Martti Virtanen
Missing 'OUT's added

#7 Updated by Martti Virtanen almost 3 years ago

  • File deleted (Technical chnages #554.xlsx)

#8 Updated by Martti Virtanen over 2 years ago

  • File Technical changes #554-2.xlsx added

2017-11-20 Martti Virtanen
logic rows for 580O and 580A were not included in technical changes. Althoug they are not changed in the case, they are potentially affected and should dooes appear in the table.

#10 Updated by Martti Virtanen over 2 years ago

  • File deleted (Technical changes #554-2.xlsx)

#11 Updated by Martti Virtanen over 2 years ago

2017-12-01 Martti Virtanen
There were a few id-codes and one ord that were duplicates. I have corrected the red-marked codes.

#12 Updated by Martti Virtanen over 2 years ago

2017-12-05 Martti Virtanen

This change caused couple of additional problems in the NordDRG Fin.

1) Cases with MDC 03 (and without 03P01) and with procedure property 03S05 were assigned to DRG 477O because there is no rule with procprop 03S05 for short therapy. The rules for DRG 169O were inactivated when the dental grouping was created for Finland. That was done because the DRG 169O was totally overlapping with 580H. DRG's 168X adn 169X have been retained because the inpatient care was regarded to be ENM care. Allowing the cases with true ENM interventions to be assigned to ENM DRG's created a situation were the criteria for dental problem were not meat (no 03P01) but the intervention had only 03S41 (valid with 03P01) and 03S05 (not valid with MDC 03 in NordDRG Fin).

The DRG 169O still overlapps with 580H and to recreate DRG 169O in NordDRG Fin does not feel appealing. Therefore to correct the problem we now activate the existing lines 103D159000 and 103D159001 for DRG 169O (ENM DRG) but change the DRG to 580H (dental DRG).

2) A quite significant number of cases were moved from DRG 580B (mouth/dental group) to 580O (general ENM group)because the grouper now demands that the cases have a definitely dental problem (indicated by 03P01).

However, we reallized from the Finnish testing that the dx's for the malignancies of mouth C000-C0690 and dx's for benign tumors of mouth D1000-D1030 do not have PDGPPRO=03P01 which they obviously should have. For carcinoma in situ and tumor of unspecified or unknown behaviour the ICD-10 does not distinguish the anatomy in the area, so they cannot be classified to 03P01.

Adding the property 03P01 to C000-C0690 and D1000-D1030 diminishes the number of cases that will be moved although some changes should remain. Also this affects only NordDRG Fin.

#13 Updated by Martti Virtanen over 2 years ago

  • Status changed from Active to Further active

#14 Updated by Martti Virtanen over 1 year ago

  • Status changed from Further active to Accepted

2017-03-13 Expert group
Expert group confirmed the changes after last expert group

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