Rules with diagnosis properties wher all diagnosis with property belong to a CC category cannot separate CC and non-CC cases.
|Initiator:||Nordic Casemix Centre||Target year:||2019|
|Case type:||Owner / responsible:|
|MDC:||Old forum status:|
Mostly Swedish rules and mostly for primary care but generally applicable.
DRG D45T Primary care visit for pulmonary oedema and respiratory failure, no CC (rule #00D000915). The rule has 04P01 'Respiratory failure' (should be 'chronic obstructive lung disease') with 04X03 Respiratory failure. All dx with 04X03 belong to CC category. Thus all cases are assigned by previous line to DRG D45S.
Group E60 DRG's 'Cardiac congenital & valvular disorders' have special rules based on diagnosis property 05X04 'Cardiac valve disorder'. All dx with 05X04 belong to CC category. Therefore it is not possible to differentiate cases with and without CC.
This means that in this type of cases (for example with 04X03 and 05X04) the diagnosis porperties already indicates that the cases with the diagnoses at issue are complicated and no CC = 1 is needed. In these rules the value CC=1 must be removed (from the CC rule). It also means that the rule non-CC DRG is unnecessary and must be inactivated.
If the CC-levels of the diagnoses are changed, the situation can be re-evaluated and some of these rules may be reactivated.
A techncinal change file with this type of errors will be added and updated to this case.
#2 Updated by Mats Fernström 10 months ago
Mats Fernström, NPK Sweden 2018-09-20
These so-called unnecessary or impossible rules can slow down the grouping, but it is likely negligible. Thus, they do not cause any harm and Sweden will keep them in the definition tables that we produce ourselves (SOS version). That we want to keep them depends on the fact that the smallest change of the CC property of a diagnosis code or a change in the exclusion list may cause that the rules become fully possible, but then it is very difficult, not to say impossible, for us to remember which rules to reinstall and where in the hierarchy they should be placed. We have no system, similar to that in NDMS, to classify the rules as active or inactive. With us, there is a great risk that a deleted rule will fall into forgetfulness rather soon.
#4 Updated by Martti Virtanen 4 months ago
- Status changed from Active to Accepted
2019-03-11 Expert group
Expert group accepted that the currently impossible rules will be inactivated in NDMS. In the new NDMS the rows can be easily made visible.
Sweden will retain some of these rules as active in the SOS-version for national work.