Case #601

Clarification of a new rules for DRGlogic

Added by Ralph Dahlgren 10 months ago. Updated 4 months ago.

Status:AcceptedStart date:2018-09-14
Priority:MinorSpent time:-
Assignee:Ralph Dahlgren
Category:-
Target version:-
Initiator:Sweden Target year:2019
Case type:Minor Owner / responsible:National organisations
MDC:GEN Old forum status:
Target Grouper:SWE

Description

This text is copied from case #581 on Forum:
‘One must never use both MDC and PDGPROP on the same rule line. These properties are taken from the same principal diagnosis and since they reflect different properties of that code they usually contradict each other. Therefore using makes ther unusable. Only if the MDC and PDGPROP happen to be from the same MDC, the rule may work. This is valid also form diagnosis category although that error has never occurred untill now.’

This is rule that Martti describes has not been used for some year in Sweden at least.
Sweden has in the definitiontables for DRGlogic in Primary care som row that uses PDGPROP and MDC at the same time. This has been corrected in our updates.
This case is to inform everyone about this rule.
Everyone needs to know about it and remember for the future.
Sweden has som comment about the first sentence:
‘One must never use both MDC and PDGPROP on the same rule line’
Before agreing on this rule Sweden wants to get an explanation that is clearer.
This due to the fact that in theory the case might be that we want to use a PDGPROPfor an ICD-code and at the same time MDC to make sure that just some of the codes with the actual PDGPROP should be grouped to a specific row. Then one might argue that a new PDGPROP can be used for these ICD-codes but that has to be discussed before decision is made.

Then there is the last words:
‘This is valid also form diagnosis category although that error has never occurred untill now.’
Does this mean that when there is a DGCAT there should not be a MDC aswell?
If there are the case Sweden would like to know and if that is not the case what is the differens between PDGPROP and DGCAT and where are these rules written down?

Technical changes case #601.xlsx (1.21 MB) Martti Virtanen, 2019-03-04 12:00

History

#1 Updated by Martti Virtanen 10 months ago

2018-09-24 Martti Virtanen

Sorry for not being precise.
A pricipal diagnosis property cannot be used with major diagnosis category (MDC) nor with diagnosis category (MDC is defined by the first two characters of diagnosis category). These are different aspects of one and the same diagnosis and are therefore in most cases contradictive.

In principle it is unnecessary to use MDC when diagnosis category is used. The diagnosis belonging to a diagnosis category are a subgroup of diagnosis belonging to an MDC. For example diagnosis belonging to diagnosis category 01M01 are a subgroup of diagnosis belonging to MDC 01. However, this does not cause any discrepancy and the grouper will work as if the MDC was not used. We have retained the MDC to ease the finding of the MDC in the tables.

In cases where a principal diagnosis can indicate problems in another MDC we use principal diagnosis property (PDGPRO) to allow (with a special rule[s]) assignment of the case to DRG[s] in the other MDC. Typical example is O996 'Liver disorders in pregnancy, childbirth and the puerperium' that includes biliary problems. The diagnosis belongs to MDC 06 'Diseases and disorders of digestive system' (and diagnosis category 06M99). Although (at least WHO version) excludes liver disorders (code O266 'Liver disorders in pregnancy, childbirth and the puerperium')form O996 at least biliary problems with biliary interventions have been coded during pregnancy with O996. To accept this kind of combination the code O996 has also the principal diagnosis property 07P14 'Hepatobiliary problem during pregnancy' and there are special rules for the combinations of MDC 07 interventions with 07P14.

Interestingly I noted, tbat O266 belongs to MDC 14 'Pregnancy, childbirth and pueperium' and does not have the property 07P14. - Another example of problems of the obstetrical chapter in ICD-10 and DRG-systems.

#2 Updated by Martti Virtanen 4 months ago

2019-03-04 NCC (MV)
See also case #603.
The only exception to the rule that MDC and PDPGROP shall not be used it then Norwegian special principal diagnosis property 40P80 'Same day emergency care conditions'. Because it is not related to any existing MDC it can be used together with MDC's.

#3 Updated by Martti Virtanen 4 months ago

2019-03-04 NCC (MV)
Technical changes without changes.

#4 Updated by Martti Virtanen 4 months ago

  • Status changed from Active to Accepted

2018-03-19 Expert group
The problem was discuessed. No changes are needed.

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