Case #620

Healthy person following sick

Added by Ralph Dahlgren 8 months ago. Updated 5 months ago.

Status:Re-activatedStart date:2019-01-24
Priority:MinorSpent time:-
Assignee:-
Category:-
Target version:NordDRG 2020
Initiator:Sweden Target year:2020
Case type:Major Owner / responsible:National organisations
MDC:MDC23 Old forum status:
Target Grouper:SWE

Description

Problem
ICD-10 code Z763 Healthy person accompanying sick person
This case has appeared in connection within the Swedish Code Network.
It concernes a case where a mother who delivered a baby. The baby needed light therapy due to "jaundice".
They then signed in the mother in hospital together with the child and diagnosed the mother with Z763 Healthy person accompanying a sick person.
The parents were not Swedish citizens and this diagnosis, Z763 Healthy person accompanying sick person groups in Sweden to DRG W29E Other influence on health condition U (Without Complication), DRG weight 0.39. This will when billing the parents mean a cost for them around SEK 20 721.
The question was whether this was reasonable or not.
In Sweden there is a variation if the mother/father is signed into the hospital. It is done differently county to county.
The grouping is correct as the code Z763 Healthy person accompanying sick person can be grouped to:
DRG W29A Other factors influencing the state of health, very complicated, weight 0.746 (equivalent to SEK 40 473)
or
DRG W29C Other factors affecting the health state, complicated, weight 0.538 (equivalent to SEK 29,189)
or
DRG W29E Other factors affecting the health condition, not complicated, weight 0.39 (equivalent to SEK 21,159)
The weight ‘1’ is 54 254 SEK
All depending on added diagnosis.
It is understandable to register the healthy person in Patient Administrative System ( Called PAS in Sweden). It is about responsibility and security.
But due to the fact that this concerns quite a few healthy ‘patients’, around 1 250, in Sweden we want these patients to be grouped to a new DRG. But children under 1 year will due to their cost in the Swedish cost data be grouped to DRG Q60N ’Nyfödd utan allvarliga problem’ (DRG 391 Normal newborn).
Analysis
The Swedish Department of Health and Welfare – 2019-01-24
What is interesting is the Swedish cost data is that the the ICD-10 diagnos Z763 Healthy person accompanying sick as the main diagnos has been grouped to other DRG than W29E. If one belive that Z763 stands for 'Healthy person accompanying sick', there are cases that are grouped to DRG W29C (a CC-DRG) and DRG W29A (a MCC- DRG). This is rather strange since this person getting the diagnos Z763 is healthy.
The Swedish cost data shows that:
1 case is grouped to W29A (very complicated DRG) which costs SEK 26 403. Length of stay is 4 days for a person who is healthy. The weight of DRG W29A is 0,746 corresponds to SEK 40 473.
15 cases are grouped to W29C (complicated DRG) which has an average cost of SEK 28 513. Mean length of stay are 2.4 days for a person who is healthy. The weight 0.538 corresponds to SEK 29 189.
1 233 cases are grouped to DRG W29E which has an average cost of SEK 22 172. Mean length of stay are 2.0 days for a person who is healthy. The weight 0.39 corresponds to SEK 21 159.
There are 10 other cases that are grouped into a total of 3 different DRGs. These are Q55N Newborns, birth weight 2500 g or more, with another significant problem, Q30N Newborn, birth weight 1500-2499 g, without multiple problems, Q05N Newborn, death within 2 days or transferred to another unit within 5 days. Mean cost SEK 35 893. Mean length of stay are 2.6 days.

Suggestion
The Swedish Department of Health and Welfare – 2019-01-24
Sweden wants to create a new DRG for these cases that are over 1 year of age. We suggest ‘W70N Frisk person som åtföljer sjuk (Healthy person accompanying sick person) in MDC 23.
For those under 365 days we want those cases to be grouped to DRG Q60N ’Nyfödd utan allvarliga problem’ (Com DRG 391 Normal newborn). The last few cases are out of cost and out of a medical perspective best suited to be grouped there.

Decided changes
The Swedish Department of Health and Welfare – 2019-01-24
Sweden wants this to be introduced for 2020 Pl-version.

DRG change
Cases with patient over 1 year of age will be moved from DRG W29A/C/E to the new DRG W70N Healthy person accompanying sick person. The cases that before were grouped to are Q55N Newborns, birth weight 2500 g or more, with another significant problem, Q30N Newborn, birth weight 1500-2499 g, without multiple problems, Q05N Newborn, death within 2 days or transferred to another unit within 5 days will be grouped to DRG Q60N ’Nyfödd utan allvarliga problem’ (Com DRG 391 Normal newborn).
Technical change
A new row in the Swedish DRGlogic will be introduced for DRG Q60N ’Nyfödd utan allvarliga problem’ (Com PL 2019 DRG 391 Normal newborn) just below the row for DRG Z79N Felaktig diagnoskombination (Com Pl 2019 470I Swe - Felaktig diagnoskombination) with the ord 015D800033. The new row will also have Rtc 0, icd +, mdc 23, pdgprop 23P20.
Then we want to add another new row in the Swedish DRGlogic just below this new row 015D800033 for the new DRG W70N Frisk person som åtföljer sjuk (Healthy person accompanying sick person) for MDC 23. The ord will be 015D800035, This row will also have Rtc 0, icd +, mdc 23, pdgprop 23P20.

Decision Tc for C759 Healthy person to NCC.xlsx (22 KB) Ralph Dahlgren, 2019-01-24 20:26

Technical changes case #620.xlsx (30.2 KB) Martti Virtanen, 2019-03-04 14:44

TC_C759_NEW.xlsx (20.2 KB) Mats Fernström, 2019-03-18 14:29

Technical changes case #620 - 2.xlsx (29.9 KB) Martti Virtanen, 2019-03-25 14:23

TC_C759_2019-04-08.xlsx (20.2 KB) Mats Fernström, 2019-04-08 16:03

History

#1 Updated by Kristiina Kahur 7 months ago

Finnish National DRG-Centre 2019-2-7

Code Z763 has been used 16 times in 2017 in Finnish university hospitals and only once in 2016. There are too few cases for separate DRG in Finnish version.

#2 Updated by Martti Virtanen 7 months ago

  • File Technical changes case #620.xlsx added

2019-03-04 NCC (MV)
This proposal aafects only NordDRG Swe and can be performed without any effect on other versions.

The proposal is technically OK, althoug it could be solved with a new diagnosis category rather than by a principal diagnosis property. Principal diagnosis property was invented make it possible to assign in special circumstances cases to DRG in other MDC than the usual MDC (and diagnosis category) of a diagnosis. In this case the new DRG is also from MDC 23. The neonatal cases can also be assigned to the neonatal DRG using the diagnosis category. However, if other countries do not wisht to use this grouping Z763 should probably still be listed in the residual group of MDC 23 (23M99) and then the principal diangosis property is better.

However there is no reason to place the rule for DRG 650X/W70N among neonatal rules. Since ther principal dg is from MDC 23, it is naturally placed among the rules of MDC 23 and actually can be placed just before the existing rules for residual cases where the cases have been previously assigned.

The neonatal rule can be placed in the neonatal area but placing it on top of that area would overrule all other neonatal problems. Obviously it is a deiscrepancy in data if a premature child is registered to have true neonatal problem and the same time would have principal dx 'Healthy person accompanying sick person'. However, since placing the rule at the end of neontal rules, would not change the assignment of correctly coded cases, I see no reason to take the risk.

These proposed changes to the Swedish proposal are shown in the technical changes. The model of using diagnosis category is also included.

#3 Updated by Martti Virtanen 7 months ago

  • File deleted (Technical changes case #620.xlsx)

#5 Updated by Mats Fernström 6 months ago

Mats Fernström, NPK Sweden, 2019-03-18 (NPK ID C759)
At the meeting last week I objected to Martti’s positioning of the two rules. Here are my comments in written.
Martti: “The neonatal rule can be placed in the neonatal area but placing it on top of that area would overrule all other neonatal problems”.
My comment: Yes, that is true but also intended. A MDC 15 case with the principal diagnosis 'Healthy person accompanying sick person' and any secondary diagnosis for a true neonatal problem is totally wrong. Such a case should actually go to DRG 470 but we realize that it is a mistake in the registration and want to be forgiving and since we think that it is the secondary diagnosis that is a mistake we will let the cases go to DRG 391/Q60N. Thus we want the rule where we suggested but it should be complemented with >0 in the field DUR because the problem with 'Healthy person accompanying sick person' is only present for inpatients.
Martti: “there is no reason to place the rule for DRG 650X/W70N among neonatal rules”
My comment: Yes, that is also true but we don’t want to place the rule in the MDC 23 area because then there is a risk that cases with the principal diagnosis 'Healthy person accompanying sick person' and any secondary real diagnosis is grouped to a medical DRG although such cases also should go to DRG 470. Even here we want to be forgiving and since we think that it is the secondary diagnosis that is a mistake we will let the cases go to DRG W70N. An alternative to have the rule where we suggested is to complement it with >364 in the field AGELIM and place the rule in the pre-MDC area with ORD 000D0000301. This rule should also complemented with >0 in the field DUR because the problem with 'Healthy person accompanying sick person' is only present for inpatients.
At the meeting Martti proposed that the rule for DRG 650X/W70N could be placed in the inpatient pre-MDC area instead. Then there is no need for an agelim. This was accepted. Updated Swedish technical changes are in the file TC_C759_NEW. Xlsx.

#6 Updated by Martti Virtanen 6 months ago

2018-03-11 Expert group
The proposal was accepted as proposed by Swe.

#7 Updated by Martti Virtanen 6 months ago

  • Status changed from Active to Accepted

#8 Updated by Mats Fernström 5 months ago

Mats Fernström, NPK Sweden 2019-04-08 (Swe ID C759)
DRG W70N was discussed at the meeting with the Swedish NPK Policy Group (2019-03-27) and it was recommended that episodes with the healthy person shall not be reported to the national cost database as individual episodes. All costs for the healthy person shall instead be added to the costs for the sick person when calculating KPP (cost per patient). So far this is not a routine and therefore there is still a need for the new DRG but the code will be changed to Z95N and it shall have the DRG weight = 0 (zero) like most of the Z DRGs. Updated technical changes are in the file TC_C759_2019-04-08.xlsx. Martti has to replace his file Technical changes case #620 - 2.xlsx with a new one, not only because of this change of DRG code, but also because we accepted his suggestion that the rule could be placed in the inpatient pre-MDC area.

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