Case #626

Integrating ICPC2 codes into NordDRG system

Added by Kristiina Kahur over 2 years ago. Updated about 1 month ago.

Status:AcceptedStart date:2019-02-08
Priority:NormalSpent time:-
Assignee:Kristiina Kahur
Category:-
Target version:-
Initiator:Finland Target year:2022
MDC:GEN Owner / responsible:National organisations
Target Grouper:FIN Old forum status:

Description

ICPC2 (International Classification of Primary Care, Second edition) codes are currently not part of the NordDRG system, and cases with ICPC2 codes are assigned into error DRGs (470E Main diagnosis invalid and 470U Main diagnosis invalid, short therapy).
However, in Finland, the codes are used (often in ER by nurses) and should be taken into account also in the assignment process.
Technically it should be possible by adding ICPC2 into primary classification and mapping the ICPC2 codes with ICD+ ones so that the properties of respective ICD+ codes would be given also to ICPC2 codes.
We would like to have preliminary discussion in March meeting and after that submit the tables where ICPC2 codes are mapped with ICD+ codes.

ENG_icpc-2e-v7.0.xlsx - Appendix 1 (126 KB) Kristiina Kahur, 2019-02-25 11:37

FIN_ICPC2_excl_process_codes.xlsx (351 KB) Elina Hermiö, 2021-07-01 09:38

FIN_ICPC2_excl_process_codes_NDMS.xlsx (52.2 KB) Kristiina Kahur, 2021-08-31 15:25

History

#1 Updated by Kristiina Kahur over 2 years ago

  • Target year 2020 added

#2 Updated by Ralph Dahlgren over 2 years ago

2019-02-23 Ralph Dahlgren
It would be interesting to know how Findland would incorporate this in their DRG system before the meeting. It is then easier to understand the idea behind. Because as I understand it is used in the ER by nurses, isn't doctors in the ER also seeing the same patient?
On WHO webb-page it says as follows:
'WHO has accepted ICPC-2 within the WHO FIC mainly as a reason for encounter classification, and users may use it as a classification for primary care or general practice wherever applicable.
ICPC-2 classifies patient data and clinical activity in the domains of General/Family Practice and primary care, taking into account the frequency distribution of problems seen in these domains. It allows classification of the patient’s reason for encounter (RFE), the problems/diagnosis managed, interventions, and the ordering of these data in an episode of care structure
Classification Structure
It has a biaxial structure and consists of 17 chapters, each divided into 7 components dealing with symptoms and complaints (comp. 1), diagnostic, screening and preventive procedures (comp. 2), medication, treatment and procedures (comp. 3), test results (comp. 4), administrative (comp. 5), referrals and other reasons for encounter (comp. 6) and diseases (comp. 7).'
It is an interesting idea but ICPC2 contains quite alot of codes.
Is it not possible for nurses to use ICD-10 codes instead?
If this big amount of mapping is not done before it arrives to the Nordic Casemix Centre it will make alot of work for the centre. Is there enough time for this work now when also working with the NDMS?

#3 Updated by Kristiina Kahur over 2 years ago

Finnish National DRG-Centre 2019-2-25

The official/original mapping is provided in Appendix 1.
In column I (icd10), ICD10 codes corresponding to a ICPC2 code are listed (there can be more than one ICD10 code per ICPC2 code). The first one should be the one which is most relevant to respective ICPC2 code and should be used for mapping. In Finland, some modifications in mapping have been made. The mapping is publicly available.
Given that ICPC2 is much more robust classification compared to ICD10, the mapping is somehow conditional. Nevertheless, based on the mapping, each ICPC code should be given the same propertie(s) which have been given to respective ICD10 code and this way the ICPC2 codes can be taken into account in the grouping process.
As for seeing the patients in ER, it might be that the nurses only are seeing the patients and are using ICPC2 codes in that case.

Source: https://ehelse.no/icpc-2e-english-version

#4 Updated by Martti Virtanen over 2 years ago

  • Status changed from Active to Further active

2019-03-11 Expert group
This work is currently only for Finland. We can integrate ICPC codes to ICD+ based on the existing mappings using the primary mapping ICPC-ICD.
The case is left open form possible further work in Finland.

#5 Updated by Martti Virtanen over 1 year ago

  • Status changed from Further active to Rejected

2020-03-09 Expert group
The expert group was informed of the possibility to add ICPC-2 codes, that have a preferred linkage to ICD-10, to NDMS and NordDRG defintion tables.
Any change is on national level. If the ICPC-2 codes are added to the system, they will not appear as independent codes but only as linked national codes in the combined code list.
This case is closed without any changes to NDMS now (formally rejected).

#6 Updated by Elina Hermiö 4 months ago

Finnish National DRG-Center 1.7.2021

Background:
ICPC2 codes are used in Finland in joint ER departments (health center emergency services and emergency services for specialist medical care) and cases with ICPC2 codes are assigned into error DRGs.

Analysis:
We used data from year 2019 and 2020 and analyzed the use of ICPC2 codes in hospitals. Most common ICPC2-codes formed 54% (N=69468) of all ICPC2-codes. We aware that the mapping is not the best possible. It can be corrected if needed after implementation.

Suggestion:
Finland would like to integrate all ICPC2 codes, except procedural codes, to ICD10+ based on the existing mapping ICPC2-ICD10.
Because there can be more than one ICD10 code per ICPC2 code, we suggest that the first one should be the one which is mentioned in column Q, or if the Q column is empty, we will use the code which is mentioned first in the column U. ICPC2 code should be given the same properties which have been given to respective ICD10 code.
Given that some ICPC2 codes are identical as ICD10 codes (on 3 character level) we suggest to add prefix ´PC_´ to ICPC2 codes (for instance ICPC2-code R83  PC_R83).

Appendix
Mapping excluding process codes.

#7 Updated by Kristiina Kahur about 1 month ago

Nordic Casemix Centre/Kristiina Kahur 31-8-2021

ICPC2 codes have been added into Finnish version in NDMS. The full list and mapping with ICD+ codes is attached to the ticket.
The features of ICPC2 codes will be given based on the mapped ICD+ codes.
Given the mapping of ICPC2 to ICD10 codes is very robust, it might be needed to revise the mapping at some point in the future.
If any comments, please use this ticket or bring them up in Expert Group meeting.

#8 Updated by Kristiina Kahur about 1 month ago

  • Status changed from Re-activated to Accepted

2021-09-06 Expert group

This ticket is closed. If any changes needed in mapping of ICPC2 and ICD+ codes, national organization will inform via Forum according to annual timetable.

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