Case #627

T855 groups to DRG 921O

Added by Anja Fagervold 7 months ago. Updated 6 months ago.

Status:Further activeStart date:2019-02-12
Priority:MinorSpent time:-
Assignee:Anja Fagervold
Category:-
Target version:-
Initiator:Norway Target year:2020
Case type: Owner / responsible:
MDC:MDC06, MDC21 Old forum status:
Target Grouper:NOR

Description

Problem
ICD-10 code T855 "Mekaniske komplikasjoner ved proteser, implantater og transplantater i fordøyelsesorganer", outpatient contacts groups to DRG 921O "Poliklinisk konsultasjon vedr skader/ forgiftninger/ skadelige medikamentvirkninger", MDC 21. It seems more reasonable that this should group to a DRG in MDC 6.


Suggestion

Norwegian Directorate of Health – 2019-01-22
We suggest that outpatient contacts with the main diagnosis T855 "Mekaniske komplikasjoner ved proteser, implantater og transplantater i fordøyelsesorganer" should group to DRG 906O "Polikliniske konsultasjoner vedørende andre fordøyelsessykdommer", not DRG 921O.


Technical change

We create a new COMPL in the sheet comp.cat 06C82 Mechanical complication of implants in digestive system. This is added to the code T855 in the sheet dg.
We also change properties from MDC 21 to MDC 06. See technical changes added.

Technical changes_case 627.xls (110 KB) Anja Fagervold, 2019-03-01 15:06

Technical changes case #627.xlsx (70.4 KB) Martti Virtanen, 2019-03-06 12:38

History

#1 Updated by Mats Fernström 7 months ago

Mats Fernström, NPK Sweden, 2019-02-13
First a few small details. 06C82 is already in the system but with a different meaning and when introducing a new complication category one should also establish an exclusion list for this category, otherwise it will be able to complicate every single health contact.
Secondly, we cannot judge this proposal, and therefore not accept it either, because there is no economic analysis. You have to consider that the changes of the grouping properties that you propose for the code T855 also will affect in-patient grouping and that will happen in all national versions.
If you just want that outpatients shall be grouped to DRG 906O instead of DRG 921O you can create a new pdgprop and a new grouping rule leading to DRG 906O based on that pdgprop but it would look nice with an economic analysis even then, if you have the possibility.

#2 Updated by Kristiina Kahur 7 months ago

Finnish National DRG-Centre 2019-2-14

The use of T855 in Finland is minor in both positions, as main or secondary diagnosis (7 and 2 times respectively in 2017)
Breakdown between medical specialties is as follows:
-four cases in gastroenterology and
-one case in acute care, pediatric neurology, general surgery, pediatric surgery, cardiac and thoracic surgery.
This does not provide clear consistency to argue which MDC would fit better instead of MDC21.
Given the small number of cases we cannot provide adequate economic analysis either.

Looking at MDCs of all diagnosis codes under T85, there are different approaches. Some MDCs are determined based on anatomy, some base on the etiology.
T850 Mechanical complication of ventricular intracranial (communicating) shunt, MDC 21 Other injury, poisoning and toxic effects diagnoses
T851 Mechanical complication of implanted electronic stimulator of nervous system, MDC 01 Other disorders of the nervous system
T852 Mechanical complication of intraocular lens, MDC 02 Other disorders of the eye
T853 Mechanical complication of other ocular prosthetic devices, implants and grafts, MDC 02 Other disorders of the eye
T854 Mechanical complication of breast prosthesis and implant, MDC 30 Non-malignant breast disorders
T855 Mechanical complication of gastrointestinal prosthetic devices, implants and grafts, MDC 21 Other injury, poisoning and toxic effects diagnoses
T856 Mechanical complication of other specified internal prosthetic devices, implants and grafts, MDC 21 Other injury, poisoning and toxic effects diagnoses
T857 Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, MDC 21 Other injury, poisoning and toxic effects diagnoses
T858 Other complications of internal prosthetic devices, implants and grafts, not elsewhere classified 21 Other injury, poisoning and toxic effects diagnoses
T859 Unspecified complication of internal prosthetic device, implant and graft, MDC 21 Other injury, poisoning and toxic effects diagnoses.

If MDC 21 of T855 woud be replaced with MDC 06, should MDC 21 of T850 be replaced with MDC 01 (if to use the anatomical approach)?

#3 Updated by Anja Fagervold 7 months ago

  • File deleted (Technical changes_case 627.xls)

#4 Updated by Anja Fagervold 7 months ago

You are of course right Mats, this will also affect in-patient grouping which is also our intention. This will affect very few cases as T855 was only used as main diagnosis in 44 cases and as second diagnosis in 23 cases in Norway year 2017, approx the same in 2016. Given the small number of cases an adequate economic analysis is not possible or necessary. We want to make the change given the medical argument; T855 belongs in MDC 06.
We have changed 06C82 to 06C90 and also added the compl. exclusion list in the technical changes added. (We did not have 06C82 in the Norwegian version, so that’s why we chose that. Hope 06C90 works out better).

As a comment to Kristiinas question if T850 should be replaced with MDC 01, we think it can still be grouped to MDC 21. Ventricular intracranial shunts are often canalized to the abdomen and complications can therefore just as often be in the abdomen as in the ventricular system. Because it will vary if T850 belongs to MDC 01 or MDC 06 we think that the more general MDC 21 is a good alternative.

#5 Updated by Martti Virtanen 6 months ago

2019-03-06 NCC (MV)
This proposal has two parts that are only loosely connected.

First the question what is the diagnosis category (and MDC) of T8550 ‘Mechanical complication of gastrointestinal prosthetic devices, implants and grafts’.

This dx belongs to the group T85 ‘Complications of other internal prosthetic devices, implants and grafts’ that is listed in the ICD+ sheet of the technical changes. It includes 2 codes for central nervous system complications (T8500-T8510), 2 codes for eye complications (T8520-T8530), 1 code for breast complications (T8540), 1 code for gastrointestinal complications (T8550) and for complications of unspecified organs (T8560-T8590).
The first code T8500 ‘Mechanical complication of ventricular intracranial (communicating) shunt’ , the code at issue T8550 and codes T8560-T8590 that do not specify the organ are assigned to MDC 21. T8510 is assigned to MDC 01 (nervous system), T8520 to MDC 02 (eye) and T8540 to MDC 30 (Breast).
T8500 does not specify whether the problem is in brain or stomach where the other end of the shunt is.
T8550 does not specify whether the problem is liver or pancreas (MDC 07) or gastrointestinal (MDC 06)

Thus all that do not specify the organ MDC are assigned to MDC 21 (‘Injuries, poisonings and toxic effects of drugs’). In the group T80-T88 ‘Complications of surgical and medical care, not elsewhere classified’ the MDC assignment follows the same principle.

This is not invented by us, we have copied it from the original HCFA DRG system. I can see the reasons for the decision. When you don’t know the organ for sure, the diagnosis is assigned to MDC 21 that does not specify the organ.
If we decide to use MDC 06 for T8550 how will we deal with the cases from MDC 07. It is even practically a problem if a liver intervention has been performed (if the MDC is 06 that would result in DRG 468/477).

Second the complication category of T8550 is 21C02 called ‘Complication of surgical or other procedure’. It is important to note that a belonging to a complication category means that dx as a secondary dx complicates the case, if the principal dx is not one of the excluded codes. Thus the meaning of the complication category is really the content of the exclusion list.
The 21C02 exclusion list includes a large number of diagnosis indicating intervention complications on broad spectrum including 5 gastrointestinal complications.

The idea is, that cases with these different complication codes must not be complicated by repeating the information with secondary diagnosis indicating complication (in this case T8550).
One can ask, why the other codes in the T85 group are allowed to complicate other complication diagnoses when T8550 (and T8560-T8590) are not.
Actually T8500 seems to have a clearly false complication category 21C13 ’ Complication of orthopaedic device’. That should be corrected but it is a different case.

Although the this is a very rare diagnosis the eventual changes need to be accepted by all participants.

#7 Updated by Martti Virtanen 6 months ago

2019-03-11 Expert group
The case was postponed for economical analysis (Sweden, Finland, Norway?)

#8 Updated by Martti Virtanen 6 months ago

  • Status changed from Active to Further active

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