Case #640

Tracheostomy on newborns

Added by Kristin Dahlen about 1 month ago. Updated 28 days ago.

Status:AcceptedStart date:2019-03-01
Priority:MinorSpent time:-
Assignee:Kristin Dahlen
Category:-
Target version:-
Initiator:Norway Target year:2020
Case type:Minor Owner / responsible:
MDC:MDC15 Old forum status:
Target Grouper:NOR

Description

Tracheostomy on newborns is fortunately a rare procedure. In most cases a tracheostomy performed on newborns give DRG 483 Tracheostomy. A Norwegian hospital have reported an exception to this, at least in the Norwegian logic. If we have a newborn, age of days=0 and a combination of tracheostomy (GBB00) and a procedure with procpr 15S03 minor neonatal procedure, the DRG will be 390. The procedure with procpr 15S03 makes a change in DRG result from 483 to 390. If we test the same case only be changing the age of days to 9 days, the DRG result will be 483.

Example:
Main condition Z380, secondary condition P285 and procedurecodes GBB00 tracheostomy and PHX15 Innlegging av sentralvenøst kateter via v..

With age of days=0 – DRG 390
With age of days=9 – DRG 483

Without the minor neonatal procedure the DRG result will be 390 also in the first case.

(PS. we have a coding rule in Norway stating that if register a newborn age of days=0 the main condition shall always be Z38.-. The DRG result is independent of whether you use Z380 or for ex P285 as the main condition)

We have not yet made a proposal for change or a technical description, at first we want to report the problem to hear if this is a common problem or if it is only in the Norwegian version.

Technical changes case #640.xlsx (2.95 MB) Martti Virtanen, 2019-03-12 10:56

History

#1 Updated by Martti Virtanen about 1 month ago

  • File Technical changes case #640.xlsx added

2019-03-08 NCC (MV)
There is no proposed change.
The neontal groupin is placed separately before the outpatient and inpatient areas of the DRG-logic. There were certainly good reasong for that but the documentation is lost. I think the idea was that neonatal care is quite different of all other types patients.
However, this means tthat neonatal grouping passes by lung transplant, heart transplant, liver transplant, kidney transplant, tracheostomy, intensive circulatory support and a number of other issues.
These are rare or almost impossible situations and in most intances the possible cases are indeed very intesive neonatal care. Whether this causes a problem of cost distribution within the neonatal groups should be analyzed economically.
All neonatal rules that in theory can bypass the tracheostomy rule ares listed in the technical changes (withou changes).

#2 Updated by Kristiina Kahur about 1 month ago

Finnish National DRG-Centre 2019-3-8

There is no such newborns’ cases with tracheostomy (GBB00) and procedure with procpr 15S03 Minor neonatal procedure in Finnish data.
In total, there is 13 cases with GBB00 at age <365 days. Five grouping to DRG 483, three to 482, one to DRG 470U (error DRG) and four to other MDC 15 DRGs (385A, 386N, 387N and 389A).
No economic analyses can be provided.

#3 Updated by Ralph Dahlgren about 1 month ago

2019-03-10 Ralph Dahlgren
When grouping the Norwegian suggested diagnosis and procedure codes with the Swedish NordDRG grouper for 2019 we got the following result:

Age of patient 0 - 7 days
DRG: Q55N Nyfödd, födelsevikt 2500 g eller mer, med annat signifikant problem, is equal to DRG 390 Neonate, birthweight 2500 g or more, with other significant problem
SP712 is the reason why we get grouped to DRG Q55N

Age of patient 8 days or more
DRG: W01E Trakeostomi ej pga öron-, näs- och halssjukdom, ej komplicerat is equal to DRG 483 Tracheostomy except for face, mouth & neck diagnoses
GBB00 is the reason why we get grouped to DRG W01E

After that we have made a search in PAR (Our Patien Registre). The search has been done with a fixed main diagnos Z380 Ett barn fött på sjukhus (A child born i Hospital). Then the secondary diagnosis can be anything but P285 Frånvaro av andning hos nyfödd (Lack of breading in newborn) must be one of them. nomatter how many more there are. This means that it can be many more secondary diagnosis.
Both the codes mentioned above has to be in the cases but there may be more.
So in our data to be counted as hits, they must have main diagnos Z380 and also among secondary diagnoses have P285.
Two procedure codes has to be also present, se below:
GBB00 Trakeostomi (Tracheostomy)
PHX15 Innlegging av sentralvenøst kateter via v. This code Sweden does not have. So I picked another procedure code that is also mapped to NCSP+ code PHXA31. This is SP712 Implantation av vaskulär injektionsport via vena jugularis interna (Implantation of vascular injection port by the internal jugular vein). It has the required grouping properties.
These two procedure codes must be present, but there may be more.

We have no combinations that machted the above mentioned requirements.

The reason for this is that in Sweden the child that has been born and are so sick that it requires a GBB00 tracheostomy and SP712 will not have Z380 Ett barn fött på sjukhus (A child born i Hospital) as main diagnos.
This is a very sick child and in Sweden it would get a ICD-10 code starting with ’P’.

So I used as main diagnos P284 Absence of breathing in newborn, GBB00 Tracheostomy, SP712 Implantation of vascular injection port by the internal jugular vein and grouped that.
The result is as below:
If the child is 0-7 days old it will be grouped to DRG Q55N Newborn, birth weight 2500 g or more, with another significant problem
If the child is 8 days or older it will be grouped to DRG W01E Tracheostomy not because of ear, nose and throat disease, not complicated.
The result is the same as above.
This has to be discussed and decided if any futher investigation/changes should be done.

#4 Updated by Martti Virtanen about 1 month ago

  • File Technical changes case #640.xlsx added

2019-03-11 Expert group (Stockholm)
Expert group decided that the interventions for tracheotsomy
GBSB00 Tracheostomy
GBSB02 Tracheostomy with dilatation
GBSB03 Percutaneous tracheostomy
must be regarded as neonatal intensive care interventions (15S02)
Cases with these interventions during the neonatal period will be assigned to neonatal DRG's (388-390/Q05Q55) and those for healthy newborn to DRG 470/Z78 subgroups.
A small error for DRG 483X is corrected (marked green in technical changes).

#5 Updated by Martti Virtanen about 1 month ago

  • File deleted (Technical changes case #640.xlsx)

#6 Updated by Martti Virtanen about 1 month ago

  • File deleted (Technical changes case #640.xlsx)

#8 Updated by Martti Virtanen 28 days ago

  • Status changed from Active to Accepted

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