NDMS #662

CC category coding and CC exclusions in NordDRG

Added by Martti Virtanen 11 months ago. Updated 6 months ago.

Status:Further activeStart date:2019-11-05
Priority:MinorDue date:
Assignee:-Spent time:-
Target version:Target version 2021
Owner / responsible:Nordic Casemix Centre


Initiated: 2019-11-05
Initiator: Martti Virtanen: Nordic Casemix Centre
Responsible at National organization: Martti Virtanen: Nordic Casemix Centre
Sent to NordDRG Forum: yyyy-mm-dd
CC category coding and CC exclusions in NordDRG
In NordDRG presence of Complications and Comorbidities (CC’s) is defined by the presence of a secondary dx indicating complication or comorbidity or in some exceptional cases by a complicated intervention. The latter is based on CC value given to this type of interventions (codes).
Dx that may indicate CC situation belong to one of the Complication categories (COMPLCAT). The definition of a complication category is the list of principal dx’s that it cannot complicate (COMPLEX-list). These dx basically indicate the same or related condition that the dx’s that belong the complication category. At it’s shortest the COMPLEX-list consists of the single dx that belongs to the complication category.
Originally NordDRG as many other DRG systems had only one CC-level. A patient case could either be with CC or without CC. The rules of the DRGlogic define which of the basic DRG’s are devided to these (sub)groups.
In 2012 (Case #110) NordDRG introduced a division of CC cases to Major Complications and Comorbidities (MCC) and ‘usual’ complications and comorbidities (CC). A diagnosis belonging to a complication category (COMPLCAT) could either be classified to be ‘Major’ level or usual level. This level is indicated by the leter ‘G’ or ‘C’ as the third character of the complication category code (COMPLCAT f.ex. 01G01/01C01). The complication category is still defined by its exclusion list and as long as the numeric characters are the same, the exclusion list is the same.
In practice the new system changed the 3rd character to a modifier of the complication category. To avoid unnecessary changes, this modifier was placed to (retained in) the middle of the code.
In the case above the CC category is actually 0101 and the modifier is G/C.
The placing of the modifier in middle is unusual. Usually the modifier would have been place at the end of the code i.e. the code+modifier should read: 0101G / 0101C.
In the COMPLEX-list the CC-value was still for this example 01C01 with the C in the middle. This exclusion list is valid for cases with modifier levels (for both 01G01 and 01C01). There cannot be separate COMPLEX list for 01G01 and 01C01. Dx’s that must have different COMPLEX-lists belong by definition to different CC categories (f. ex.0102 instead of 0101). Therefore the COMPLEX list has never values of the type xxGxx.
The nonstandard coding has resulted in several misunderstandings about the issue. The different codes (xxGxx/xxCxx) tend to be regarded as different categories.
Clinical analysis
This is only technical change not affecting the grouping.
Economical analysis
Since grouping is not changed, no economic changes will occur.
After discussion with Swedish experts we recommend that the CC-category coding should be changed to the standard model
Complication category code: f .ex. 0101
Modifier: C / G (or a / b / … or 1 / 2/…
In the Diagnosis feature table the COMPLCAT value would be code + modifier f. ex. 0107C / 0107G
The COMPLEX value would f. ex. 0107
For practical reasons although the COMPLEX – values are actually in a separate file, they are shown in the Diagnosis feature table together with other properties of dx’s .
The new system will allow filtering Diagnosis features for each complication category (f. ex. 0107) so that codes related to the selected complication category will be shown.
For example:
C7190 (Malignant neoplasm of brain, unspecified) COMPLCAT 0107C
C7190 (Malignant neoplasm of brain, unspecified) COMPLEX 0107
C7130 (Malignant neoplasm of parietal lobe) COMPLCAT 0107G
If the modifier coding is also changed (to a/b.. or1 / 2 …) the system will allow more easily addition of further CC levels (that exist in many other DRG-versions). 1 and 2 could also refer to the values used in the rules of DRGlogic.
Technical change
Code structure change.
DRG change
No changes.


#1 Updated by Martti Virtanen 11 months ago

  • Target year 2021 added

#2 Updated by Martti Virtanen 11 months ago

  • Target version changed from Target version 2020 to Target version 2021

#3 Updated by Martti Virtanen 7 months ago

  • Description updated (diff)

#4 Updated by Martti Virtanen 7 months ago

  • Tracker changed from Case to NDMS
  • Description updated (diff)

2020-03-03 Martti Virtanen
This is very much a technical change to the new NDMS, so I switch it to NDMS discussion

#5 Updated by Martti Virtanen 6 months ago

  • Status changed from Active to Further active

2020-03-09 Expert group
Expert group accpeted the principal. The modifier coding needs further discussion, but initially the numeric values (1,2,...) were found attractive.

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