Case #662

CC category coding and CC exclusions in NordDRG

Added by Martti Virtanen 12 days ago. Updated 12 days ago.

Status:ActiveStart date:2019-11-05
Priority:MinorSpent time:-
Assignee:-
Category:-
Target version:Target version 2021
Initiator:Nordic Casemix Centre Target year:2021
Case type: Owner / responsible:Nordic Casemix Centre
MDC:CC Old forum status:
Target Grouper:Not applicable

Description

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
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Problem
CC category coding and CC exclusions in NordDRG
Analysis
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 exception 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’x 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 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 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.
Suggestion
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.

History

#1 Updated by Martti Virtanen 12 days ago

  • Target year 2021 added

#2 Updated by Martti Virtanen 12 days ago

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

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