Case #673

Sepsis from 2020

Added by Mats Fernström 29 days ago. Updated 4 days ago.

Status:ActiveStart date:2020-01-30
Priority:MinorSpent time:-
Assignee:Mats Fernström
Target version:NordDRG 2021
Initiator:Sweden Target year:2021
Case type:Minor Owner / responsible:National organisations
MDC:MDC18 Old forum status:
Target Grouper:SWE


In accordance with the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), the Swedish National Board of Health and Welfare has introduced new diagnosis coding instructions (valid from 2020-01-01) for cases with sepsis. Because of these new coding instructions there is a need for some small changes the NordDRG logic.
The new coding instructions (in short):
• The text to the ICD code R65.1 is changed from “SIRS with infectious origin with organ failure” to “Sepsis according to Sepsis-3 criteria”.
• For generalized septic infections, where there is no information on the source of the infection, codes for sepsis from ICD-10 chapter 1 are used.
• In these cases there is no need to use the additional code R65.1 ‘Sepsis according to Sepsis-3’.
This means that sepsis according to Sepsis-3 is included in the conditions for sepsis in chapter 1.
As a consequence, we can no longer retain the principle that the addition of the secondary diagnosis R65.1 leads to a complicated DRG. Coding twice of the same thing must not lead to a complicated DRG!
To achieve this we have to add all codes for sepsis to the exclusion list for COMPL 18G80, which is the COMPL value for R65.1. We have selected all codes with DGCAT 18M01 (Septicemia) in NordDRG 2020 but also added some other codes where inclusion criteria is sepsis, i.e. A2410 ‘Acute and fulminating melioidosis’ (with DGCAT 18M99) and O8500 ‘Puerperal sepsis’ (with DGCAT 14M99).
However, R572 ’Septic shock according to Sepsis-3 criteria’ also has COMPL 18G80 (Severe sepsis & shock- major CC) and addition of the sepsis codes to the exclusion list will have the effect that septic shock can’t complicate sepsis without shock, which we think is wrong. Thus we suggest that R572 gets a new COMPL (18G81 ‘Septic shock- major CC’). On the exclusion list for this COMPL we want only R572 ’Septic shock according to Sepsis-3 criteria’ and A483 ‘Toxic shock syndrome’. (Actually, it is unnecessary to have R572 on the exclusion list because the code has DGCAT 99M00 and cannot be used for principal diagnosis but we will have it on the list for principal reasons – it will make it clear that a diagnosis must not be able to complicate itself.)
With the new COMPL for septic shock we have to change the text to 18G80. We suggest “Sepsis according to Sepsis-3 criteria- major CC”.

As mentioned, in the work on this case we discovered that there are diagnostic codes that mean sepsis but they do not have DGCAT 18M01. For a better medical description, they should have 18M01. We have therefore analyzed how it would be in a cost perspective if we change DGCAT to 18M01. The analysis is presented in Appendix_C826.xlsx and it indicates that it is OK to change DGCAT from 18M99 to 18M01, but the code with 14M99 (O8500 Puerperal sepsis) should retain its DGCAT.
The suggestions in this case are supported by Olafr Steinum, specialist in infectious diseases.

Our suggestion in summary.
In the table compl. cat. (or the table dg in the new NDMS structure):
o The text to 18C80/18G80 is changed from “Severe sepsis & shock”/”Severe sepsis & shock- major cc” to “Sepsis according to Sepsis-3 criteria”/”Sepsis according to Sepsis-3 criteria- major CC”.
o A new COMPL, 18C81/18G81 Septic shock/Septic shock- major CC is inserted.
In the table compl. excl:
o The new COMPL 18C81/18G81 is inserted with the codes A4830 and R5720 in the column “code”.
o For the COMPL 18C80/18G80 all codes with DGCAT 18M01 are added in the column “code”, but also the following codes:
A2410 Acute and fulminating melioidosis
A2820 Extraintestinal yersiniosis
A3270 Listerial septicaemia
A4270 Actinomycotic septicaemia
B3770 Candidal septicaemia
O859/O8500 Barnsängsfeber/Puerperal sepsis
In the table dg the DGCAT 18M99 is changed to 18M01 for the following codes:
A2410 Acute and fulminating melioidosis
A2820 Extraintestinal yersiniosis
A3270 Listerial septicaemia
A4270 Actinomycotic septicaemia
B3770 Candidal septicaemia

Detailed technical changes are in the file TC_C826.xlsx.

The DRG changes are moderate. Less than 600 cases per year in Sweden will be grouped to DRG 416N/S10E (Septicemia age > 17 w/o cc) instead of DRG 416M/S10A (Septicemia age > 17 w mcc) or 416C/S10C (Septicemia age > 17 w cc) and very few cases (less than 100 per year) will go from different DRGs to a DRG for sepsis (416/S10).

Appendix_C826.xlsx (19.7 KB) Mats Fernström, 2020-01-30 15:12

TC_C826.xlsx (23.6 KB) Mats Fernström, 2020-01-30 15:12


#1 Updated by Kristiina Kahur 4 days ago

Finnish National DRG-Centre/Kristiina Kahur 24-2-2020

Finland does not have specific sepsis coding guidelines. Other than that this change seems clinically meaningful change to be introduced.

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