Case #676

Removal of COMPL 19C02 ‘Psychosis’ from diagnosis without psychosis

Added by Veronika Stemme 8 months ago. Updated 6 months ago.

Status:AcceptedStart date:2020-02-04
Priority:MinorSpent time:-
Assignee:Veronika Stemme
Target version:-
Initiator:Sweden Target year:2021
Case type: Owner / responsible:National organisations
MDC:MDC19 Old forum status:
Target Grouper:EST, FIN, ICE, LAT, NOR, SWE


Veronika Stemme, The National Board of Health and Welfare, Sweden
We have found that many diagnosis in MDC 19 'Mental diseases and disorders' have COMPL 19C/G02 'Psychoses' although the diagnosis does not mean that the patient have a psychosis. These cases should be able to be complicated by psychosis diagnosis. We therefore suggest that they get a new COMPL; 19C07 'Other psychiatric problems' or 19G07 'Other psychiatric problems - major CC'
The diagnosis in case #625 (Property COMPL 19C02 should be removed from F729 and F739) from Norway last year are included in this case.

This is really a matter of medical description, but we have tried to do some economic analysis on both outpatient and inpatient cases. We compared DRG-grouping before and after adding the technical changes included in this case. We found that the cases with non-psychosis primary diagnosis and a psychosis diagnosis as secondary diagnosis were moved, as we wanted, from uncomplicated to complicated DRG:s and they fitted better, also according to cost data ,in the new groups in more than half of the cases. The cost data on psychiatric cases though is not complete and the cases we analysed were few – but anyway, the cost data did not speak against the change.

Suggestion/DRG change
Cases in MDC 19 with primary diagnosis without psychosis should be complicated by psychosis diagnosis as secondary diagnosis, thus these cases should move from uncomplicated DRG:s to complicated DRG:s.

Decided changes
We want these changes implemented in the Swedish version of NordDRG 2021.

Technical changes
COMPL 19C02/19G02 is removed from a number of diagnosis that do not include psychosis. These diagnosis do instead get COMPL 19C07 'Other psychiatric problems' and 19G07 'Other psychiatric problems - major CC'
New COMPL are introduced: 19C07 'Other psychiatric problems' and 19G07 'Other psychiatric problems - major CC'

See attached file “Technical changes CPK-ID 777”

Technical changes CPK-ID 777.xlsx (59.7 KB) Veronika Stemme, 2020-02-04 14:26

2020-03-30_676_TC_from_NDMS.xlsx (37.7 KB) Kristiina Kahur, 2020-03-30 21:09


#1 Updated by Martti Virtanen 7 months ago

Martti Virtanen 2020-03-03
This list is interited from HCFA rules. The idea must be that certain conditions are sever enough that coding the 'psychosis' in addtion would only mean repeating information.
The rules are created for avoiding DRG greep and the proposed change adds a definite possiblity to increase the reimbursement by 'correct' coding.
The problem may not exist now (since it has not been possible) but it may appear after this type of change is instituted.

#2 Updated by Kristiina Kahur 6 months ago

Nordic Casemix Centre/Kristiina Kahur 30-3-2020

The Expert group accepted the changes all countries 2020-03-09. The TC are updated.

Also available in: Atom PDF