Case #377

Updated by Martti Virtanen almost 5 years ago

Description:

National ID: CPK ID C414
Initiated: 2012-02-16
Initiator: Ralph Dahlgren, The Swedish National Board of Health and Welfare

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Problem
From the Swedish health care system suggestions have come up that codes that concerns K80.- and K82.- are about the same thing but they complicate each other. This have now made the clinics to use double coding to get extra reimbursement.

Analysis
NPK Sweden – 2014-12-07
The involved codes are shown below:
K800 'Calculus of gallbladder with acute cholecystitis' Gallsten med akut kolecystit COMPL 07C15 Cholelithiasis
K801 'Calculus of gallbladder with other cholecystitis' Gallsten med annan kolecystit COMPL 07C15 Cholelithiasis
K803 'Calculus of bile duct with cholangitis' Koledokussten med kolangit COMPL 07C21 Choledocholithiasis
K804 'Calculus of bile duct with cholecystitis' Koledokussten med kolecystit COMPL 07C21 Choledocholithiasis
K808 'Other cholelithiasis' Annan specificerad gallstenssjukdom COMPL 07I15 Cholelithiasis
K810 'Acute cholecystitis' Akut kolecystit COMPL 07G18 Acute cholecystitis
- Major complication
K820 'Obstruction of gallbladder' Avstängning av gallblåsan utan uppgift om gallsten COMPL 07C17 Obstruction, perforation of fistula of gallbladder
K821 Hydrops i gallblåsan COMPL 07C17 Obstruction, perforation of fistula of gallbladder
K822 Gallblåseperforation COMPL 07C17 Obstruction, perforation of fistula of gallbladder
K823 Gallblåsefistel COMPL 07C17 Obstruction, perforation of fistula of gallbladder
K830 Kolangit COMPL 07C19 Cholangitis
K830A Skleroserande kolangit COMPL 07C19 Cholangitis
K830X Kolangit, annan eller UNS COMPL 07C19 Cholangitis
As it is for now the above codes can affect an inpatient case and make it group to a complicated/very complicated DRG by adding an extra code that is actually included in the first code.
The ICD kode K80.0 Gallsten med akut kolecystit (Gallstones with acute cholecystitis ) groups to DRG G40E Gallvägssjukdomar, ej komplicerat (Old DRG 208 Biliary tract diseasaes, not complicated ) . If added the ICD code K810 Akut kolecystit ( acute cholecystitis ) the patient will be grouped to DRG G40A Gallvägssjukdomar, mycket komplicerat (old DRG 208 Biliary tract diseases, very complicated ) and that is not acceptable.
Suggestion
The Swedish National Board of Health and Welfare – 2014-12-07
The suggestion is to add to the Compl. Excl. table the specific codes that is needed to prevent the above mentioned to happen.

Decided changes
DRG change
Some cases that now are grouped to complicated DRG will group to basic level a DRG.

Technical change
Se Excell file: Technical changes, Decision NPK C414.

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