Case #366

Updated by Martti Virtanen over 5 years ago

Finnish national DRG-centre performed an analysis with aim to revise the diagnosis codes which are complicating the cases of cesarean section (CS).
In current logic there are 155 diagnoses codes with CC-property 14Gxx/14Cxx, which would complicate any case (incl CS) if coded as secondary diagnosis. However, these codes do not have the property 14X12 (Complication of cesarean section) and thus, do not complicate the CS when coded as primary diagnosis. This means that those codes complicate the CS case only when coded as secondary diagnosis; when coded as primary diagnosis, the case is not assigned to CC-DRG.

For analyses the data of five Finnish university hospitals was used (2013).
As first step, the cases of DRG 371 (Cesarean section w/o cc) were derived from data (#2870). Then the cases (#586) where any of 155 diagnosis codes with property 14Gxx/14Cxx were coded as primary diagnosis were separated and cost-analysed (out of 155 only 29 codes were used). Same was done with cases having no 14Gxx/14Cxx property diagnosis code as primary one.

The results of the cost analysis showed that some of those 155 codes do not create additional costs and therefore the cases should not be assigned to DRG 370 (Cesarean section w cc) either, no matter whether the codes are used as primary or secondary diagnosis.

Same time, there were diagnosis codes with property 14Gxx/14Cxx which clearly increase the mean cost of cases when coded as primary diagnosis. As those codes currently do not have property 14X12, the cases are assigned to non-CC DRG (DRG 371). It is not fair from use of resources point of view.

The results of cost analysis are depicted in attached .xls file, sheet “results”. On same sheet are also the mean costs of cases in DRG 371 when the codes with property 14Gxx/14Cxx were used as primary diagnosis.

Base on the analyses the proposal is as follows:
1) The codes of cases which are more expensive than mean cost of DRG 371 + 50%, i.e. 3761 EUR + 50% = 5 574 EUR, are given the property 14X12;
2) From the codes of cases which are less expensive than 5 574 EUR the property 14Gxx/14Cxx is removed;
3) The properties of codes which were not used in current analysis will remain the same and will not change.
The revised property list is in attached .xls table, sheet “revised properties”.