Case #402

Updated by Martti Virtanen over 5 years ago

National ID: C521-second part
Initiated: 2014-01-16'
Initiator: Mats Fernström The Swedish National Board of Health and Welfare
Responsible at National organization: Mats Fernström The Swedish National Board of Health and Welfare
Sent to NordDRG Forum: 2015-02-05
Status: ACTITEM - Active item
National ID: C521-first part see case #394
Cases with GEXX00 'Needle biopsy of mediastinum' (TGE00 Punktionsbiopsi av mediastinum) in combination are assigned to the DRG D76O/778V 'Thorax puncture' (Toraxpunktion, öppenvård).
Cases with combination of GEXX00 and JDDE02 'Ultrasound in upper gastrointestinal endoscopy' (XJD02 'Ultraljudsundersökning vid övre gastrointestinal endoskopi') are assigned to DRG F72O/711O 'Endoscopy of the upper gastrointestinal tract, outpatient' (Endoskopi av övre gastrointestinalkanalen, öppenvård).
DRG D76O is a Swedish DRG that requires more resources than DRG F72O/711O.
This means that in Sweden using the combination of procedure codes the patient groups to a DRG requiring less resource.
This problem is due to the hierarchy in the Swedish DRGlogic.
We should avoid situations were more correct coding results in assignment of less resource intensive DRG than leaving out some of the codes. This is obviously wrong also from clinical point of view. The system should not encourage bad primary coding by giving more reimbursement.

The Swedish National Board of Health and Welfare – 2015-01-16
The rule for DRG D76O/778V 'Thorax puncture') should be moved up to just before the first rule for DRG F72O/711O .

The change should be introduced to the Swedish NordDRG for 2016.

*DRG change*
A number of outpatient visits will be grouped into DRG D76O instead of other outpatient DRG.

*Technical change*
• In the Swedsih DRGlogic the rule for DRG D76O is changed. The old ORD-value 200D037 is changed to ORD 104D040300.
For technical changes see Excel-file “Decision C521 to Forum”.

Introduction: NordDRG [SWE] [2016]