Case #381

Updated by Martti Virtanen almost 5 years ago

National ID: C454
Initiated: 2014-12-08
Initiator: Ralph Dahlgren

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*Problem* Problem
The initiator pointed out that a patient with principal dx G4780 'Other sleep disorders' (Andra a diagnos G478 Andra specificerade sömnstörningar) sömnstörningar or G4790 'Sleep disorder, unspecified' (Sömnstörning, ospecificerad) G479 Sömnstörning, ospecificerad are assigned grouped to DRG T49N/432C 'Other unspecific T49N Ospecificerade psykiska besvär (Former DRG 432C Unspecified mental disorders' (Ospecificerade psykiska besvär).
Cases with R0650 'Mouth breathing ' (Munandning
disorders). This is odd since the ICD-codes "R06.5 Munandning och snarkning) snarkning" and G4730 'Sleep apnoea' (Sömnapnésyndrom) "G473 Sömnapnésyndrom" are assigned grouped to C37C Obstruktivt sömnapnésyndrom, komplicerat ( Former DRG C37C-E/520N-C 'Obstructive sleep apnoe syndrom/w CC' (Obstruktivt 520C ) or. C37E Obstruktivt sömnapnésyndrom, ej kompliserad/kompliserad). komplicerat (Former DRG 520N). According to the initiator the investigation of the problems are the same.

*Analysis* Analysis
The Swedish National Board of Health and Welfare 2014-12-08
The Swedish cost data (KPP) shows little difference between the cost for ICD-10 codes G478 Andra specificerade sömnstörningar and G479 in DRG T49N/432C T49N and the cases in DRG C37C-E/520N-C. C37C/E.
Assigning cases with If changing the grouping properties of these two codes so that they group to DRG C37C-E/520N-C would C37C/C37E instead there will also result in be a more homogeneous distribution description of the DRG's

*Suggestion*
same patient group.
Suggestion

The Swedish National Board of Health and Welfare 2014-12-08
The patients with ICD-10 diagnoses G478 Andra specificerade sömnstörningar ( Other specified sleep disorders ) and G479 Sömnstörning, ospecificerad ( Sleep disorder, unspecified ) should not be grouped into a DRG concerning “unspecified mental disorder”, T49N, if a sleep apnoe examination (procedure with 03V02) is performed. These patients should instead be grouped to DRG C37E Obstruktivt sömnapnésyndrom, ej komplicerat (Former DRG 520N) or C37C Obstruktivt sömnapnésyndrom, komplicerat ( Former DRG 520C ).
Decided changes
The Swedish National Board of Health and Welfare 2014-12-08
This is to be introduced in the Swedish version of NordDRG 2016


DRG change
Some outpatient cases (doctor visits) will be grouped to DRG C37O instead of DRG C76O and T99O. The remaining cases in DRG C76O will be visits at other personal categories than doctors. For inpatients some will be moved from DRG T49N to DRG C37E/C37C.

Technical change
We cannot move G4780 G478 and G4790 G479 to a diagnosis category in MDC 03 because there is still a possibility that these unspecific codes may be used for other problems than apnoe that diagnoses are treated in psychiatric care.
Using a new principal diagnosis property 03P05 ‘Sleep apnea' it is possible
Therefor we have to construct three new rules that bypass this problem.
Cases with G4780 or G4790 as principal dx continue to be assigned to
for DRG T49N/432C if no sleep apnoe investigation (interventions with procedure property 03V02) is performed:

!Sleep_apnoe_interventions.jpg!

If any of
C37 in the interventions is performed Drglogic table based on that G478 and G479 are given a new PDGPRO 03P05 ‘Sleep apnea’. In the cases should be assigned to DRG C37O-E-C/520O-N-C.

The
new rule for DRG C37O/520O (outpatient rule only used in NordDRG SWE) already uses C37O we cannot use the PROCPRO 03V02 either, since both the proc1 (99V20 'Outpatient visit') and secproc (99V35 'Medical doctor') leaving no place for PROCPRO 03V02 thus demanding another solution.

Sweden wants this change to be introduced in the NordDRG SWE 2016

_Technical change_

A new principal diagnosis property 03P05 'Sleep apnoe' is created. This property is given to dx G4780 and G4790 and to all linked national codes.

A new diagnosis property
fields are occupied. Therefore we add DGPROP 03X05 ‘Sleep apnoe examination‘ is given to all the procedure codes with procedure property 03V02

Three new rules are added to the Drglogic-table for DRG C37O-E-C/520O-N-C. They are copies of the current rules but MDC 03 is removed, PDGPROP has value 03P05 and Dgprop1 03X05.

03V02:
• AA093 Multipel sömnlatenstest (MSLT)
• AA094 Polysomnografi
• AG005 Apnémonitorering
• AV100 Sömnapnéutredning II
• AV101 Sömnapnéutredning III
The text on the DRG C37E/C will have a name change to “Sömnstörningsutredning” ( Investigation of sleep Disturbance), Disturbance ), C37O will have a name change to “Läkarbesök vid sömnstörningar” ( Doctor's appointment of sleep disorders ).

DRG change

Some outpatient cases (doctor visits) will be grouped to DRG C37O instead of DRG C76O/767V 'Sleep apnoe examination, short therapy' and T99O/880V 'Other medical contact for psychiatric problem, short therapy'. The remaining cases in DRG C76O/767V will be visits at other personal categories than doctors. For inpatients some will be moved from DRG T49N/432C to DRG C37E-C/520O-N-C.

For more details see the Excell-file “Decision, technical changes, NPK C454”

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