Case #403

Updated by Martti Virtanen over 4 years ago

National ID: HD-0092, HD-0110 and HD-0117
Initiated: 2015-02-25
Initiator: Norwegian Directorate of Health
Responsible at National organization: Ruth Foseide Flenning and Kristin Dahlen
Sent to NordDRG Forum: 2015-02-25
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Problem
A plurality of diagnosis can lead to DRG 390X/Q55N 'Neonate, birthweight 2500 g or more, with other significant problem', 390, and we question if it is correct that they all classify as “significant problems” for a newborn. As can be seen in preliminary data from Norway 2014, 72% of the babies are assigned to DRG 391X/Q60N 'Normal newborn', 391, while 17% of the newborns are assigned to DRG 390X/Q55N. 390.

In addition we have registered different coding practice mainly in the area of P codes. This is misleading when it comes to medical statistics, and has also represented problems according to the activity based payment.

Based on this we have studied the list of P codes diagnoses leading to DRG 390X/Q55N. 390.

We have following comments:

* Some -some codes are descriptive of the mothers condition (P00-P04). This information represents a potential link between a mothers and child’s condition and is obviously important in a medical and statistic point of view, but is it correct to route these codes into DRG 390 independently of a healthy newborn or not?

* For -for the following codes, analysis has revealed a difference in code practice between the hospitals:
> P9220 'Slow feeding of newborn' ∙ P92.2 “langsomt næringsinntak hos nyfødt” - would it be better to rephrase the code to make the difference between a normal and pathological more clear? i.e. loss of more than 10% of birth weight and need of additional nutrition? Is it necessary to differentiate between newborns <8 days and older and only route those babyes >8 days into DRG 390?
> P8310 'Neonatal erythema toxicum' ∙ P83.1 Erythema toxicum neonatarum - a common harmless skin rash that affects healthy newborn and clears up without any treatment.
> P0340 'Fetus and newborn affected by caesarean delivery' F ∙ P03.4 Foster påvirket av forløsning ved keisersnitt – frequently coded in some hospitals

* For -for the following codes we question if it is correct to route them directly to DRG 390:
> P9250 'Neonatal difficulty in feeding at breast

∙ P92.5 “Problem med brysternæring hos nyfødt”

> P9280 'Other feeding problems of newborn' ∙ P92.8 «Andre spesifiserte problemer med næringsinntak hos nyfødte
∙ P92.9 «Uspesifisert problem med næringsinntak hos nyfødte»

> P9290 'Feeding problem of newborn, unspecified'

From how many days of age and under which conditions is it correct to assess these groups of nutritional challenges as a “significant problem”?

*Analysis* Analysis
No economic analysis available

*Suggestion*
Norwegian directorate of health

Suggestion

Norwegian directorate of health – 2015-02-25

We suggest to remove the property 15X98 “other significant problem of neonate” from the following ICD-10 codes:

> P0000 'Fetus and newborn affected by maternal hypertensive disorders' P00-P04 “Foster og nyfødt påvirket av…..”
> P0010 'Fetus and newborn affected by maternal renal and urinary tract diseases' P83.1 «Erythema toxicum neonatorum»
> P0020 'Fetus and newborn affected by maternal infectious and parasitic diseases' P92.2 «Langsomt næringsinntak hos nyfødt»
> P0030 'Fetus and newborn affected by other maternal circulatory and respiratory diseases' P92.5 «Problem med brysternæring hos nyfødt»
> P0040 'Fetus and newborn affected by maternal nutritional disorders' P92.8 «Andre spesifiserte problemer med næringsinntak hos nyfødt»
> P0050 'Fetus and newborn affected by maternal injury' P92.9 «Uspesifiserte problem med næringsinntak hos nyfødt»

Decided changes

> P0060 'Fetus and newborn affected by surgical procedure on mother' Organization – yyyy-mm-dd

DRG change

Technical change

Introduction:

> P0070 'Fetus and newborn affected by other medical procedures on mother, not elsewhere classified'
> P0080 'Fetus and newborn affected by other maternal conditions'
> P0090 'Fetus and newborn affected by unspecified maternal condition'
> P0100 'Fetus and newborn affected by incompetent cervix'
> P0110 'Fetus and newborn affected by premature rupture of membranes'
> P0120 'Fetus and newborn affected by oligohydramnios'
> P0130 'Fetus and newborn affected by polyhydramnios'
> P0140 'Fetus and newborn affected by ectopic pregnancy'
> P0150 'Fetus and newborn affected by multiple pregnancy'
> P0160 'Fetus and newborn affected by maternal death'
> P0170 'Fetus and newborn affected by malpresentation before labour'
> P0180 'Fetus and newborn affected by other maternal complications of pregnancy'
> P0190 'Fetus and newborn affected by maternal complication of pregnancy, unspecified '
> P0200 'Fetus and newborn affected by placenta praevia'
> P0210 'Fetus and newborn affected by other forms of placental separation and haemorrhage'
> P0220 'Fetus and newborn affected by other and unspecified morphological and functional abnormalities of placenta'
> P0230 'Fetus and newborn affected by placental transfusion syndromes'
> P0240 'Fetus and newborn affected by prolapsed cord'
> P0250 'Fetus and newborn affected by other compression of umbilical cord'
> P0260 'Fetus and newborn affected by other and unspecified conditions of umbilical cord'
> P0270 'Fetus and newborn affected by chorioamnionitis'
> P0280 'Fetus and newborn affected by other abnormalities of membranes'
> P0290 'Fetus and newborn affected by abnormality of membranes, unspecified'
> P0300 'Fetus and newborn affected by breech delivery and extraction'
> P0310 'Fetus and newborn affected by other malpresentation, malposition and disproportion during labour and delivery'
> P0320 'Fetus and newborn affected by forceps delivery'
> P0330 'Fetus and newborn affected by delivery by vacuum extractor [ventouse]'
> P0340 'Fetus and newborn affected by caesarean delivery'
> P0350 'Fetus and newborn affected by precipitate delivery'
> P0360 'Fetus and newborn affected by abnormal uterine contractions'
> P0380 'Fetus and newborn affected by other specified complications of labour and delivery'
> P0390 'Fetus and newborn affected by complication of labour and delivery, unspecified'
> P0400 'etus and newborn affected by maternal anaesthesia and analgesia in pregnancy, labour and delivery'
> P0410 'Fetus and newborn affected by other maternal medication'
> P0420 'Fetus and newborn affected by maternal use of tobacco'
> P0430 'Fetus and newborn affected by maternal use of alcohol'
> P0440 'Fetus and newborn affected by maternal use of drugs of addiction'
> P0450 'Fetus and newborn affected by maternal use of nutritional chemical substances'
> P0460 'Fetus and newborn affected by maternal exposure to environmental chemical substances'
> P0480 'Fetus and newborn affected by other maternal noxious influences'
> P0490 'Fetus and newborn affected by maternal noxious influence, unspecified'
> P8310 'Neonatal erythema toxicum'
> P9220 'Slow feeding of newborn'
> P9250 'Neonatal difficulty in feeding at breast
> P9280 'Other feeding problems of newborn'
> P9290 'Feeding problem of newborn, unspecified'
NordDRG [year] [version]

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