Case #134

Updated by Martti Virtanen over 5 years ago

Last updated: 2012-11-01
Status: CLOSITEM - Closed item
Error corrected
Initiated: 2012-06-29
By: National DRG Centre in Finland / Petra Kokko, Minna-Liisa Sjöblom

*Problem*
Unexpected grouping of a case and possibility to similar groupings


Following case:
*Diagnoses:*
*Diagnosis*

* E0420 Nontoxic multinodular goitre
E04.2 Monikyhmyinen atoksinen struuma

* D2240 Benign neoplasm of melanocytic naevi of scalp and neck

*Procedures:*
D22.4 Päälaen, kaulan tai niskan (ihon) melanosyyttiluomi

*Procedures*

* BASA40 Unilateral lobectomy of thyroid gland
BAA40 Kilpirauhasen toisen lohkon poisto kokonaan

* QASE80 Excision of other lesion extending through all layers of skin in head or neck QAE10 Pään tai kaulan ihon ja ihonalaiskudoksen ihon paikallisen muutoksen poisto koko ihon paksuudelta

In an inpatient case results in DRG
*
à 288B Other procedure for obesity Liikalihavuuden hoito muulla leikkauksella.

*Analysis*

This grouping There is because obesity and thyroid problems are counted as endocrine problems (MDC 10) and thre rule for DRG 288B is before the rule for DRG 290X 'Thyroid procedures'. The intervention QASE00 is for D2240 and not for the thyroid problem. Although it is not an OR-procedure together with BASA40 it is counted. The property 10S04 'OR procedure for obesity' thus fullfills error in the rule for DRG 288B.
All procedure codes linked to QxSE80 'Excision of other lesion extending through all layers of skin in...' (QxE10) and QxSE82 'Excision of other superficial lesion of skin from head and neck...' (Qxe15) would behave similarly.

grouper.

*Suggestion*

Procedure codes linked to QxSE80 'Excision of other lesion extending through all layers of skin in...' QAE10, QAE15, QBE10, QBE15, QCE10, QCE15, QDE10, QDE15 and QxSE82 'Excision of other superficial lesion of skin QXE10, QXE15 should take away from head and neck...' should not have the 10S04 property. list.

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