Case #217

Updated by Anonymous about 7 years ago

Initiated: 2014-01-27 again, postponed on Expert Network 2011-03-17
Initiator: Ralph Dahlgren, Mats Fernström, Mona Heurgren
Responsible at National organization:
Sent to NordDRG Forum: 2014-01-27
Status: Posponed Item
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*Problem*

The initiator pointed out that a case with the principal diagnos I46.0 (Cardiac arrest with successful resuscitation) is grouped to E48E Hjärtstillestånd, oförklarat, ej komplicerat (Former DRG 129 Cardiac arrest, unexplained) and if a coronary angiography (AF037) is performed the case is grouped to DRG E43C Cirkulationssjukdomar med hjärtkateterisering, med komplicerande diagnos (Former DRG 124 Diagnostic percutan cardiac procedure w circulatory complex dx.

We first tackled this as a hierarchy problem for DRG E48E (129) and E43C (124). Sweden tested that solution on the Swedish Patient register and found that some cases in other DRG were DRG (121, 123 and 124), were transferred to DRG E48E (Former 129).

Is such a transferral wanted in a medical perspective? Is it really more important to describe that the patients have a cardiac arrest (DRG 129) than that they have a myocardial infarction (DRG 121 & 123) or that they have had an intervention (DRG 124)? These questions made us look at the content in DRG E48E (Former 129).

We found that it was obviously wrong that R960 and R961 are grouped to DRG E48E (former DRG129) because R96 excludes cardiac death. R96 should be handled like R98 (Unattended death).

The remaining codes (I46) are probably associated with cardiac infarction in most cases and the reason why the cases with these codes not are grouped to the infarction groups (DRG 121-123) was probably depending on under coding. We found it especially strange that patients that have survived the cardiac arrest (the I460 cases) not have got a more precise diagnosis.

*Expert Network 2011-03-17*

The meeting recommended acceptance of that the diagnosis R96.0 and R96.1 should be grouped to MDC 23 and should have the same properties as R 98.
The case will be postponed for further investigation of the diagnosis I46.xx by Sweden. See +Case 2011-MDC05-01 Cardiac arrest+ [[http://documents.norddrg.net/issues/150]].



*Analysis*

*CPK Sweden 2014-01-27*

Examination of all the cases in KPP 2012 in DRG E48A and E48E there is an overwhelming majority of those where it is possible to suspect that there are errors in the primary classification.
Of the cases that were in the KPP 2012 for DRG E48E and E48C, total 526 cases, so was I46.9 Hjärtstillestånd, ospecificerat (Cardiac arrest, unspecified) primary diagnosis in 376 cases, I46.1 Plötslig hjärtdöd (sudden cardiac death) in cases 28 and I46.0 Hjärtstillestånd med framgångsrik hjärt-lungräddning (Cardiac arrest with successful resuscitation) primary diagnosis in 122 cases.
Among I46.0 Hjärtstillestånd med framgångsrik hjärt-lungräddning (Cardiac arrest with successful resuscitation) so can 105 patients clearly be judged to have died from other illnesses considering the secondary diagnosis, costs and duration of stay. The diagnosis include ischemic heart disease, heart failure, amyloidosis to take a few examples. One main diagnosis was ok, 6 main diagnoses were more difficult to assess when there was a discrepancy between the length of stay, costs of care, number of diagnosis and procedure codes.

*Suggestion*

*The Swedish National Board of Health and Welfare and it´s Swedish collaboration partners 2014-01-27*

wants the technical changes to be made such as that I46.0 alone should have a new PDGPROP. This PDGPROP should make I46.0 to group to a new DRG, DRG Z55 in both outpatient and inpatient care. The DRG should be called “Rare or incorrect principal diagnosis”. This is irrespective of any procedure codes or not.

*Decided changes*

The Swedish National Board of Health and Welfare and it´s Swedish collaboration partners 2014-01-27

*DRG change*

Cases from both DRG E48E and E48C will be grouped to the new DRG Z55 Sällsynt eller felaktig huvuddiagnos (Rare or incorrect principal diagnosis)

*Technical change*

I46.0 alone should have a new PDGPROP. The new PDGPROP should be 00P03 Rare or incorrect principal diagnosis. A new DRG should be created both in outpatient and inpatient. The new DRG should be “DRG Z55 Sällsynt eller felaktig huvuddiagnos (Rare or incorrect principal diagnosis) and new rows in DRGlogic should be created before DRG Z76O. The column mdc is left empty so that we can use the rule even for diagnosis codes from other mdc in the future.

*Introduction:*

NordDRG [2015] [SWE]


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