Case #122

Updated by Anonymous over 5 years ago

Initiated 2013-09-23 Nordic Casemix Centre


In relation to +Case 2009-OR-01 Problems with DRG 530-541+ []

the case about anaesthesia []:

The rule ord=190D050001 for DRG 120O is impossible, because cases without any intervention or nonsignificant interventions are assigned to preceding short therapy groups.

The rule ord=190D050000 exists to allow different interventions for haemangiomas to be performed because hemangiomas occur at different locations. There is no reason to allow for minor interventions with anaesthesia to have a special grouping and therefore the added line with anesthesia is removed.

*Comment 2013-10-17 Mats Fernström:*

The announced change (deletion of the rule with ORD 190D050001)will also change the existing grouping logic that has been valid for several years and WE CAN NOT ACCEPT THAT WITHOUT A PROPER ANALYSIS.
According to the traditional grouping logic (rule with ORD 190D050000) it is possible to get DRG 120O (now E39O in the Swedish grouper) also with smaller procedures (without OR 1) if they are combined with greater anesthesia. To keep that possibility we must have the rule with ORD 190D050001 since the OR property will be withdrawn from the anesthesia codes. It is possible that the rule is unnecessary but we have to analyze how many cases per year that are affected by a deletion of the rule and we must also see what DRGs the cases will go to instead of DRG 120O/E39O. Are the DRG results worse or better in a cost perspective?
We have no time for such an analysis now.

*Comment 2013-10-19 Martti Virtanen:*

What I noticed is that instead of making it possible to allow any significant intervention (OR=1) we with new rule allow anesthesia without any other intervention together with haemangioma to be assigned to DRG E390 (120O) or E39C (120). I thought this would not be wanted and therefore proposed that the new rule with 00X10 in both these cases would be omitted.

It is true that as long as anaesthesia interventions had OR=1 such cases were assigned to these DRG's. As you say, it also means that cases with other interventions without OR=1 together with anaesthesia will be assigned to these DRG's.

This is a tricky case, that seems to live from year to year. But I support your proposal, we keep the rules and discuss this next year again.