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<div class="journal-details-container"> <h4> Task #812 has been updated by Martti Virtanen. </h4> <div id="journal-4094-notes" class="note"><p>2022-02-16 Martti Virtanen<br>Since Kristiina asked me to comment on this case, although I don't like the idea of partial corrections to this area.</p> <p>Originally we had one DRG for obvious error DRG 470. To ease finding the reason for this assingment in a case the rtc (return character code) was invented. 0 means that groping is OK and values 1-9 that different things are wrong. We have even used some charactes for certain specific types of errors as rtc's.</p> <p>Then Sweden invented the very good idea of incorporating the rtc in the DRG code and we got the DRG 470x, where x stands for different upper case chracters that tell the user the same thing as rtc's.</p> <p>When Sweden invented the other very good idea of changing the DRG coding the new typ 'A12X' they extende the possibilities of the error DRG to second potency. Error DRG's coding is of type Z7nc wher n is a number 0-9 and c is a capital character. The possiblities are practically endless and Sweden is already using quite a number of these. This proposla creates 2 more of this type.</p> <p>My comments to the matter are:<br>1) The countries should agree about using the specific DRG's to indicate the type of error when it is necesary to tell the users why the case is assigned to an error DRG. Then we should remove the rtc's from system. <br>2) It i a good question how many different error types are needed. For example I expect that the users know when they dealing with primary care inpatients and the erros is quite obviously not specfic to this type of patients. However, if this specific information is needed the can easely handle for example in the way proposed here. <br>3) There are now 3 different typs of indication that the principal dx is invalid.</p> <blockquote> <p>The variable icd that gets a '-' value when the principal dx is missing. <br>The dgcat '00M00' is used for a number of dx that we originally thought that they are codes that should not be used as (principal)dx. <br>The dgcat '99M00' is used for specific valid ICD-codes that according to coding instructions are not allowed to be used and principal dx.</p> </blockquote> <p>These are lins in water, they move and interpretated differently at different times. I recommend that the whole area is cleaned, we get stop using rtc's and we agree on one dgcat that indicates codes not allowed as principal dx. To get rid of the icd variable a special solution is needed in the grouper that can handle the missing codes and wrong (not existing) codes. <br>I recommend a general solution but the Swe proposal propably works. It does not solve the problem for other countries.</p></div></div> <hr/> <p><strong>Mats Fernström, the National Board of Health and Welfare, Sweden 2022-02-01</strong> (Swe ID C909)</p><p>Cases with a principal diagnosis with DGCAT 00M00 are ungroupable or grouped to DRG Z71 ‘Huvuddiagnos ogiltig i NordDRG …’ (DRG 470 + rtc 8 ‘Principal diagnosis not applicable’ in Combined version). This is hardcoded in the grouper but not visible in the logic. To make the grouping logic more transparent we suggest that rules for DGCAT 00M00 are inserted in the table drg_logic. The rules should look like the existing rules with DGCAT 99M00 but with 00M00 instead of 99M00 in the field ‘dgcat’. See TC_C909 for details. The DRG change will be none. This is just a way to get rid of one of the “black holes” in NordDRG.</p><p>Another way to make the grouping logic more transparent is to give DGCAT 99M00 to all codes with DGCAT 00M00 but then we will lose the information that originally was meant with DGCAT 00M00, namely that these codes have no other features than just DGCAT 00M00.</p><p>At the same time, we should correct incorrect rtc codes in the rules with DGCAT 99M00. The code should be ‘8’ in all these rules. See TC_C909.</p><p>During the work with this case, we noticed some missing Swedish DRGs for inpatients in primary care without a principal diagnosis or with a diagnosis with DGCAT 99M00. These DRGs and the rules for them must be inserted in the Swedish version 2023PL. See TC_C909.</p>
