Martti Virtanen
2022-02-16 Martti Virtanen
Since Kristiina asked me to comment on this case, although I don't like the idea of partial corrections to this area.
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.
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.
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.
My comments to the matter are:
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.
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.
3) There are now 3 different typs of indication that the principal dx is invalid.
The variable icd that gets a '-' value when the principal dx is missing.
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.
The dgcat '99M00' is used for specific valid ICD-codes that according to coding instructions are not allowed to be used and principal dx.
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.
I recommend a general solution but the Swe proposal propably works. It does not solve the problem for other countries.
Kristiina Kahur
Updated by Mats Fernström 7 months ago
Mats Fernström, the National Board of Health and Welfare, Sweden 2022-03-09 (SWE ID C909)
For the moment we don’t want to go that far as Martti recommends. The benefit of retaining DGCAT 00M00 needs to be discussed in the Expert Group since it is an indicator that the code has no other features.
For now, we are happy with just that rules for DGCAT 00M00 are inserted in the table drg_logic to make the definition tables more transparent (plus the small error corrections described in our TC_C909).
The “general solution” recommended by Martti can suitably be discussed under Development initiative #822.
#3Updated by Kristiina Kahur 6 months ago
- File TC_812_NDMS_05042022.xlsx added
- Status changed from Active to Accepted
2022-03-18 Expert Group
This change was made in NDMS according to suggested TCs and concerns all countries. The TCs exported from NDMS are attached.
As mentioned above, this area needs additional attention and for that a separate ticket was created.
For the moment, the changes in national versions have been made according to proposal made by Sweden.
This case is closed.
- Description updated (diff)
- Status changed from Active to Accepted