Mats Fernström, the National Board of Health and Welfare, Sweden 2022-02-23 (SWE ID C927)
This is a reminder that we still want a development in the direction that we outlined in case #545 but we have created this new case since #545 is closed (see Kristiinas comment 10-8-2021). Our wishes are repeated below in short. There might be further wishes from other countries as well. The matter must be discussed by the Expert group (a smaller working group first?) and eventually decided by the Board, since the changes mean changes in the program code for all groupers, which in turn will cause some costs. With this in mind, it may be a good idea to implement the changes at the same time as ICD-11 is implemented, as the program code in the groupers then must be updated anyhow.

In the grouping rules (table drg_logic) there is a terrible mess with type of care (e.g. primary care), type of contact and type of profession in the fields for diagnoses and procedures. In addition, procedures are specified in the fields for diagnoses (via dgprop).
Instead, the rules should have separate fields for administrative parameters like type of care, contact and profession and there should be more fields for procedures so it is possible to construct rules based on more than two procedures without using dgprop. There should also be fields for the patient’s functionality or for severity of illness and other factors that can be of interest to include in the grouping logic in the future.
Furthermore, we should discuss if there should be a marker on certain rules that tells the grouper that the demands in the dgprop fields are of the type “AnyOf” (now it is always “AllOf”). Then, for example, the 32 rules for DRG Q55N ’Nyfödd, födelsevikt 2500 g eller mer, med annat signifikant problem’ (= DRG 390X ‘Neonate, birthweight 2500 g or more, with other significant problem’) could be replaced by only 2 rules. (However, such a change has a rather limited ability to reduce the total number of rules, I think, so it may be not worth the effort.)

A possibility to have multiple coding for procedures (similar to asterisk-dagger for diagnoses) so that general qualifiers (NCSP codes beginning with Z) are hooked to the right intervention code is important, however. With the present logic, an irrelevant bilateral procedure (e.g. peripheral intravenous catheters) can lead to a DRG for major bilateral interventions (e.g. DRG 471N ‘Bilateral or multiple major joint procs of extremities’).

The question about if two or more diagnoses with CC property should generate MCC property in case #818 can be added to these development discussions.

When ICD-11 is implemented in NordDRG, we all have to cope with new codes and then, at the same time, it could be appropriate to introduce systematic DRG codes that are common for all countries. It could be similar to the present Swedish codes but with more characters.