DRG Complication Analysis

This function is used for examining which diagnosis or procedure codes cause the case to be complicated (CC = complications and commodibities) or severe complicated (MCC). For many DRG groups there is normal group and complicated group and this complicated group is then more expensive in DRG revenue calculation.

Complication can be caused by secondary diagnosis or by any procedure. Note that even if the diagnoses or procedures cause complication (CC property) there may not be the corresponding complicated DRG group. This depends on the DRG version in hand.

Secondary diagnosis may cause complication. List of complicating secondary diagnosis depend on the selected principal diagnosis.

Procedures may cause complication. List of complicating procedures is static and doesn’t depend on the selected principal diagnosis.

In addition to these, there are optionally complicating secondary diagnoses and procedures. These are codes that alone do not make the case to be complicated but they require in addition another diagnosis or procedure code to become complicated.

Complicating diagnoses are also marked on the grouping page in the CC status field if you have selected the “View status” operating mode.

Function of DRG Cc analysis is very simple: enter principal diagnosis and VisualDRG displays then codes that make the case complicated. You can enter the dg code manually, select it by using find function equal to find function in DRG Grouping or you may click a button for copying the principal diagnosis from DRG grouping page automatically.

The List diagnosis only from the same MDC as the principal diagnosis option allows you to restrict the diagnoses to be searched so that only diagnoses belonging to the same main diagnosis category (MDC) as the main diagnosis are displayed in the lists. This allows you to limit the perspective to diagnoses similar to the main diagnosis.

You can filter and sort the rows of all lists by code and rubric. In addition, you can filter the list of complicating diagnoses according to the level of complication.

If you want to copy the lists to Excel, for example, select the desired rows and press Control + C. You can use keyboard shortcuts, such as Ctrl + Shift + arrow keys, to help you select rows.

Optionally complicating diagnoses

Some dg codes make case optionally complicated. This means that code alone as a secondary diagnosis doesn’t make case complicated, but only in conjunction with yet another secondary dg code. This is called optionally complication. Such codes are listed on bottom of CC analysis page and the list doesn’t depend on the selected principal diagnosis. In order to see what other codes are required to make case complicated, double click on row and another window listing those codes is open. You can select and add codes directly to DRG groping page by double clicking.

Example (from one version - actual diagnoses vary depending on DRG version in use):

• DG1 = E109 (Diabetes type I), M, 60y, 2d -> DRG = Diabetes, >35yr, not complicated.
• Go to CC analyses page and see optionally complicating list. You see K309 (functional dyspepsia) in the list. Add that as DG2 to the case -> DRG = Diabetes, >35yr, not complicated (no change in DRG, and K309 is not reported as complicating dg in dg status).
• Go to CC analyses and double click K309. A new window will open and select from that window: K221 (Ulcer of esophagus) and add that by double clicking it to the case as 3rd diagnosis. -> DRG = Diabetes, >35yr,complicated. Also you see that both K309 and K221 are marked as CC as diagnosis status.