DRG Complication Analysis

Complications and comorbidities in DRG

This function is used for examining which diagnosis or procedure codes cause the case to be complicated (CC = complications and comodibities) or major complications or comorbidities (MCC). For many DRG groups there is normal group and complicated groups. Complicated groups have higher weights and are then more expensive in DRG revenue calculation and invoicing.

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 and procedures are also marked on the grouping page after the name by CC or MCC boldfaced texts.

How to use complication analysis

In VisualDRG 5 complication analysis is integrated in Find function of diagnosis and procedures. It has not a page of its own. Complication analysis is available for PROfessional edition users of VisualDRG. In diagnosis and procedures Find function you have a filtering option: [X] Filter diagnoses that complicate the main diagnosis (+your current main diagnosis, if selected). If you check this, then only complicated diagnoses are presented in the listing. Also selection of CC (complicating) or MCC (major complicating) is displayed in the table and can be used as filter at the top of the table.

Example:

1. Enter main diagnosis O800 (normal delivery).
2. Go to Find diagnosis
3. Check [x] Filter diagnoses that complicate...
4. Enter diab in Name Find field.
5. Select some of the diabetes diagnosis and click Add.
6. Now that diagnosis is added to delivery as secondary diagnosis, marked with CC and the resulting DRG becomes complicated.

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 can be found by using filter Optionally complicating diagnoses in diagnosis find function. Select the 1st secondary diagnosis from the list and then the other required diagnosis can be selected from the diagnosis results list. Procedures cannot be Optionally complicating.

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

1. Enter main diagnosis O800 (normal delivery), F, 30y, 2d -> DRG = Normal delivery, not complicated.
2. Go to Find diagnosis, then select K291 from the Optionally complicating diagnosis.
3. Select from the diagnosis list E1680, then click Add. (Note that also some codes w/o CC or MCC are now presented in the list)
4. You can select whether to add one or both of these as secondary diagnosis. If you add only one of these, the case doesn't become complicated. If you select both, then the case becomes complicated.