Effects of major diagnostic choices on DRG grouping and weight changes
10.3760/cma.j.issn.1000-6672.2020.02.005
- VernacularTitle:主要诊断选择对DRG入组和权重变化的影响
- Author:
Hao HUANG
1
;
Li ZHANG
;
Ying WANG
;
Yingmei DENG
;
Chunling LIU
;
Weiping JIAO
;
Yingfeng WU
;
Chen ZHANG
;
Yelong QIU
;
Youli HAN
Author Information
1. 首都医科大学宣武医院，北京 100053
- From:
Chinese Journal of Hospital Administration
2020;36(2):108-112
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the influence of the choice of main diagnosis on diagnosis-related groups(DRG) grouping and weight change, by taking cerebral infarction as the entry point.Methods:From January 1, 2019 to March 31, 2019, 331 patients in three DRG groups(BR25, BR23, BR21) with cerebral infarction were selected. The original group was used as the control group; the main diagnosis was exchanged with the first other diagnosis, then DRG group was used as the experimental group. The difference of the number of cases and weight between the two groups was analyzed.Results:41.4%(137/331) of the patients in the experimental group were enrolled in BZ11 with other neurological disorders associated with important comorbidities and comorbidities, and 82.5%(273/331) patients′ weight increased after diagnostic conversion.Conclusions:Choosing other diagnosis as the main diagnosis may change the weight of the disease and affect the corresponding disease benefit. In order to prevent downcoding, DRG grouping should be detailed, and DRG payment should consider how to reflect the value of difficult cases; for upcoding behavior, medical insurance center and relevant medical institutions should check the correctness of coding, and monitor in place.
