Appendix 4

The 10 pre MDC categories are low volume but usually very resource intensive. Eight DRG’s were wholly allocated to SRG categories. The two remaining relate to tracheostomy patients with a wide range of clinical conditions.

There are 49 DRG’s in this large MDC of which 42 were fully allocated to an SRG, 24 to Neurology, 9 to Neurosurgery and 3 each to Vascular Surgery and Rehabilitation. Carpal tunnel release is almost equally carried out by neurosurgeons and orthopaedic surgeons in the principal referral hospitals. It was allocated to Orthopaedics rather than Neurosurgery as this common procedure is a routine service for Orthopaedic Surgeons in the smaller hospitals. Since Geriatrics is not used in the main list of SRG’s, DRG 56 relating to dementia was allocated to Psychiatry.

Four DRG’s involving cranial and peripheral nerve procedures were split among Neurosurgery, Neurology, Plastic Surgery and Orthopaedics. A further three DRG’s for malignant neoplasms of the nervous system were allocated to medical oncology if no procedure was carried out; otherwise the allocation was to neurosurgery.

There are 19 DRG’s in MDC 2 of which 18 were fully allocated (17 to Ophthalmology and 1 to Neurology). Orbital Procedures were split so that facial fracture reduction was allocated to plastic surgery and the remainder to Ophthalmology.

This is a moderately large MDC containing 31 DRG’s. Twenty nine were fully allocated to an SRG including 15 to ENT, 7 to Plastic Surgery and 5 to Head & Neck Surgery. The other two DRG’s relating to neoplasms of ear, nose and throat were split between ENT and medical oncology. The presence of a procedure determined the allocation in a similar manner to that followed for neurological neoplasms.

There are 42 DRG’s in this section and all but one were directly allocable. The break-up was 33 DRG’s to Respiratory Medicine, 6 to Cardiothoracic Surgery and 2 to Perinatology. The one exception was DRG 165 (Other OR procedures) which is mostly respiratory medicine but also containing a significant amount of tonsil and adenoid removal belonging to ENT.

This is one of the largest of the MDC groups containing 66 DRG’s. Sixty five were allocated as a whole DRG with 31 to Cardiology, 16 to Cardiothoracic Surgery, 12 to Vascular Surgery, 4 to Miscellaneous Medicine and 2 to Renal Medicine.

DRG 240 (Other operating room procedures) comprises many unrelated procedures but it was important to identify the high proportion of arteriovenostomy and allocate this to renal medicine.

The panel decided that treatment of venous thrombosis and of syncope is more appropriately allocated to a miscellaneous category than to vascular surgery or cardiology because of the vague nature of the symptoms and the large proportion of these diagnoses treated in small hospitals.

This MDC contains 53 DRG’s of which 51 have been wholly allocated. The decision to create separate SRG categories for Upper GIT surgery and Colorectal Surgery required some thought to be given for procedures such as Appendicectomy. It was decided to allocate only those digestive tract procedures definitively associated with Upper GIT and Colorectal and place the remainder with Miscellaneous Surgery. Colonoscopy has been placed with gastroenterology rather than colorectal surgery. In smaller hospitals that prefer to use the base list, endoscopy reverts to surgery rather than medicine. The final allocation included 25 DRG’s to Gastroenterology, 11 to Colorectal Surgery, 10 to Miscellaneous Surgery, 4 to Upper GIT Surgery and 1 to Medical Oncology.

Two DRG’s were split being the residual category of ‘Other Surgical Procedures’. It was found that about 50% of these were gynaecological (e.g. Dilatation & Curettage) while the other 50% could be placed with Miscellaneous Surgery.

This is one of the smaller MDC groups in number of cases although 29 DRG’s are included. Hospital returns allowed 26 to be wholly allocated, including 11 to Upper GIT Surgery, 10 to Gastroenterology, 3 to Medical Oncology and 2 to Miscellaneous Surgery. Pancreas transplants are assigned to transplantation.

The DRG’s relating to medical pancreas conditions were split. Those stipulated as chronic were allocated to Gastroenterology and those stated as acute or for cysts were given to Upper GIT Surgery.

Musculoskeletal Disorders is the largest of the MDC groupings comprising 80 DRG’s. Seventy three were wholly allocated to SRG categories: 59 to Orthopaedics, 4 to Neurosurgery, 4 to Rheumatology and 2 each to Vascular Surgery, Plastic Surgery and Medical Oncology.

A major issue concerns the allocation of medical back patients. This very large group of patients are normally admitted under neurosurgeons in the largest hospitals (unless a pain unit exists) while orthopaedic surgeons take on an increasing role as hospitals decrease in size and complexity of specialist staff. It was decided to allocate medical backs to neurosurgery in teaching hospitals and to orthopaedic surgery elsewhere.

Four DRG’s relate to bone diseases and specific arthropathies. These were split among endocrinology, rheumatology and orthopaedics.

The MDC comprises 30 DRG’s of varied specialties. There are 27 DRG’s directly allocated including Plastic Surgery, Colorectal Surgery, Breast Surgery, Vascular Surgery, Miscellaneous Surgery, Medical Oncology and Dermatology.

DRG’s 502 and 504 are split between Vascular Surgery and Miscellaneous Surgery. The very general DRG 515 (Minor Skin Disorders) is also split between Miscellaneous Surgery and Dermatology.

This is a small MDC of 20 DRG’s with 16 directly allocated to SRG categories. While nine are allocated to Endocrinology, the others are scattered among Head & Neck Surgery, Neurosurgery, Vascular Surgery and Gastroenterology.

DRG 524 (Obesity Procedures) is split between Upper GIT Surgery and Plastic Surgery. The two DRG’s related to metabolic disorders are also split with an important component belonging to renal medicine. Finally no allocation was possible for DRG 528 which included a wide variety of operating procedures.

There are 37 DRG’s included in this MDC of which 29 are wholly allocated to an SRG category. Twenty have been placed with Urology, six with Renal Medicine and 2 to Transplantation. The single DRG for renal dialysis is its own SRG.

There are a number of splits between Urology and Renal Medicine involving six DRG’s. The other two splits relating to urinary system neoplasms are divided between Urology and Medical Oncology depending on whether a procedure occurred.

Twenty of the 24 DRG’s in this section were wholly allocated to Urology. It was decided to place circumcision with Miscellaneous Surgery rather than urology or obstetrics, the other two possibilities. It is recognised that routine neonatal circumcision is often performed by general practitioners. Malignant neoplasms were divided between urology and medical oncology in the same manner as for urological neoplasms.

All 19 DRG’s in this small but high volume MDC were wholly allocated to SRG categories. Seventeen were placed with gynaecology and two with medical oncology. This represents an important change from SRG Version 1. However, placement of genital neoplasm with oncology is consistent with the hospital reporting and supported by the empirical information from inpatient statistics which indicate that almost no procedures are undertaken for patients in these DRG’s.

There are 18 DRG’s in this MDC of which fourteen are allocated to Obstetrics and two to Gynaecology. The remaining two DRG’s relate to abortion and are split between spontaneous (allocated to Obstetrics) and legally induced (allocated to Gynaecology) abortions.

There are 26 DRG’s all are wholly allocated to an SRG. The hospital data is very clear and there were no problem areas for the panel to consider. Twenty two DRG’s have been placed with Perinatology, two with obstetrics, one with Cardiothoracic Surgery and one with Miscellaneous Surgery.

A very small MDC with only 10 DRG’s. Five are wholly allocated to Haematology and two to Miscellaneous Surgery. The three remaining DRG’s relate to both immune disorders and reticuloendothelial conditions. These are split between Immunology and Haematology respectively.

A considerable degree of splitting is recommended for this small MDC of 18 DRG’s. Ten are allocated in whole, 5 to Haematology, 3 to Medical Oncology and 2 to Radiotherapy.

Four DRG’s recommended for splitting involve major operating room procedures. Neck dissections are included in the Head & Neck SRG while the other lymph node excisions are placed with Miscellaneous Surgery. A similar approach was taken with the four DRG’s listed as having other operating room procedures. These are split between Miscellaneous Surgery for simple lymph excisions while patients undergoing the remaining minor procedures (typically biopsies) are usually admitted under the care of a haematologist.

The infectious diseases section comprises 19 DRG’s of which 16 are wholly allocated to SRG categories. The break-up is 7 to Immunology, 7 to Miscellaneous Medicine and 2 to Miscellaneous Surgery.

The three DRG’s relating to operating room procedures for infectious diseases cannot be allocated because of the wide range of procedures and specialties involved.

The eight DRG’s are all allocated to Psychiatry.

There are only four DRG’s of which 2 are allocated to Drug & Alcohol and 1 to Psychiatry. DRG 860 is split with alcoholic psychoses belonging to Psychiatry and intoxication to Drug & Alcohol.

There are 26 DRG’s in the injuries MDC with whole allocation to a broad range of specialties. These include 8 to Miscellaneous Surgery, 5 to Miscellaneous Medicine, 4 to Plastic Surgery, 3 each to Orthopaedics and Neurosurgery and one (allergies) to Immunology. Multiple trauma without major procedure is difficult to allocate because two or more diagnoses must be considered but the panel suggested Miscellaneous Surgery as appropriate. The numbers are very small.

DRG’s 901 and 902 (Other procedures for other injuries) could not be allocated.

The decision was taken that severe 3rd degree burns were allocated to a specialised burns unit with all other burns allocated to plastic surgery. The whole of DRG 921 falls under the first heading and DRG’s 922, 923, 924, 927 and 928 under the second heading. DRG 926 (Severe Burns) is difficult to allocate probably because the required dual coding system may not have been followed at all sites. It was decided to split DRG 926 with deaths and 3rd degree burns to multiple sites allocated to Burns units.

DRG 920 (Burns transferred) was allocated to Miscellaneous Surgery to avoid double counting in this smallest SRG.

The final 13 DRG’s are generally unable to be allocated. There are two specific Rehabilitation categories. DRG 936 (Endoscopy with malignant history) was split between urology and gastroenterology. The remainder could not be allocated arising through the non anatomical approach that was used in framing the DRG’s in this MDC. Social admissions are a large component and these were felt to belong with Miscellaneous Medicine. The common diagnoses and procedures are extracted to assist with allocation by the actual code selected.

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