Abstract

ACEDO GUTIERREZ, M.S. et al. The codification as tool in the clinic management of pain units. Rev. Soc. Esp. Dolor [online]. 2015, vol.22, n.4, pp.145-158. ISSN 1134-8046.  https://dx.doi.org/10.4321/S1134-80462015000400002.

Introduction: The main tools of information for clinical management are based on the systematic collection of clinical data, which is embodied in the MDS (Minimum Basic Data Set), and the use of patient classification systems, being the AP-DRGs those adopted in our country for the health administration. The data needed to perform the grouping DRGs are contained in the MDS and among them are: The main diagnosis, interventions or other procedures performed and secondary diagnoses, which should be coded with ICD-9-CM. The DRG system is a management tool that allows an analytical accounting system, through the relative weights of each DRG. Objectives: To show the codification of diagnoses that are carried out in a Multidisciplinary Unit of Chronic Pain by ICD-9-CM, unique system officially recognized by our health services, and demonstrate the importance that correct coding of diagnoses of pain has to obtain the DRGs that best describe the degree of complexity of the processes that are treated, with the corresponding "cost per case". Material and methods: We reviewed the medical records to obtain the information necessary to perform the encoding. For each diagnoses a master code (main diagnoses) is assigned and if necessary one or more secondary codes are added. It is assigned a code for the procedure performed. Once the codification is obtain, along with the necessary data for each patient, the various DRGs are obtained, with their corresponding weights. Results: Diagnoses were coded with ICD-9-CM from 2002 until 2012, performing a database with encoding of the most common diagnoses in a chronic pain unit. It has been obtained each year information about grouping of pathologies by DRG, and its weights. From 2002 to 2009 the most common DRG was the 243, "Medical pathology of spine", that account for 57% of cases. Beginning in 2010, the new codification was introduced, including the code 338 and as a consequence the DRGs changed. The category 338, "Pain not classified under other concepts", is part of the chapter of Diseases of the Nervous System and Senses Organs. The most frequent DRGs were: 035 "Other disorders of nervous system without CC", 42.28% of cases; 243 "Medical pathology spine" 18% and 019 "Disorders of cranial and peripheral nerves without CC" 15.5%. The characteristics of these DRGs are described together the diagnoses of pain that are included in each of them. Conclusions: The use of coding diagnoses and procedures with ICD-9-CM is an effort to unify the language used in clinical practice. It is necessary that the coding is done correctly and consistently to get results that reflect real activity that takes place in a service and what it costs. In order for the codification to become relevant in the clinical management by processes, it is essential that the unit managers must be familiar with these tools. In the medium term, the used of ICD-10-CM will be established in clinical practice in Spain.

Keywords : ICD-9-CM; DRG; Codification; Pain unit.

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