German Diagnosis Related Groups (G-DRG): Results of Sociomedical Expertises in Acute Cerebrovascular Diseases

Acute cerebrovascular diseases are the most common cause for permanent disability and the most expensive diseases in industrialised countries. Therefore, all sociomedical DRG expertises (n = 7227, 94.15% initial expertises, 5.85% subsequent expertises) of the Medical Services of the German Statutory Sickness Insurance (MDK) Berlin-Brandenburg in the years 2005-2008 concerning correct G-DRG coding in acute cerebrovascular diseases were evaluated using descriptive statistics. Changes of major diagnostic category (MDC) were done in 4.35% of initial and in 2.84% of subsequent expertises, G-DRG changes without MDC change in 10.41% of initial and 14.42% of subsequent expertises, changes of severity code within one G-DRG in 25.81% of initial and 24.82% of subsequent expertises. No change of cost weight was seen in 59.44% of initial and 57.92% of subsequent expertises. In 1.29% of initial and 1.89% of subsequent expertises, the cost weight given by the hospital was lower than the cost weight determined by MDK. In 39.27% of initial and in 40.19% of subsequent expertises the cost weight given by the hospital was higher than the cost weight determined by MDK. Longitudinal comparisons of the years 2005-2008 showed an increase of changes of severity codes and of the cases with cost weight given by the hospital being higher than the cost weight determined by MDK. A decrease was seen in MDC changes, in G-DRG changes without MDC change and of cases with unchanged cost weights. The results point at learning effects considering the right coding as well as at the existence of further room for improvement concerning the quality of coding after hospital treatment of acute cerebrovascular diseases.