Clinical Complexity Level
Clinical Complexity Level also Comorbidity and Complication Level (CCL, "clinical degree of complexity", "degree of severity", degree of complications and comorbidities) is a measure in the area of diagnosis- related case groups (G-DRG) whose care by the Institute for the Remuneration System in Hospital ( InEK).
description
The CCL plays a role in the documentation in the healthcare system and hospital financing, and in particular in its billing. The secondary diagnoses (ICD-10 code) in the "are grouping " with the various medical diagnoses grouped (clustered "gegroupt") and determined to the DRG. This DRG significantly controls the remuneration for the hospitals by the health insurance companies or corresponding institutions that cover the costs of medical care. What is decisive is what is declared as the main diagnosis and what is declared as a secondary diagnosis.
The CCL shows the severity of the comorbidities and complications in the secondary diagnoses . The weighting is divided into up to five levels, which are generally assigned to all secondary diagnoses and depending on the medical or operative partition of the DRG:
| CCL (level) | description |
|---|---|
| 0 | no complication or comorbidity (CC) or close connection with the main diagnosis or the code is already included in the data set. |
| 1 | Code for a minor complication or comorbidity |
| 2 | Code of moderately severe complication or comorbidity |
| 3 | Code for a major complication or comorbidity |
| 4th | Code for an extremely serious complication or comorbidity |
| 5 | Code for an extremely serious complication or comorbidity for better illustration, remuneration (since 2014) |
| 6th | Code for an extremely serious complication or comorbidity for better illustration, remuneration (since 2014) |
The same secondary diagnosis can also have different high values depending on the basic DRG. As part of the adjustment of the patient-related overall severity (Patient Clinical Complexity Level; PCCL), levels 5 and 6 were added from 2014.
Overall patient severity (PCCL)
The PCCL value from 0 to 6 is calculated from several of the severity-weighted secondary diagnoses (CCL values) of a patient and results in the overall medical severity of the treatment case for each treatment episode and is given with the PCCL (Patient Clinical Complexity Level), which is the measure for the is the cumulative effect of the CC diagnoses. The calculation is carried out using a smoothing formula and a process that continues to become increasingly complex. This prevents similar constellations of secondary diagnoses from being evaluated multiple times.
The higher the PCCL, the higher the case remuneration and, in its design, functions as a cost separator.
Comparison of documentation with high overall severity of a patient (PCCL 3) and without:
Pneumonia (inflammation of the lungs) with effusion
- Diagnoses:
- Main diagnosis (ICD-10) : J15.0 pneumonia with Klebsiella pneumonia
- Secondary diagnosis (ICD-10): J90 pleural effusion
- Procedure (OPS) : 8-144 Intercostal Drainage with Catheter
G-DRG coding as E62B respiratory tract infection with complications or comorbidities (CC) and an overall severity (PCCL 3) results in 3091.40 euros (as of 2006 in Germany)
Pneumonia (inflammation of the lungs) with effusion
- Diagnoses:
- Procedure (OPS) : 8-144 Intercostal Drainage with Catheter
G-DRG coding as E62B respiratory infection without complications or comorbidities (CC) and (PCCL 0) results in 2409.90 euros (as of 2006 in Germany).
Web links
- Determination of relevant secondary diagnoses
- Hammerschmitt. The pattern of illness - portioning and numbering of the health goods - the DRG accounting system in Telepolis . Heise publishing house. January 21, 2006
- The DRG family (ZIM)
- G-DRG (InEK ( Institute for the Hospital Remuneration System ))
- DRG research group of the University of Münster with web grouper