case mix index for L&D

[healtheconomist]

For the record, I'm not a nurse, just a health economist trying to understand what it is you do.

I have the ICD-9 codes for all of the pregnancy and labor and delivery categories, about 1,000 by the time I include all of them at the 5 digit level. One category is Normal Labor and Delivery. The rest are all the complications. Yet even within the Normal L&D there are single births, multiple births with various outcomes including live and still born.

I'm looking for some kind of classification scheme that might be in use that would indicate different levels of complexity, either a scale 1 to 1000 depending on the degree of complexity or a more general categorization, 1-5: 1) these ICD-9 codes are "normal"; 2) these are a little less normal; 3) these are pretty tricky; 4) these are a big problem; 5) these indicate a train wreck.

The DRGs give some indication of the resource intensity but are based on Medicare data and Medicare dose not deliver a lot of babies.

Does anyone use a classification index that identifies deliveries as something more than normal and complicated? Thanks for the help.

[bbnurse]

Well, nurses don't do this type of "coding" or "classification". This is the physician's role to indicate the diagnosis.

Nurse's record in the medical record the observations and measurements on the laboring/delivering pt., but do not make that type of notation.

Good luck. The medical records coders might be able to answer for you. And your comment: "....Medicare does not deliver a lot of babies" fits the issues that all those 1000 codes have created.

Too many rules by folks toooo far away from the bedside. I'm not trying to be rude, it just is part of the reason no nurses have answered your questions.

Hope you find a system.Try a medical records coder for your answer.