A review of the complexity adjustment in the Korean Diagnosis-Related Group (KDRG)

The Korean Diagnosis-Related Groups (KDRG) was revised in 2003, modifying the complexity adjustment mechanism of the Australian Refined Diagnosis-Related Groups (AR-DRGs). In 2014, the Complication and Comorbidity Level (CCL) of the existing AR-DRG system was found to have very little correlation with cost.

[...]

Conclusion:

The CCL, the first step of complexity adjustment using secondary diagnoses,

exhibited low performance. If highly accurate coding data and cost data become

available, the performance of secondary diagnosis as a variable to reflect the

case complexity should be re-evaluated.


Implications:

Lack of reviewing the complexity adjustment mechanism of the KDRG since 2003

has resulted in outdated CC lists and levels that no longer reflect the current

Korean healthcare system. Reliable cost data (vs. charge) and accurate coding

are essential for accuracy of reimbursement.



A review of the complexity adjustment in the Korean Diagnosis-Related Group (KDRG) (Sage).


DOI: 10.1177/1833358318795804