Case 2012-MDC02-01 Bilateral cataract surgery
|Target version:||Expert Group 2012|
|Case type:||Major||Owner / responsible:||National organisations|
|MDC:||MDC02||Old forum status:||CLOSITEM - Closed item|
|Target Grouper:||COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE|
Last updated: 2012-03-19
Status: CLOSITEM - Closed item
By: Mona Heurgren, National Board of Health and Welfare, Sweden
Expert Network 2012-03-08 - Change recommended
Board 2012-03-19 - Recommendation accepted
CPK ID: 402
There is a problem concerning DRG B12O Lens operations except discission of secondary cataract, daycare (Linsoperationer utom discission av sekundär katarakt, öppenvård, earlier DRG 039O). Today cataract surgery is done bilateral at the same time to save time for patients.
The proportion of patients receiving both eyes at the same time in outpatients is increasing from year to year. In the survey year 2010 was about 3.4% of all bilateral operations and is expected to increase sharply in coming years.
Medical it is clear that it’s better to have a split that shows one side or bilateral cataract surgery.
The thought is to see if it’s possible to get a DRG for bilateral cataract surgery.
Analysis by NPK, Sweden:
Split of DRG B12O in two. One DRG B12Q Unilateral lens operations except discission of secondary cataract, daycare (Ensidig linsoperation utom discission av sekundär katarakt, öppenvård), the other B12P Bilateral lens operations except discission of secondary cataract, daycare (Bilaterala linsoperationer utom discission av sekundär katarakt, öppenvård).
B12P will have the same grouping rules as former B12O except that the clinicians also have to use ZXA10 Bilateralt which has PROCPR 99S13. B12P should be placed before B12Q in DRGlogic.
For technical changes see TECHNICAL CHANGES SWE 2012-02-17.xls
Martti Virtanen, NCC 2012-02-29
I support this proposal, that has been included in the Finnish NordDRG version for since 2008 version. As proposed here also in the Finnish model only outpatient cases are split.
However, sometimes the intervention of the right eye is different from the left eye but still both are cataract surgery. In this case the coding should not be bilateral but ‘right’ and ‘left’. The Finnish model accommodates to this by adding an extra row to the definition table.
I propose that the Finnish model that has been used for several years is accepted in all NordDRG versions.
Martti Virtanen, NCC 2012-03-08
As suggested but with additional change of bilaterality described by new diagnosis property 99X04 instead of procedure property 99S13.
Expert Network, 2012-03-08
The meeting recommended the suggestion with the additional change of bilateraly by a new dg.prop 99X04 instead of procprop 99S13 and adds 99X04 to ZXXA10.
The meeting recommended that all bilateral properties are checked.
The case will be closed