Case #141

Case 2012-SWE-01 Pain medicine in DRG W99O/884O

Added by Anonymous over 7 years ago.

Status:AcceptedStart date:2014-01-02
Priority:NormalSpent time:-
Assignee:-
Category:-
Target version:Expert Group 2012
Initiator:Sweden Target year:2013
MDC: Owner / responsible:
Target Grouper:SWE Old forum status:CLOSITEM - Closed item

Description

Last updated: 2012-04-13
Status: CLOSITEM - Closed item
Initiated: 2012-01-20
By: Peter Löthman, Svenska Smärtläkareföreningen, Sweden
CPK ID: 412

Problem

Specialists in Pain medicine are treating the pain, not the underlying medical problem. Therefore they usually (> 50 %) also register pain as the principal diagnosis with one of the codes beginning with R52 (Pain, not elsewhere classified). Outpatient visits with these principal diagnoses are grouped to DRG W99O/884O (Övriga läkarbesök vid andra problem) which is a huge rest group (> 290 000 visits/year) with poor medical description ability. For better medical description representatives for “Svenska Smärtläkareföreningen” suggest that the visits instead are grouped to a new DRG called “Övriga läkarbesök vid smärtproblem”.

Analysis

NPK – 2012-04-04

Cost data (KPP 2010) shows that the visits in DRG W99O with a principal diagnosis code beginning with R52 are 5 % of the total number of visits and the mean cost is 40 % higher than the mean cost for other visits in that DRG (see table below). Thus the criteria for a DRG split are fulfilled. The suggestion to create a new DRG was primarily to get a better medical description but the analysis shows that there also will be a better economical description.

A similar split of DRG W99X (Läkarbesök i team vid andra problem) and DRG W99Z (Läkarvård per tel vid andra problem) was not suggested by the specialists in Pain medicine but it should of course also give a better medical description. Cost data is presented in the tables below.

The number of cases with a principal diagnosis code beginning with R52 in DRG W99X and W99Z are enough (12 % and 16 % respectively) for creation of separate DRGs but the difference in mean cost is very small in DRG W99X (only 3 %). However, the initiators wanted a change mainly for better medical description ability and therefore we suggest a split also for DRG W99X and W99Z.

Thus NPK suggest three new DRGs for the cases with a principal diagnosis code beginning with R52. The code R529 (Smärta eller värk, ospecificerad) is excluded however. The reason to exclude the unspecified R529 is the same as in other pain management groups (A76O, A77O, X21O and X23O) – the use of unspecified codes must not be encouraged. The new DRGs should be numbered W98O, W98X and W98Z and the texts should be “Övriga läkarbesök vid smärtproblem”, Läkarbesök i team vid smärtproblem” and “Läkarvård per tel vid smärtproblem”, respectively.

Changes

DRG change

Suggestion by: NPK – 2012-04-04

Outpatient visits with a principal diagnosis code beginning with R52 (with the exception of R529) that previously was grouped to DRG W99 will instead be grouped to the new DRGs beginning with W98.

Decision: 2012-04-04

The problem concerns only the Swedish outpatient grouping and NPK has decided to introduce the change in the Swedish grouper for 2013.

Technical change

Suggestion by: NPK – 2012-04-04

All diagnosis codes beginning with R52, with the exception of R529, already have the DGPROP value 90X11 (Severe or general pain) but they must also have the new PDGPROP 90P11. The rules for the new DRGs should be copies of the existing rules to DRG W99O, W99X and W99Z, placed immediately before the existing rules but 90P11 is inserted in the field PDGPROP. The use of PDGPROP 90P11 instead of the existing DGPROP 90X11 guarantee that only cases with pain as the principal diagnosis are grouped to the new DRGs.

Decision: 2012-04-04

The problem concerns only the Swedish outpatient grouping and NPK has decided to introduce the change in the Swedish grouper for 2013.

Introduction

NordDRG 2013 Sweden

SWE-01_1.jpg (7.7 KB) Anonymous, 2014-01-02 11:27

SWE-01_2.jpg (13.9 KB) Anonymous, 2014-01-02 11:27

Appendix_CPK_ID_412.xls (446 KB) Anonymous, 2014-01-02 11:29

Also available in: Atom PDF