Case #159

Case 2011-MDC09-01 Skin procedures on penis and scrotum

Added by Anonymous about 7 years ago.

Status:AcceptedStart date:2014-01-08
Priority:NormalSpent time:-
Assignee:-
Category:-
Target version:Expert Group 2011
Initiator:Sweden Target year:2012
MDC:MDC09 Owner / responsible:
Target Grouper:COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE Old forum status:CLOSITEM - Closed item

Description

Last updated: 2011-04-20
Status: CLOSITEM - Closed item
Initiated: 2010-01-01
By: Mats Fernström, NPK, Sweden
Expert Network 2011-03-17 - Change recommended
Board 2011-04-04 - Recommendation accepted

BACKGROUND

CPK ID 277

Problem

In NordDRG 2010 some new codes for skin procedures on penis and scrotum were introduced. See table below.

Some of the codes have got somewhat peculiar grouping properties in connection with skin diseases (MDC 09). See table below which includes the Swedish outpatient DRG weights for 2011.

From a clinical perspective we see no reason why “destruction” (KFD73 and KGD20) shall be grouped to a heavier DRG than “excision” (KFD70). We find it even more remarkable that a simple “suture of skin” (KGH05) is grouped to a DRG with much higher weight than “excision” (KFD70) is.

Analysis

These new codes are still not present in the latest Swedish KPP database (it is from 2009) so we have no cost data for them. Therefore we studied if there are any differences in costs between “destruction” and “excision” of skin lesions on other parts of the body. We defined the “destruction” and “excision” cases according to the following table.

All these codes have OR 2 and procedure property 09S08 (among others) and therefore they are grouped to DRG 270 if performed on inpatients and no CC factors are present. In DRG 270 we found the following destruction and excision cases:

There is no demand on OR property to get DRG 270 so the destruction cases can be with or without greater anesthesia but the excision cases are all without anesthesia because the codes for excision also have the procedure property 09S01 and that property together with the OR 1 property from anesthesia results in DRG 266. Despite this discrepancy, the excision cases were more expensive than the destruction cases.

In an outpatient material, the destruction cases are grouped to DRG 270O (via the procedure property 09S08) and the excision cases to DRG 266O (via the procedure property 09S01) if performed with greater anesthesia. In these DRGs we found the following destruction and excision cases:

Thus this part of the study also shows that the excision cases were more expensive than the destruction cases.
Concerning KGH05 (Suture of skin of penis) it is not possible yet to make an economic analysis but from a clinical and logical perspective it is obvious that this procedure should be grouped in the same way as skin sutures on other parts of the body.

Suggestion by NPK

We suggest that:

  • KFD70 (Excision of lesion of skin of scrotum) is handled like excision of skin lesions on other parts of the body when the principal diagnosis is a skin diseases (MDC 09). This means that the procedure property 09S01 has to be added. Excision of skin lesions on the trunk (QBE10) also has the property 09S20 (Pilonidal sinus procedure) but that is not relevant for KFD70.
  • KFD73 (Destruction of lesion of skin of scrotum) and KGD20 (Destruction of lesion of skin of penis) are handled like destruction of skin lesions on other parts of the body when the principal diagnosis is a skin diseases (MDC 09). This means that the OR property has to be changed from 1 to 2, that the procedure property 09S02 has to be deleted and that the properties 09S08 and 09V05 has to be added. (The property 09S20, if present, can remain.)
  • KGH05 (Suture of skin of penis) is handled like skin sutures on other parts of the body. This means that the OR property has to be changed from 2 to 0, that the procedure properties 09S01 and 22S01 has to be deleted and that the properties 09S07 and 09V05 has to be added.

COMMENTS

Expert Network 2011-03-17

The meeting recommended acceptance of the proposal that:

  • KFD70 (Excision of lesion of skin of scrotum) the procedure property 09S01 has to be added
  • KFD73 (Destruction of lesion of skin of scrotum) and KGD20 (Destruction of lesion of skin of penis) that the OR property has to be changed from 1 to 2, that the procedure property 09S02 has to be deleted and that the properties 09S08 and 09V05 has to be added. (The property 09S20, if present, can remain.)
  • KGH05 (Suture of skin of penis) that the OR property has to be changed from 2 to 0, that the procedure properties 09S01 and 22S01 has to be deleted and that the properties 09S07 and 09V05 has to be added.

The case will be closed.

Martti Virtanen 2011-03-31

The assignment to DRG 266/266O demands OR=1 (which the assignment to DRG 270/270O does not demand). Therefore KFSD70 needs to be changed from OR=2 to OR=1 for this change to happen.

Mats Fernström, NPK 2011-04-07

Marttis comment dated 2011-03-31 is probably based on a misunderstanding. It was not proposed that KFD70 (Excision of lesion of skin of scrotum) always must be grouped to DRG 266/266O. The accepted proposal was that KFD70 is handled like excision of skin lesions on other parts of the body when the principal diagnosis is a skin disease (MDC 09).

All Q*E codes have OR = 2 and the procedure properties 09S01, 09S08 and 09V04. KFD70 already has OR = 2 and the procedure properties 09S08 and 09V04 so the only change needed, is to add 09S01 (09S20 and 09V09 must not be added for obvious reasons).

KFSD70 will then, like excision of skin lesions on other parts of the body, be grouped to DRG 266/266O in the presence of greater anaesthesia but otherwise to conservative inpatient DRGs or national outpatient DRGs.

The changes for KFSD73 and KGSD20 must be complemented with the addition of the procedure property 09V05 in the Swedish version.

CHANGES

Technical change 2011-03-31

  • KFSD70 ‘Excision of lesion of skin of scrotum’ shall have procedure property 09S01 ‘Skin graft or debridement procedure’ and the property 09S08 ‘Other skin, subcutaneous tissue or breast procedure.
  • KFSD73 ‘Destruction of lesion of skin of scrotum’ and KGSD20 ‘Destruction of lesion of skin of penis’ shall have procedure property 09S08 and property 09S02 shall be removed. OR=1 shall be changed to OR=2.
  • KGSH05 ‘Suture of skin of penis’ shall be changed from OR=2 to OR=0. Procedure properties 09S01 and 22S01 will be removed and 09S07 and 09V05 added.

DRG change 2011-03-28

  • Cases with KFSD70 will be assigned to DRG 266/266O.
  • Cases with KFSD73 or KGSD20 will be assigned to DRG 270/270O instead of DRG 268/268O.
  • Cases with KGSH05 will be assigned to conservative DRG’s if no other OR=1 procedures are performed.

Introduction

NordDRG 2012

2011_MDC09-01_1.jpg (19.1 KB) Anonymous, 2014-01-08 13:01

2011_MDC09-01_2.jpg (32.5 KB) Anonymous, 2014-01-08 13:01

2011_MDC09-01_3.jpg (48 KB) Anonymous, 2014-01-08 13:02

2011_MDC09-01_4.jpg (40.4 KB) Anonymous, 2014-01-08 13:02

2011_MDC09-01_5.jpg (61.8 KB) Anonymous, 2014-01-08 13:02

Also available in: Atom PDF