Case 2010-MDC06-01 JAP00 Freeing of adhesions in the peritoneal cavity
|Target version:||Expert Group 2010|
|MDC:||MDC06||Owner / responsible:|
|Target Grouper:||COMMON||Old forum status:||CLOSITEM - Closed item|
Last updated: 2010-04-09
Status: CLOSITEM - Closed item
By: UMAS, Skåne/CPK, Sweden
Expert Network 2010-03-12 - Change recommended
Board 2010-04-09 - Recommendation accepted
CPK ID 307
A NordDRG user reported a case operated for ileus caused by adhesions in the peritoneal cavity after a previous operation for colon malignancy. The patient had also a postoperative hernia that was operated in the same session. The registered code for the principal diagnosis was K913 (Postoperative intestinal obstruction) and the secondary diagnoses were N994 (Postprocedural pelvic peritoneal adhesions) and K439 (Ventral hernia without obstruction or gangrene). The registered procedure codes were JAP00 (Freeing of adhesions in the peritoneal cavity) and JAD30 (Repair of incisional hernia using prosthetic material). The grouping result was DRG 160 (Hernia procedures except inguinal & femoral, age > 17 w/o cc) with the weight 0,9523. If JAD30 was not registered the DRG result was DRG 171 (Other digestive system o. r. procedures w/o cc) with the weight 1,1088. The DRG user found it wrong that addition of a procedure (JAD30) caused a DRG with lesser weight.
Actually this is incorrect primary coding. When intestinal obstruction is present the procedure codes under JFK shall be used instead of the JAP codes, in this case preferably JFK10 (Freeing of adhesions in intestinal obstruction). Then this case will be grouped to DRG 151 (Peritoneal adhesiolysis w/o cc) with the weight 1,8406.
When looking at this case, however, we studied the grouping of JAP00 (Freeing of adhesions in the peritoneal cavity) and JAP01 (Laparoscopic freeing of adhesions in the peritoneal cavity) and found that the grouping of JAP00 can be questioned. According to Swedish cost data (2008) the patients with JAP00 are much more expensive (65 935 SEK) than the rest in DRG 171 (40 445 SEK) and they seem to fit better in DRG 151.
See the tables below.
Patients with JAP01 (37 cases) have a mean cost of 38 990 SEK and seem to fit well in DRG 171. The difference between JAP00 and JAP01 is probably due to that the laparoscopic technique is not possible in cases with massive adhesions.
If the patients with JAP00 in DRG 171 are transferred to DRG 151 we will have the following result.
JAP00 should have the procedure property 06S10 instead of the present property 06S10. JAP00 will then be grouped like the JFK codes to DRG 150/151.
Expert Network 2010-03-12
The meeting recommended accepting the proposal to change procprop for JAP00 from 06S10 to 06S04.
JASP00 and corresponding national codes are given property 06S04 instead of 06S10.
Cases with JASP00 are assigned to DRG 150-151 ‘Peritoneal adhesiolysis’ instead of DRG 170.