Case 2010-MDC06-02 Collapse DRG 705O and 710O
|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: CPK, Sweden
Expert Network 2010-03-12 - Change recommended
Board 2010-04-09 - Recommendation accepted
CPK ID 302
A DRG user found it wrong that JFA15 (Endoskopisk polypektomi i kolon) is paid less than UJF35 (Koloskopi med biopsy). JFA15 is grouped to DRG 705O (Terapeutisk koloskopi, öppenvård) with the weight 0,0861 and UJF35 is grouped to DRG 710O (Koloskopi, öppenvård) with the weight 0,1063 (Swedish weights 2010). If both JFA15 and UJF35 are registered the case will be grouped to the cheaper DRG 705O.
The following table is from the Swedish cost database for outpatients 2008.
Cost data clearly shows that polypectomy (JFA15) is less expensive than colonoscopy with biopsy (UJF35) and also that therapeutic colonoscopy on the whole (DRG 705O) is less expensive than diagnostic colonoscopy (DRG 710O). One reason for this is probably high PAD costs for diagnostic colonoscopy.
One way to solve the problem is to change the hierarchy in drglogic and move the rules for DRG 710O to places before the rules for DRG 705O according to the principle “most expensive comes first” but people will probably still think that “therapeutic” must be more expensive than “diagnostic”.
CPK suggest another solution, namely to collapse therapeutic and diagnostic colonoscopies into one group. The mean cost for DRG 705O and 710O differs only with 10 % and, as a matter of fact, none of the procedures in DRG 705O fulfil the criteria for a split, if all the procedures had been in the same DRG from the beginning.
Expert Network 2010-03-12
The meeting recommended accepting the proposal to put DRG 705O and 710O together to one DRG Coloskopi. It was also proposed that the other endoscopies even should be investigated.
Procedure properties ending E05 are changed to corresponding E10 ending properties (06E05, 17E05 or 21E05). However, 07E05 is changed to 07E14, see table .
Cases of DRG 705O are combined to DRG 710O with the exception of hepatobiliary problems that are assigned to DRG 714O.