Case #176

Case 2010-MDC08-01 Suggestion of changes DRG 209

Added by Anonymous about 7 years ago.

Status:AcceptedStart date:2014-01-13
Priority:NormalSpent time:-
Assignee:-
Category:-
Target version:Expert Group 2011
Initiator:Finland, Sweden Target year:2013
MDC:MDC08 Owner / responsible:
Target Grouper:COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE Old forum status:CLOSITEM - Closed item

Description

Last updated: 2012-04-13
Status: CLOSITEM - Closed item
Initiated: 2009-12-02
By: Minna-Liisa Sjöblom/Maisa Lukander, HUS, Finland
Error corrected by NPK Sweden
Initiated: 2012-04-04
By: Mats Fernström, NPK, Sweden
Expert Network 2010-03-12 - Postpone recommended
Board 2010-04-09 - Recommendation accepted
Expert Network 2011-03-17 - Change recommended
Board 2011-04-04 - Recommendation accepted

BACKGROUND

We have been studying group 209A Major joint procedures of lower extremity, not reoperation and 209B Reoperation on prothesis in pelvic, knee or ankle or lower limb reattachement.

In group 209A we have noticed that emergency prothesisoperations make cost structures challenging. If emergency operations and elective operations are shared for own groups, there will be significant difference between costs. Also volumes are sufficient.

Problem

It is important that emergency operations will be separate from elective operationgroups. There are often problems in emergency operations, patient needs more researching and also the staying in hospital is longer.

Comparison of costs and tendering between public and private sectors is difficult if emergency and elective operations are in the same group.

Analysis

In Helsinki university hospital difference in costs between emergency and elective operations were 24 %. If we have a group 209C for emergency operations for pelvic, 27 % of cases in group 209A will be moved to group 209C. These cases includes 36 % of days in hospital.

Suggestion

We suggest, that prothesisoperations for pelvic and knee will be in separated groups, because costs are so different and volumes are quite big. And also emergency operations and elective pelvic operations will be separated.

See table Suggestion_of_changes_DRG_209A_B_and_C_Finland.xls

COMMENTS

Expert Network 2010-03-12

The meeting recommended postpones the case for analysis by Sweden and Norway. Analysis from Finland is available. The countries should also discuss this with their own clinicians.

NPK (former CPK), Sweden 2011-02-18

The concept “Akut operation” is not clearly defined in Sweden and therefore it is not possible to use it as a grouping variable. In Swedish data we can instead split up the primary hip procedures by using the principal diagnosis, either it´s an injury or a chronic disease. In this case we have:

The cost difference in Swedish data is only 15 percent (split criteria = at least 20 %) and the variations for the most cases are slightly improving.

In the new Swedish CC-grouper we have another solution that seems to work better from an economical point of view. A modified version of the CC-grouper logic that suits the common version of NordDRG is shown below (trimmed data).

Suggestion

We support the idea of splitting the DRG´s 209A and 209B into hip (called “pelvic” in the case) procedures and knee procedures. The primary hip procedures should then be divided according to CC-logic instead of emergency/scheduled logic. The Swedish data indicates that all criteria for such a split are fulfilled.

To avoid confusion among the NordDRG users we suggest that the old DRG codes 209A and 209B are not re-used after the split. According to this model DRG 209A and 209B will be replaced by the following groups (arranged in the usual weight order for hip and knee procedures respectively):

COMMENTS

Expert Network 2011-03-17

The meeting recommended acceptance of the proposal that DRG 209A and 209B will be removed and introduce 5 new DRG instead:

  • 209C Major joint secondary procedure on hip
  • 209D Major joint primary procedure on hip w cc
  • 209E Major joint primary procedure on hip w/o cc
  • 209F Major joint secondary procedure on knee/ankle
  • 209G Major joint primary procedure on knee/ankle

The case will be closed.

CHANGES

Technical change 2011-03-31

5 new DRG’s are created:

  • 209C Major joint secondary procedure on hip
  • 209D Major joint primary procedure on hip w cc
  • 209E Major joint primary procedure on hip w/o cc
  • 209F Major joint secondary procedure on knee/ankle
  • 209G Major joint primary procedure on knee/ankle

3 new procedure properties are created with extens 1:

  • 08S93 Secondary hip replacement
  • 08S94 Secondary knee replacement
  • 08S95 Secondary ankle replacement

Procedure property 08S93 is given to all codes in the group NFSCxx (and all linked national codes).

Procedure property 08S94 is given to all codes in the group NGSCxx. (and all linked national codes).

Procedure property 08S95 is given to codes into the group NHSC00-NHSC59 (and all linked national codes).

The rules 5 for DRG 209A and DRG209B are removed.

7 new rules are created instead in the same ord-area as follows:

  • For DRG 209C with properties: ICD=+, MDC 08, OR=S, procpro1=08S93
  • For DRG 209D with properties: ICD=+, MDC 08, OR=S, procpro1=08S81, CC=1
  • For DRG 209E with properties: ICD=+, MDC 08, OR=S, procpro1=08S81, CC=0
  • For DRG 209F with properties: ICD=+, MDC 08, OR=S, procpro1=08S94
  • For DRG 209F with properties: ICD=+, MDC 08, OR=S, procpro1=08S95
  • For DRG 209G with properties: ICD=+, MDC 08, OR=S, procpro1=08S82
  • For DRG 209G with properties: ICD=+, MDC 08, OR=S, procpro1=08S83

The property 08S79 will no more be used and therefore the codes in the group are given following properties:

  • NESP29 Replantation of extremity at level of pelvis =>08S93
  • NFSP29 Replantation of extremity at level of hip or thigh =>08S93
  • NFSR89 Total excision of femur with prosthetic replacement =>08S93
  • NGSP29 Replantation of extremity at level of knee or lower leg =>08S94
  • NHSP09 Replantation of toe =>08S74
  • NHSP29 Replantation of foot =>08S95
  • NHSP99 Other replantation in ankle or foot =>08S95

OBS! The properties 08S82, 08S82 and 08S83 have to be retained on the listed procedures since they are needed in the assignment to DRG 471N ‘Multiple joint replacement’.

DRG change 2011-03-28

Prosthetic replacement of hip (209C, D, E) and knee/ankle (209F, G) will be separated in DRG. Primary (209D, 209E, 209G) and secondary (209C, 209F) interventions will be kept separately. Primary hip is divided to with CC (209D) and without CC (209E) groups.

Replantation of lower extremity at pelvis or hip level is combined with secondary hip replacement (209C). Replantation of knee, lower leg, ankle or foot level is combined with secondary knee/ankle (209G). However replantation of toe is combined to other foot procedures (DRG 225N) where prosthetic operations on this level are.
Multiple joint replacement is still assigned to DRG 471N.

Introduction

NordDRG 2012

Problem

CPK ID 371

The decision was that “the property 08S79 will no more be used”. However, NHP99 ‘Annan replantation i fotled eller fot’ still has the property 08S79, both in the traditional Swedish grouper and in the CC grouper, which erroneously leads to DRG H01N (Sekundära ledproteser samt replantationer i höft) in the CC grouper. NHP99 has also the property 08S95 which is correct and leads to DRG H03N (Sekundära ledproteser samt replantationer i knä/fotled) but that property has no effect on the grouping since the rule with 08S79 is situated before the rule with 08S95.

It is an obvious error that NHP99 (NHSP99 in ICD+) still has the property 08S79 and therefore it must be deleted in all versions. Then all the rules containing 08S79 also could be deleted. For a correct grouping of NHP99 in outpatients the rule with ORD 108D03001 must be replaced by a similar rule but with the value 08S95 instead of 08S79 in the field procpro1.

The technical changes are also precised in Appendix_CPK_ID_371.xls.

Since this is an error correction it can be introduced already in the 2013 planning version without prior discussion in the NordDRG Expert Network.

Introduction

NordDRG 2013

Suggestion_of_changes_DRG_209A_B_and_C_Finland.xls (27.5 KB) Anonymous, 2014-01-13 13:59

2010-MDC08-01_1.jpg (12.4 KB) Anonymous, 2014-01-13 14:11

2010-MDC08-01_2.jpg (14.5 KB) Anonymous, 2014-01-13 14:11

2010-MDC08-01_3.jpg (21.3 KB) Anonymous, 2014-01-13 14:11

2010-MDC08-01_4.jpg (13.2 KB) Anonymous, 2014-01-13 14:12

Appendix_CPK_ID_371.xls (915 KB) Anonymous, 2014-01-13 14:13

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