Case 2009-MDC08-01 Operations on connective tissue tumours in thorax are grouped to DRG 468/477
|Target version:||Expert Group 2009|
|MDC:||MDC08||Owner / responsible:|
|Target Grouper:||COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE||Old forum status:||CLOSITEM - Closed item|
Last updated: 2009-09-10
Status: CLOSITEM - Closed item
By: Barbro Odhe, SLL/CPK, Sweden
Expert Network 2009-02-26 - Change recommended
Board 2009-03-20 - Recommendation accepted
CPK ID 272
The diagnosis code C493 (Malignant neoplasm of connective and soft tissue of thorax) together with the procedure code GAE06 (Excision of lesion of chest wall) is grouped to DRG 477 although the primary coding is correct. (The text has been shortened and translated by Mats Fernström at CPK.)
This outcome of the grouping depends on that C493 belongs to MDC 08 but GAE06, like almost all procedure codes beginning with GA, has no procedure property in MDC 08. The same problem occurs also with the diagnosis codes D213 (Benign neoplasm of connective and other soft tissue of thorax) and C413 (Malignant neoplasm of ribs, sternum and clavicle) but D167 (Benign neoplasm of ribs, sternum and clavicle) or C761 (Malignant neoplasm of thorax) together with the procedure code GAE06 is grouped to DRG 076/077 (Other resp system o. r. procedures …).
It is not logical that C413, C493 and D213 are grouped differently than C761 and D167 in combination with a procedure code in chapter GA and DRG 468/477 should be avoided when the primary coding is correct. Thus, the grouping logic should be changed so that C413, C493 and D213 in these cases are grouped like C761 and D167. One way to achieve that is to change the dgcat for C413, C493 and D213 from 08M05 to 04M03 (like the dgcat for C761 and D167) unless this change gives unwanted side effects.
CPK has analysed the economic effect of such a change, see table below based on the Swedish cost database 2007.
As seen in the table, seven cases with the mean cost 139 000 SEK are transferred from DRG 468 to DRG 075 and five cases with the mean cost 42 000 – 76 000 SEK are transferred from DRG 477 to DRG 077. The economic effect by the suggested change is minor, however, since the number of cases affected is very little.
Martti Virtanen 2009-02-19
The proposed change would move all conservative cases from MDC 08 to MDC 04 (DRG 239 ‘Pathological fractures & musculosceletal & conn tiss malign’ to 082 ‘Respiratory neoplasms’) which is in principle wrong. In the case of D16.7 the use of 04M03 is probably also wrong, I would think that it should belong to 08M99 as all other codes in the D16 group.
Principally more correct solution is to allow GAE06 in MDC 08. This is especially logical, because NCSP does not have any group in chapter N (orthopaedics) for chest wall which still is even a bony structure.
This would mean that most of the codes in the GAE group would have properties:
08S04 ‘Musculosceletal system or connective tissue biopsy ‘
DRG 216 ‘Biopsies of musculosceletal system & connective tissue’ or corresponding 216O
GASE00 ‘Incision or biopsy of chest wall’
08S20 ‘Other musculosceletal system or connective tissue OR procedure’
DRG 233-234 ‘Other musculoscelet sys & conn tiss o. r. proc’.
The Finnish costs (untrimmed) for the groups at issue are:
If the cases are comparable in Finland and Sweden the 7 cases with major surgery seem to be more expensive than the cases in orthopaedics whereas the 6 cases with minor surgery are fairly comparable with the cases in DRG 216.
It seems that orthopaedic problems of thorax are much more resource intensive than other orthopaedics. There the unorthodox model proposed by Mats must also be considered. The effect on concervative cases should be assessed.
Expert Network 2009-02-26
The meeting recommended a special rule in MDC08 so that GAES06 and similar procedures are grouped to DRG 075/077.
4 new rules are created in DRGlogic table:
- before current rule 408D03100 the new rule is a copy of current rule 408D03100 but DRG is changed to 075X and procpro1 to 04S01
- before current rule 408D1210 two new rules. The first is a copy of current rule 408D1210 but DRG is changed to 076X, Compl to 1 and procpro1 to 04S02. The second is also a copy of current rule 408D1210 with the same changes but Compl remains empty and DRG is changed to 077X.
- after current rule 108D30000 the new rule is a copy fo current rule 108D30000 but DRG is changed to 077O and procpro1 to 04S02
Respiratory system procedures in MDC 08 are assigned to respiratory DRG’s (075, 076, 077, 077O) despite the main diagnosis. Major respiratory interventions have not occurred in short therapy. Therefore they are neither accepted with MDC 08 principal diagnoses.
Martti Virtanen 2009-09-10
The rules for DRG 076X and 077X have been placed relatively high in the MDC 08 logic.
This is not acceptable because minor and unspecific procedures with property 04S02 will result in DRG 76-77 in clearly orthopedic cases.
The rules have to be placed after the specific MDC 08 surgical rules i.e. after current rule 408D301 (arthroscopy) in all versions of NordDRG.