Case #216

Task #10: Delivery of major update proposals for NordDRG 2015

Kidney transplantation with special pre-surgical treatment

Added by Anonymous about 7 years ago. Updated about 6 years ago.

Status:AcceptedStart date:2014-01-27
Priority:MajorSpent time:-
Assignee:Ralph Dahlgren
Category:-
Target version:Expert Group 2014
Initiator:Sweden Target year:2015
MDC:MDC11 Owner / responsible:Nordic Casemix Centre
Target Grouper:SWE Old forum status:

Description

National ID: 235
Initiated: 2014-01-27
Initiator: Ralph Dahlgren
Responsible at National organization: Ralph Dahlgren/Susann Bengtsson-Berggren
Sent to NordDRG Forum: 2014-01-27

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Problem

Today there are two types of kidney transplants. "Old" regular kidney transplantation, and transplantation with pre-surgical treatment. Transplants with special pre-surgical treatment makes it possible to, especially at live-donor donation, to transplant without regard to blood type. In some cases also in patients with other types of antibodies, for example against the prospective donor. This can make it possible through special pre-surgical treatment to receive a kidney from a relative that earlier could not be a donor.

This increases the possibility of transplantation. The results are completely equivalent to those obtained by conventional living-donor transplant. This special pre-treatment costs 200-400000 SEK. This due to factors like: extended care, the specific pillars immune-absorption, the absorption treatment, measurement of antibodies, additional medication, etc.'

Analysis

Current DRG:

M01O Kidney transplantation, outpatient 302O
M01C Kidney transplant, complicated 302C
M01E Kidney Transplant cc 302N

Current surgical procedure codes:

KAS20 'Homologous kidney transplant, living donor'
combined with
DR001 'Apheresis with simultaneous adsorption, eg LDL, granulocytes'

Data from PAR 2011: 13 of a total of 407 means that the number of DR001 + KAS20 is about 3.3%.
Weight List 2013: Per DRG point 41 501 SEK.
M01C Kidney Transplant K Weight (2013), 9.2832 ~ 385 262 SEK
M01E Kidney Transplant U Weight (2013), 7.2344 ~ 300 235 SEK
KPP 2011:
DRG M01C: Looking at the inner case containing KAS20 + DR001, these have an additional cost of approximately 102 500 SEK in DRG M01C. > 25% higher cost compare to ordinary patients in the same DRG.
M01E: When you look at the inner case containing KAS20 + DR001, these have an additional cost of about 181 100 SEK in DRG M01E. ~ 60% higher cost compare to ordinary patients in the same DRG.

Suggestion

The National Board of Health and Welfare – 2014-01-27

DR001 have to get a new DGPROP. We suggest DGPROP 11X03 Pre-surgical Apheresis and adsorption.
DRGlogic has to be changed so that there must be a copy of DRGlogic line for M01C but add it DGPROP 11X03 which DR001 has. This will make these special care episodes to group to M01C.

Decided changes

The National Board of Health and Welfare – 2014-01-27

The changes are to be introduced in SWE NordDRG 2015.

DRG change

The cases with the combination KAS20 'Homologous kidney transplant, living donor' and DR001 'Apheresis with simultaneous adsorption, eg LDL, granulocytes' will all be grouped to M01C Kidney transplant, complicated (Former 302C). This means that some cases from DRG M01E Kidney Transplant cc 302N will move to M01C Kidney transplant, complicated 302C.

Technical change

DR001 have to get a new DGPROP. We suggest DGPROP 11X03 Pre-surgical Apheresis and adsorption.
DRGlogic has to be changed so that there must be a copy of DRGlogic line for M01C but add it DGPROP 11X03 which DR001 has. This will make these special care episodes to group to M01C.

Introduction:

NordDRG [2015] [SWE]

Decision CPK ID case 235.xls (64 KB) Anonymous, 2014-01-29 12:58

History

#1 Updated by Anonymous about 7 years ago

  • Priority changed from Normal to Major
  • Start date changed from 2014-01-29 to 2014-01-27
  • Old forum status deleted (ACTITEM - Active item)
  • Owner / responsible Nordic Casemix Centre added

#2 Updated by Anonymous about 7 years ago

  • Assignee set to Martti Virtanen

#3 Updated by Anonymous almost 7 years ago

  • Case type deleted (Major)

#4 Updated by Anonymous almost 7 years ago

  • Description updated (diff)
  • Assignee changed from Martti Virtanen to Ralph Dahlgren
  • Parent task set to #10

#5 Updated by Martti Virtanen almost 7 years ago

2014-03-18 Martti Virtanen
This can be performed without effect on other than SWE version, since the intervention DR001 is linked to WGX410 'Apheresis with special adsorption' that has no codes in other national versions. However, the Swedish code DR057 'Hemoimmunbehandling inför transplantation på grund av preformerade antikroppar'. Does it belong to the same group or do we need another NCSP+ code to separate these codes.

Another question is that could we simply make WGX410 to a complicating intervention code? Are the codes used in any other situation? Would it be OK that all such situations would be assinged to CC-DRG if possible?

#6 Updated by Anonymous almost 7 years ago

Comment Expert Group 2014-03-24

No data available about how the coding is done in any other countries.
Splitting of DRG has already been done in Sweden. Only the groups will change position.

No split or change done in common version.

#7 Updated by Martti Virtanen almost 7 years ago

2014-03-27 Martti Virtanen

This new therapy is presumably in use even in other countries. It is recommendable that the new CC logic and the necessary intervention codes will be taken in use also in other countries to allow DRG to reflect the resource needs.

Technical change

A new PROCPROP 11X05 ‘Pre-surgical apheresis and adsorption’ is created
This property is given to WGX410 'Apheresis with special adsorption' and all linked codes (only in SWE)
In Drglogic a new rule is added immediately after current rule 400D300505 for DRG 302C (in SWE logic). The new rule is a copy of 400D300505 but Compl is removed and Dgprop1 is given value 11X05.

DRG change

Patient cases with 11S01 ‘Kidney transplant’ and WGX410 are assigned to CC DRG.

#8 Updated by Ralph Dahlgren almost 7 years ago

We do not want this rule to be place inbetween M01C and M01E. So we want the ord number to be 400D300501 so this rule will come before the current rule of M01C.
MVH
Ralph

#9 Updated by Anonymous about 6 years ago

  • Status changed from Active to Accepted

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