Case 2009-MDC01-01 Surgery with decompression of ulnar nerve and Carpal tunnel syndrome
|Target version:||Expert Group 2009|
|MDC:||MDC01||Owner / responsible:|
|Target Grouper:||COMMON||Old forum status:||CLOSITEM - Closed item|
Last updated: 2009-03-20
Status: CLOSITEM - Closed item
By: Mikael Antonsson/CPK, Sweden
Expert Network 2009-02-26 - Change recommended
Board 2009-03-20 - Recommendation accepted
CPK ID 278
Operation with decompression of the ulnar nerve gives DRG 008/008O. If a Carpal tunnel syndrome is operated at the same time one will get DRG 006/006O with a lesser weight. It is the same problem with In-patients and Out-patients.
Comments and suggestion by CPK
As a principle, addition of a secondary procedure should almost never result in a DRG with lesser weight. This is important because otherwise we have a risk for underreporting of procedures, which will lead to incorrect medical registers.
In this particular case it is obvious that a combined decompression of both the ulnar and median nerves is more expensive than a single decompression of the median nerve and therefore an economic analysis is not necessary.
To solve the problem, it is not possible to move the rules for DRG 006/006O to after the rules for DRG 008/008O because that would lead to no cases at all in DRG 006/006O. A change that could decrease the problem is to introduce a demand that the carpal tunnel syndrome must be the principal diagnosis in the rules for DRG 006/006O. Today it is enough that the carpal tunnel syndrome is a secondary diagnosis. The change can be performed by alteration of the present dgprop 01X05 to a pdgprop (as a suggestion 01P05).
Expert Network 2009-02-26
The meeting recommended that the rules for DRG 006/006O (carpal tunnel syndrome) should have a main diagnosis property demand as proposed.
A new principal diagnosis property 01P04 ‘Carpal tunnel syndrome’ is created.
All diagnosis with the property 01X05 are given the new principal diagnosis property 01P04
In the current rules 101D060 for DRG 006O and 401D061 for DRG 006X the diagnosis property (dgprop1) 01X05 is removed and principal diagnosis property (pdgprop) is given value 01P04.
For assignment to DRG 006O and DRG 006X the diagnosis of Carpal tunnel syndrome has to be principal diagnosis. Other cases currently assigned to these DRG’s are assigned to DRG’s 008O ‘Periph & cranial nerve & other nerv sys proc’ and 007X/008X ‘Periph & cranial nerve & other nerv sys proc.