Case #229

Task #11: Delivery of minor update proposals for NordDRG 2015

AAL10 Intracranial endovascular thrombolysis

Added by Anonymous almost 6 years ago. Updated almost 5 years ago.

Status:AcceptedStart date:2014-01-31
Priority:MinorSpent time:-
Assignee:Ralph Dahlgren
Category:-
Target version:Expert Group 2014
Initiator:Sweden Target year:2015
Case type: Owner / responsible:Nordic Casemix Centre
MDC:MDC01 Old forum status:
Target Grouper:COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE

Description

National ID: 403
Initiated: 2014-01-29
Initiator: Ralph Dahlgren
Responsible at National organization: Ralph Dahlgren
Sent to NordDRG Forum: 2014-01-30
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Problem

A question regarding the cost of endovascular treatment has occurred due to the fact that the county is charged when a patient is treated outside its own county. The isolated action (AAL10 = Intracranial endovascular thrombolysis) had a price of 34 000 SEK. If conducted as part of the inpatient period (I63.9 + AAL10) is classified, however, as DRG A08E Other intracranial vascular Surgery (Former DRG 001BN) , non comkplikated with a estimated cost around~ 270 000 SEK, or A08A Other intracranial vascular Surgery, very complicated (Former DRG 001BM) with estimated cost ~ 527 000.

The Question is if these patients really are so expensive that they should be grouped to the current DRG or to another DRG?

Analysis

Suggestion

The Swedish National Board of Health and Welfare and collaboration partners 2014-01-29

Give AAL10 other grouping properties so that the cases groups to DRG A04N Kirurgi för ej rupturerade intrakraniella aneurysm och kärlmissbildningar (Former DRG 001CN Surgery for non-ruptured intracranial aneurysms and vascular malformations). The name for the DRG must be changed to Åtgärd för ej rupturerat aneurysm, kärlmissbildning och infarkt.(In English something like ”Remedy for non-ruptured aneurysms, vascular malformations, and infarction”).

Decided changes

The Swedish National Board of Health and Welfare and collaboration partners 2014-01-29

DRG change

The cases in DRG A08E and A08A that has the procedure code AAL10 will be moved to DRG A04N.

Technical change

There are several options are available:

One that all diagnosis codes that may be relevant for this procedure code (AAL10) gets a new PDGPROP. Very difficult to include all the possible diagnoses.

Our proposal is therefore to provide a new PROCPRO to AAL10. This PROCPRO for ALL10 will be a new code specific for the procedure code AAL10 and no other code will have the same PROCPRO. According to the Common version we have chosen 01S30 (Available as we could see). The suggested text for PROCPRO is “Intracranial endovascular thrombolysis”. Technical changes also include to make a copy of DRGlogic row A04N, remove PDGPROP 01P01 and PROCPRO 01S27. Add to MDC column 01 and the new 01S30 in PROCPRO column. Changes must be made in the definition tags DRGlogic, PROC, PROC PROP, DRG NAMES.

Introduction

NordDRG [2015] [SWE]

CPK ID 403 Decision.xlsx (23.8 KB) Anonymous, 2014-02-06 14:22

2014-CPK-ID-403.jpg (45.7 KB) Anonymous, 2014-02-06 14:24

History

#1 Updated by Anonymous over 5 years ago

  • Case type deleted (Minor)

#2 Updated by Martti Virtanen over 5 years ago

2014-03-13 Martti Virtanen
It seems obvious that AAXC10 'Intracranial endovascular arterial thrombolysis' cases do not belong to DRG 001B. Both in CC and non-CC cases the cost seems to be round half of the mean cost of the group.
The intervention has been included in the group of craniotomies. This is obviously not true, no hole is made to the cranium while performing this intervention. I have for a long time been thinking that this is not the correct group for this intervention.

NordDRG has (derived from US) a group for extracranial vascular interventions for neurological problems (DRG 5). AAXC10 is actually extracranial intervention although the catheter may go to intracranial space. The interventions resulting in assignment to DRG 5 (those with PROCPRO 01S03)include interventions like thrombectomy or embolectomy of the arteries leading to brain. This may be done by catheter. AAXC10 fits well to this group.
In the Finish data (without CC division) group 1C (corresponding to Swedish A04x) has about 2/3 of the weight of 1B (SWE A08x) and DRG 5 (SWE A28C) almost 1/2 of 1B.
A more simple solution would be to change the procedure property of AAXC10 (and all linked codes) to 01S03.

#3 Updated by Anonymous over 5 years ago

  • Parent task set to #11

#4 Updated by Anonymous over 5 years ago

  • Target Grouper COMMON, DEN, EST, FIN, ICE, LAT, NOR added
  • MDC MDC01 added

Comment Expert Group 2014-03-24

The cost weights and also clinical definition concludes that the options is to move 1B either to 1C or to DRG 5.

Proposal to move to 1C is accepted by all countries.
Take it halfway and then continue the case by re-opening.

#5 Updated by Martti Virtanen over 5 years ago

2014-03-27 Martti Virtanen

Technical change

A new PROCPRO 01S30 ‘Intracranial endovascular trombolysis’ is created

This property is given to AAXC10 'Intracranial endovascular arterial thrombolysis' and all linked codes. Other properties of AAXC10 will not be changed.

In Drglogic a new rule is created immediately after current rule 401D014001. It is a copy of 401D014001 but MDC is given value 01, PDGPROP 01P01 is removed and 01S27 replace by 01S30.

The name of DRG 001C is changed to ‘Intervention of intracranial vascular abnormality or infarction’

DRG change

Cases with AAXC10 with MDC 01 principal dx are assigned to DRG 001C (A04N) instead of 001B (A08A)

#6 Updated by Anonymous almost 5 years ago

  • Status changed from Active to Accepted

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