Task #11: Delivery of minor update proposals for NordDRG 2015
ZZQ20 and 03S01
|Target version:||Expert Group 2014|
|Case type:||Owner / responsible:||Nordic Casemix Centre|
|MDC:||Old forum status:|
|Target Grouper:||COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE|
National ID: CPK ID 547
The Swedish National Board of Health and Welfare (SOS) makes own definition tables parallel to the process at the Nordic Casemix Centre (NCC) and the current problem was discovered during routine comparison between SWE2014CC-SOS-PR02 (SOS version) and SWE2014PR0F (NCC version) in the autumn 2013.
Late in the updating process for NordDRG 2014 we noticed that the procedure property 03S01 (Major head or neck procedure) had been withdrawn from the code ZZQ20 (Fritt mikrovaskulärt transplantat av hud, muskel och ben) in the NCC version. Marttis motivation was: “This material code does not fit in the 03S01 group that has also other questionable codes”. We think that he means ZZQ00 (Fritt mikrovaskulärt hudtransplantat) and ZZQ10 (Fritt mikrovaskulärt transplantat av hud och muskel) which also have 03S01.
The property 03S01 leads to DRG C05N/049A (Andra större operationer på huvud eller hals) and in the Swedish cost database for 2011 there were 20 patients with ZZQ00, ZZQ10 or ZZQ20 among the 295 cases in DRG C05N. See table below.
A withdrawal of 03S01 from the ZZQ codes can cause that the ZZQ cases are grouped to DRGs that are less expensive than DRG C05N/49A but our data shows that the ZZQ cases are more expensive than the other cases in that DRG. Therefore a withdrawal of 03S01 from the ZZQ codes is no good.
Marttis comment “does not fit in the 03S01 group” is correct however, the ZZQ cases are too expensive for DRG C05N/49A. Since they are not many enough to create a separate DRG we have to look for alternative DRGs. The only DRGs with a higher weight in MDC 03 are the tracheostomy and the cochlea implantation groups, see table below.
In a pure cost perspective the ZZQ cases fit very well in DRG C02N/049B but this is a rather special group that was asked for by the profession some years ago and there is a widespread interest to follow the statistics for cochlea implantations so therefore we think that DRG C01/482 is a better alternative for the ZZQ cases. Since the ZZQ codes have CC property they will end up only in the complicated group (DRG C01C/482C) but they fit better there than in the present DRG. The DRG text may be changed to something like “Tracheostomy or microvascular grafts for face, mouth & neck diagnoses”.
The technical changes to achieve that the ZZQ cases are grouped to DRG C01/482 can be done in different ways. It is not good however to give the ZZQ codes the property 00S03 (which now leads to DRG C01/482) because that property is used also in rules for other DRGs. We suggest a new procedure property, 00S30 ‘Free microvascular graft’ (which in the future can be used even in other MDCs) and construction of new rules for DRG C01/482 based on that property. The new rules must be placed before the present rule for DRG C05N/49A.
NPK, Sweden – 2014-02-13
Cases with ZZQ00, ZZQ10 or ZZQ20 that now are grouped to DRG C05N/049A should instead be grouped to DRG C01/482 with a new DRG text.
To achieve that we suggest that ZZQ00, ZZQ10 and ZZQ20 are given a new procedure property (00S30 instead of 03S01) and construction of new rules for DRG C01/482 based on that property. The new rules must be placed before the present rule for DRG C05N/49A.
#1 Updated by Martti Virtanen over 5 years ago
- Description updated (diff)
2014-03-18 Martti Virtanen
This case is one the cases caused by the harmonisation of the properties of procedures in different countries (case #277).
The property 03S01 has been removed in some version from ZTXQ20 (ZZQ20). For harmonization it has either to be restored or removed from all versions. The discussion already shows that this is not straight forward.
This situation deals with additional codes that shall only be used with another intervention code as additional codes. In an optimal situation the main code for the intervention should indicate the procedure group and the additional code would only indicate the method. The necessary method may however, as in this case, indicate a much higher resource need than the patients with standard intervention.
The additional codes seem to complicating factors. May be there could be CC or even MCC groups based on the intervention?
Is there any complication in any country if 03S01 is restored? Does it affect the tooth and mouth procedure grouping from Finland?
#2 Updated by Martti Virtanen about 5 years ago
2014-03-27 Martti Virtanen
A new procedure property 00S30 ‘Free microvascular graft’ is created
The new property is given to
ZTXQ00 'Free microvascular graft of skin'
ZTXQ10 ‘Free microvascular graft of skin and muscle’
ZTXQ20 ‘Free microvascular graft of skin, muscle and bone’
ZTXQ30 ‘Free microvascular graft of muscle’
and all linked codes.
In the Drglogic 2 lines are added immediately before current line 403D002.
They are copies current line 400D30060 (for DRG 482X with PDGPROP 00P11) but PROCPRO1 is replace by 00S30 on both lines.
On second line PDGPROP 00P11 is removed and MDC 03 added.
In the Drgnames the name of DRG 482X is replaced by ‘ENMT problem with tracheostomy or transplantation’
In SWE version 4 rows are added instead of 2. The first 2 lines are as above but DRG is 482C and CC=1. On the last 2 lines DRG is 482N and CC empty.
The Swedish Drgnames need to be checked by NPK.
Inpatients with ZTXQ00, ZTXQ10, ZTXQ20 and ZTXQ30 with MDC 03 or 00P11 principal dx will be assigned to DRG 482 (C01x)
#4 Updated by Mats Fernström about 5 years ago
2014-04-17 Mats Fernström
In the description of technical changes it is forgotten that also the procedure code ZZQ00 (probably ZTXQ00 in NCSP+)was included in our suggestion. Our cost data showed that cases with ZZQ00 also is much more expensive than the rest in DRG C05/482.
#6 Updated by Martti Virtanen about 5 years ago
2014-05-14 Martti Virtanen
Sweden has proposed that 03S01 should be removed from all the codes. This will not affect the DRG assignment of inpatients. The effect on outpatients is theoretical and it is more correct that the codes do not have 03S01.
Thus if 03S01 will be removed from all codes at issue.
#8 Updated by Mats Fernström over 3 years ago
Mats Fernström, NPK, Sweden, 2016-03-15
Checking up this old case before the spring meeting, I noticed that there were no rules for DRG C01E (= without CC) based on the new procedure property 00S30 ‘Free microvascular graft’ in the Drglogic table in NordDRG 2016 SWE. According to the decision there should be two such rules so during the meeting I reported that as an error. Now (after the meeting) I see why the rules are missing. They were “impossible” and deleted during creation of NordDRG 2016 according to the decision in NCC case #421.
Thus this case (#293) can be closed without further activity.