Case #348

Percutaneous sclerotherapy of veins

Added by Martti Virtanen about 5 years ago. Updated over 3 years ago.

Status:AcceptedStart date:2014-10-20
Priority:Error correctionSpent time:-
Assignee:-
Category:-
Target version:Expert Group 2015
Initiator:Nordic Casemix Centre Target year:2015
Case type:Minor Owner / responsible:Nordic Casemix Centre
MDC:MDC05 Old forum status:
Target Grouper:SWE

Description

Background
This case is linked to case #64

NCSP+ has group of codes for ‘Injection of therapeutic agent into or percutaneous occlusion of veins’. All national versions except the Finnish have corresponding codes as the group PHT. In the Finnish version differentiates between ‘intravenous therapy’ (PHM), ‘injection of chemical or occlusive substance’ (PHT) and ‘ultrasound quided foam sclerotherapy’ (PHL). None of the groups has all PHST codes, but most are covered quite often with duple codes in the different groups. Sweden and Norway have group PHV for ‘endovenous obliteration’. Iceland has all NCSP+ codes including the ultrasound guided –codes. Estonia and Latvia have the PHT codes. Denmark has the lowest number codes, covering the group mostly with unspecific codes.

Original NCSP had only PHT-codes.

All versions have additionally the code TPH10 ‘Sclerotherapy of varicose veins’.

Problem:
Is the content of TPH10 ‘Sclerotherapy of varicose veins’ different from other group PHST codes? Most probably TPH10 refers to interventions on vena saphena magna (PHST10) , parva (PHST12) or perforans (PHST15) but because of the unspecified nature it can be presented by PHST99.

If TPH10 has a totally different content from PHST-group the definitions of PHT-group codes should be corrected. Currently, I expect that the codes can be used interchangeably.

Sweden wants that TPH10 should not have the Swedish property 05V03 ‘Closure of other minor blood vessels’ resulting in DRG E77O ‘Sclerosing or embolization of other minor vessels, outpatient’. Without this property typical cases [I83.9 ‘Varicose veins’ with TPH10 + XS915 (MD)+XS900 (Visit), outpatient] would be assigned to E51O ‘Medical doctor visit for cardiovascular problem’.
In other countries the 05V03 has no effect since it is used only by Swedish version. In Norwegian version the same case would be assigned to DRG 823P ‘Other outpatient visit for intermediate level interventions’, in Finish version as well as versions using NordDRG COM logic to DRG 805O ‘Minor intervention for cardiovascular diseases’.

Solutions?
I would propose that linkage of TPH10 to PHST99 would be retained. The grouping in Sweden without the linkage would be to conservative group with lower weight (?) than with the property 05V03. This is closer to the grouping of similar case in other versions of NordDRG

Case #348 Technical changes.xlsx (18.1 KB) Martti Virtanen, 2015-03-31 14:11

History

#1 Updated by Martti Virtanen about 5 years ago

2014-10-22 NPK, Sweden
In Sweden, cases with TPH10 (Sklerosering av benvaricer) previously, before version 2014, were grouped to a separate DRG (E81O Sklerosering av ytliga varicer, besök) via the procedure property 05V07. There were very few cases, however (only 6 in the KPP database 2011 and only 74 in the national patient register 2011) so in NordDRG version 2014 we decided to delete DRG E81O (together with another 13 low frequent Swedish outpatient DRGs as described in case CPK ID 497). The 6 patients in DRG E81O had a mean cost close to the average cost for DRG E99O (Övriga läkarbesök vid sjukdomar i cirkulationsorganen) and much lower than the cost for DRG E77O (Sklerosering/embolisering av andra mindre kärl, öppenvård) and therefore we decided that DRG E99O was OK. If TPH10 is linked to PHT99 (Injektion av läkemedel i eller perkutan ocklusion av annan ven) the cases will have procedure property 05V03 and then they will be grouped to DRG E77O. We can accept that since there still are very few cases with TPH10 (only 8 in the KPP database 2012).
A side effect of this discussion is that the NCSP codes PHT are no good since they can stand for both ordinary drug injections and for sclerotherapy.

#2 Updated by Martti Virtanen about 5 years ago

2014-10-22 Martti Virtanen
I agree with Swedish comment that it is not quite clear what all is covered by group PHST codes. However it is obvious that Sclerotherapy is one of the therapyforms that can be included here.
If it is necessary to differentiate sclerotherapy and other therapy of veins separate codes are needed.

#3 Updated by Anonymous almost 5 years ago

  • Priority changed from Normal to Error correction

#4 Updated by Martti Virtanen almost 5 years ago

2015-03-02 NPK (modified by Martti Virtanen)
During this analysis of case #390 we found that the procedure code TPH10 ’Sklerosering av benvaricer’ has the property 05S15 (Other vascular procedures) but in a medical sense it fits much better together with the codes with 05S18 (Vein ligation or stripping) which leads towards DRG E30 if OR=1 is present. TPH10 has OR=2 so as a principle we then need a rule for 05S18 combined with greater anesthesia (00X10). For Sweden this is not necessary, however, because TPH10 also have a Swedish procedure property (05V03) which leads to the Swedish DRG E77O ‘Sklerosering/embolisering av andra mindre kärl, öppenvård’. Furthermore, we don’t think that greater anesthesia is needed in any case with only TPH10.

Suggestion for further change:
The procedure property for TPH10 ’Sclerotherapy’ is changed from 05S15 to 05S18.

#5 Updated by Martti Virtanen almost 5 years ago

2015-03-03 Martti Virtanen
The Swedish proposal takes up this discussion that was left open.
Sclerotherapy is an injection of sclerosing (therapeutic) agent into a vein that is then occluded by this percutaneous intervention. It is not defined which vein is occluded, it is only stated that this is about varices. Varices occur in oesophagus and perianally in some special situations and possibly also att some odd locations but the main location is lower extemities.
Being very an 'ortholiniguist' I read this as saing 'unspecified vein' which has resulted in mapping to PHST99 'Injection of therapeutic agent into or percutaneous occlusion of other vein'. This results in property 05S15. Mapping in any of the PHST-group codes for lower legg would result in property 05S18 as proposed by Sweden.
My first option would be to delete TPH10, since it is double code and thus an error of the coding system. For the time beeing we should accept that it indicates therapy of lower leggs and link it to PHST15 'Injection of therapeutic agent into or percutaneous occlusion of communicating veins of lower leg or thigh'.

#6 Updated by Ralph Dahlgren over 4 years ago

Technical changes should be that procpro for TPH10 is changed from 05S15 to 05S18. These Changes was included in Swedish case C457 (NCC #348 = this case).

#7 Updated by Martti Virtanen over 4 years ago

2015-03-31 Martti Virtanen
The technical changes was missing.
The change is somewhat more complicated, alhough in principle as Ralph stated.

#8 Updated by Mats Fernström over 4 years ago

2015-04-07, NPK, Sweden
We do not accept the part of Marttis suggestion that 05V03 is removed from TPH10. We suggest that 05V03 is added to PHST15.

#9 Updated by Mats Fernström over 4 years ago

2015-04-09 NPK Sweden
We have misunderstood and 05V03 must not be added to PHST15.

#10 Updated by Anonymous almost 4 years ago

  • Target version set to Expert Group 2015

#11 Updated by Martti Virtanen over 3 years ago

  • Status changed from Active to Accepted

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