Case #350

Reduction of ankle and foot fractures

Added by Martti Virtanen over 4 years ago. Updated about 3 years ago.

Status:AcceptedStart date:2014-10-20
Priority:Error correctionSpent time:-
Assignee:Martti Virtanen
Category:-
Target version:Expert Group 2015
Initiator:Nordic Casemix Centre Target year:2015
Case type: Owner / responsible:Nordic Casemix Centre
MDC:MDC08 Old forum status:
Target Grouper:COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE

Description

Background
Sweden has will start to use NCSP original structure of codes in groups NHJ0x ‘Closed reduction of fracture of ankle or foot’ and NHJ1x open reduction of ankle or foot’ both with 5th character localizing the intervention as well as in the other NHJ subgroups which has less significance for DRG’s. The old Swedish codes (NHJx9) only included ankle and there was no mention of metatarsal or toe interventions.
The Finnish NCSP version has specific codes for ankle (NHJ08) and metarsal and toe (NHJ40) closed reduction, and a code for open reduction of metatarsal and toe fractures (NHJ50). The Finnish version has no codes for open reduction of ankle without internal fixation (probably realistic)
The Danish, Norwegian and Latvian versions follow the original NSP but have deleted the NHJx9 codes that do not specify the part of the foot/ankle that has been operated on.
The Estonian version has all codes of orginal NCSP (including NHJx9).

Problems:
The Swedish code for closed reduction of metatarsal bones (NHJ08) was linked to code for open reduction (NHJ10) which is an obvious error and resulted in false properties.
For some reason only NHSJ00 ‘Closed reduction of fracture of ankle or foot; lateral malleolus’ has had OR=2 property, other closed reductions have OR=0. The old Swedish code (NHJ09) has been linked to NHSJ00 and thus has had OR=2. The Finnish NHJ08 is linked to NHSJ06 and NHJ40 to NHSJ07 and thus they both have OR=0. The other national versions have been linked to the corresponding codes and thus had varying OR properties. In the other group NHSJ codes the properties do not vary and there is no problem.
There is inconsistency in the grouping of NSJx6 (tarsal bones) with respect to properties 08S76 (ankle or foot) and 08S74 (ankle), and 08X15 (ankle) and 08X12 (foot).
Because of the linkage to NHJSx0 the Swedish deleted NHJx9 codes will retain properties 08S74 and 08X15.
The codes not used by the Finnish version are missing the property 21S10 (only used by the Finish multitrauma model and not visible any way in any other version).

Corrections
These are obvious problems that should be corrected as soon as possible, if possible already in 2015 version. Significance is however low.
The Swedish NHJ08 is now correctly linked to NHSJ08 and shall have corresponding properties.
All NHJ0x codes shall have OR=2.
All NHSJx0..4 codes shall have properties 08X15 'Problem of the ankle' and 08S76 'Procedure on ankle or foot'. All NHSJ5..8 codes shall have properties 08X12 'Problem of the foot' and 08S74 'Procedure of foot except major joint'. All NHSJx9 codes shall have 08S76 property but no 08X15 nor 08X12.
All codes in NHSJ group must also have 21S10 property for the Finnish multiple trauma solution. It is now missing from the codes not used by the Finnish version.
Despite quite complex corrections the effects on DRG’s will remain very few. OR=2 may affect outpatient groupings in some versions (outpatient intervention group instead of conservative groups) but not the SWE version.
The test versions of multitrauma groupings will need a small correction that can be performed later.

History

#1 Updated by Martti Virtanen over 4 years ago

  • Description updated (diff)

2014-10-21 Martti Virtanen
Sweden (Mats Fernström quite rightly noted that calcaneus and tarsal bones usally are regarded as foot and only talus and lower end of tibia and fibula belong to ankle.
I have modified the proposal above accordingly.

However the NHSJx9 codes are defined in the original NCSP as ankle or foot in contrast to the old Swedish NHJx9 codes which only state ankle. Therefore these Swedish codes are linked to NHSJx0 (lateral malleolus) as the NCSP has no code for unspecified ankle. Thus the original NCSP codes NHSJx9 and all linked codes will not have 08X12 nor 08X15 but will have 08S76 (ankle or foot).

This case is valid for NHSK group codes which have to be corrected in the same way.

#2 Updated by Martti Virtanen over 4 years ago

  • Description updated (diff)

#3 Updated by Martti Virtanen over 4 years ago

  • Description updated (diff)

#4 Updated by Anonymous over 4 years ago

  • Priority changed from Normal to Error correction

#5 Updated by Veronika Stemme about 4 years ago

2015-04-16 NPK, Sweden:
We have noticed an error. The code NHSJ49 still has DGPROP 08X15.

#6 Updated by Martti Virtanen about 4 years ago

2015-04-17 Martti Virtanen
Liselotte notified that the Swedish codd NHJ49 still has the property 08X15 'Problem of the ankle'

When checking not just NHJ49 but all other NHJx9 codes I realised thatTh
1) the there is an error in the text above - all thesed codes should have 08X15.
2) there are a number of misstakes in the NHJx9 codes - they do not have the same properties as the linked NCSP+ code (NHSJx0)

This must be corrected, it cannot not be used int the VAGS based NDMS.

The point was that earlier Sweden used only NHJx9 codes but decided to follow the more exact common Nordic coding. The earlier x9 codes were used mostly for ankle interventions and therefore it was decided that they should be linked to an ankle intervention (NHSJx0, lateral malleolus). Therefore they will have 08S76 'Procedure on ankle or foot'. They must not have 08X12 'Problem of the foot' but 08X15 is correct according to this thinking.
If this is not correct, the NHJx9 can be linked to (still existing) NCSP+ code NHSJx9 '...ankle or foot; other or unspecified'. It has neither 08X12 nor 08X15.

#7 Updated by Mats Fernström about 4 years ago

2015-04-22 NPK, Sweden
The Swedish code NHJ99 (Annan operation vid fraktur på fotled eller fot) is a special problem that I will comment on further down in the text.
The other nine Swedish codes of the type NHJx9 was inactivated 2014/12/31 but they must remain in the system for five years and then they must be handled properly in the grouper. We accepted Marttis statement from 2014-10-20 when he wrote: "All NHSJx9 codes shall have 08S76 property but no 08X15 nor 08X12” because we thought that the property 08X15 was not needed. Now, when Martti says that all these codes should have 08X15, we also realize that the property really is needed so we accept that they are linked to NHSJx0 so that they will have 08X15 (in addition to the present properties).
Concerning NHJ99 (Annan operation vid fraktur på fotled eller fot) we think that the code is unnecessary. We have 91 procedure codes for different specified operations on the ankle or foot and that should be enough. We have asked the classification unit at “Socialstyrelsen” to delete NHJ99 from the Swedish primary classification of procedures but for some reason they refused. We still think that NHJ99 is bad coding so we want that code to be linked to the NCSP+ code WZZ998 (Other impossible or unspecified procedure) with the property 00S99 (Unspecified or impossible procedure).
The linkages should be done already in the planning version for 2016.

#8 Updated by Anonymous over 3 years ago

  • Target version set to Expert Group 2015

#9 Updated by Martti Virtanen about 3 years ago

  • Status changed from Active to Accepted

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