Case #372

Care events without patient contact

Added by Anonymous almost 5 years ago. Updated over 3 years ago.

Status:AcceptedStart date:2015-02-05
Priority:MajorSpent time:-
Assignee:Mats Fernström
Category:-
Target version:Expert Group 2015
Initiator:Sweden Target year:2016
Case type:Major Owner / responsible:National organisations
MDC: Old forum status:
Target Grouper:SWE

Description

National ID: C515
Initiated: 2015-01-16
Initiator: Mats Fernström The Swedish National Board of Health and Welfare
Responsible at National organization: Mats Fernström The Swedish National Board of Health and Welfare
Sent to NordDRG Forum: 2015-01-27
Status: ACTITEM - Active item
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Problem
It is quite common in healthcare that patients problems are managed without a direct contact of the persions. This may be for consideration of medical problems, to issue a certificate based on the medical records etc. In Sweden they are called “VUP” for “vårdhändelse utan patientkontakt” i.e. “care events without patient contact”. Such events should not be reported to the national patient register but it happens. Probably data is needed for local statistics and it then gets submitted to the national patient register. The situation is registgered with following procedure codes:
WNFX00/AV097 Infection source and contact determination
R1R400/DV093 Generation of plan for rehabilitation
WRZA00/GD003 Long statement of health and health related matters
WRZA00/GD001 Long statement of .../Anmälan enligt lag
WRZA00/GD004 Long statement of .../Övriga anmälningar
WRZA00/GD005 Long statement of .../Vårdintyg
WRZA00/GD007 Long statement of .../Anmälan för utredning enligt LVM
WRZA00/GD008 Long statement of .../Anmälan enligt SoL angående barn med möjligt skyddsbehov
ZZZA40/XS004 Extensive specialist consultion with written report/Distanskonsultation
WSZA99/XS013 Other administration/Avstämningsmöte med försäkringskassan

and then these events are grouped to DRG X63O Vårdadministrativa åtgärder, öppenvård (Healthcare administrative procedures, outpatient).

Sweden needs to separate the adimistrative cases with patient visit from those without a visit at the healthcare unit.

A real contact or visit at the healthcare provider is indicated either with LOS of at least 1 (day), with a significant intervention or with presence of a code indicating patient contact from the following list:

ZYZA40/XS003 Letter or telephone contact with patient
ZYZA40/XS011 Letter .../Information och rådgivning per telefon med företrädare för patienten
ZYZA40/XS012 Letter .../Information och rådgivning med patient per telefon
xxxxxx/ZV044 Letter .../Behandling administrerad via internet

ZZZA00/XS902 Team of care providers/Teambesök
ZZZA00/XS007 Team of .../Konferens med patient
xxxxxx/AV071 Team of .../Cancergenetisk utredning II
xxxxxx/DV076 Team of .../Teamrehabilitering
xxxxxx/XS008 Team of .../Konferens om patient

ZZZA10/XS903 Group of patients/Gruppbesök (i)
ZZZA10/XS901 Group of .../Deleted 2014/12/31-Gruppbesök eller gruppteambesök (i)
ZZZA10/XS904 Group of .../Gruppteambesök (i)
xxxxxx/QV012 Group of .../Gruppträning
xxxxxx/QX001 Group of .../Prevention av smittsamma sjukdomar
xxxxxx/ZX903 Group of .../Kohortvård

ZZZA90/XS900 Outpatient visit/Enskilt besök

The xxxxxxx/ marked codes were not listed by Sweden but are linked to the same NCSP+ codes and will therefore inherit same properties as other linked codes, if the NCSP+ mapping is not changed.
Out of these the Swedish codes XS008 and QX001 are problematic, because they clearly may happen without patient contact.

Analysis
The Swedish National Board of Health and Welfare – 2015-01-16
See above. This is a matter of principles and there is no need for cost analysis

Suggestion
The Swedish National Board of Health and Welfare – 2015-01-16
The new DRG, Z63O is added to Swedish version of NordDRG.
To be introduced in NordDRG 2016 Swe.

DRG change
The patient cases that now are grouped to DRG X63O Vårdadministrativa åtgärder, öppenvård but where in reality there has been no patient contact will be grouped to DRG Z63O.

Technical change
These codes would be given a new property 00X63 ‘Contact with patient or representative’

A new DRG is created 'Z630 - Administrative intervention without patient contact'

A new rule is created for this DRG in the NordDRG SWE logic before current rule 200D137 for DRG 926V/X630. The new rule will be a copy of 200D137 but it will have the value '-X0063' for Dgprop1 and 'Z' for OR. Duration will still be '<1'.
See also Excel-file “Decision C515 to Forum ”.

Introduction: NordDRG [SWE] [2016]

C515 to Forum.docx (18.2 KB) Anonymous, 2015-02-05 14:05

Decision C515 to Forum.xlsx (23.3 KB) Anonymous, 2015-03-10 14:59

Contact with patient or representative.xlsx (13.7 KB) Martti Virtanen, 2015-03-25 01:19

Case #372 Technical changes.xlsx (22.2 KB) Martti Virtanen, 2015-03-25 01:20

372.jpg (31.8 KB) Anonymous, 2016-02-24 13:11

Decision #372.xlsx (19 KB) Anonymous, 2016-02-24 13:12

History

#1 Updated by Anonymous almost 5 years ago

#2 Updated by Martti Virtanen almost 5 years ago

  • Subject changed from A new Z-DRG for care events without patient contact to Care events without patient contact
  • Description updated (diff)

#3 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

#4 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

#5 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

2015-02-11 Martti Virtanen
Because of technical problems, I have edited the basic proposal.

The basic idea of the new DRG seem to be to exclude from the existing DRG the cases that are not expected to belong to DRG based reimbursement. Therefore no statistical analysis is needed.

The proposal affects only Swedish version of NordDRG although other countries may adopt the same model if needed.

The question about the additional codes needs to be solved. It probably needs modification of NCSP+ mapping for some codes. NPK has to decide which of the codes will have the new property.

#6 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

#7 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

#8 Updated by Anonymous over 4 years ago

  • File deleted (C515 Decision C515 to Forum.xlsx)

#9 Updated by Anonymous over 4 years ago

Mats Fernström, NPK, Sweden 2015-03-10
We have looked at the codes added to the case by Martti. The following codes should also have the new property 00X63 since they clearly indicate that there has been a contact:
xxxxxx/DV076 Team of .../Teamrehabilitering
xxxxxx/QV012 Group of .../Gruppträning
xxxxxx/ZX903 Group of .../Kohortvård
Our file Decision C515 to Forum.xlsx has been updated with these three codes.

#10 Updated by Martti Virtanen over 4 years ago

  • Description updated (diff)

#11 Updated by Martti Virtanen over 4 years ago

2015-03-13 Expert group/MV
The proposal was accepted for NordDRG SWE. Other countries had no interest for the new group.

#12 Updated by Martti Virtanen over 4 years ago

2015-03-24 Martti Virtanen
The technical solutions for the new DRG demands a few changes to the NCSP+ mappings.
They are repsented in the attached file Contact with patient or representative.xlsx.
The technical description based on NCSP+ codes is now also included.

#13 Updated by Anonymous almost 4 years ago

  • Target version changed from Major-Proposals-for-2016 to Expert Group 2015

#14 Updated by Anonymous over 3 years ago

Veronika Stemme, NPK, Sweden 2016-02-24
We have looked at Marttis suggestion of other codes that should also have the new DGPROP 00X63 (Contact with patient or representative). We agree that the following codes should have 00X63 since they indicate a contact with patient or representative:

We do not agree on the procedure code XS008 Konferens om patient since the patient is not present in a conference about patient. We do not think that XS008 should have DGPROP 00X63.

#15 Updated by Martti Virtanen over 3 years ago

  • Status changed from Active to Accepted

2016-03-15 Expert group (MV)
The change from this case was discussed and accepted as case #468.
This case was closed without further discussion.

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