Injection Treatment of Urinary Incontinence
|Target version:||Expert Group 2015|
|MDC:||Owner / responsible:||National organisations|
|Target Grouper:||SWE||Old forum status:|
National ID: CPK ID C340
Initiator: Mats Fernström
Responsible at National organization: Mats Fernström, Ralph Dahlgren
Sent to NordDRG Forum: 2015-01-27
Status: ACTITEM - Active item
By injecting a gel (polyacrylamide) around the urethra, which is a relatively minor procedure, there is a treatment for women who are not candidates for surgical treatment of urinary incontinence. To ensure that the injection is done in the right place, a cystouretroscope is used. The procedure is usually performed in an outpatient setting under local anesthesia and the patient can go home within a few hours after injection. The total cost (based on KPP) is about 20'000 SEK per patient.
The procedure code used is KDSV22/KDV22 (Transluminal Endoscopic submucosal urethral injection/Transluminal endoskopisk submukös uretral injektion), which groups to DRG 718O/M72O (Endoscopy of the lower urinary tract, outpatient/Endoskopi av nedre urinvägar, öppenvård), with a reimbursement of approximately 2'000 SEK. Despite a great need for treatment of women with urinary incontinence who can´t undergo surgery, the treatment is today reduced to a minimum due to inadequate reimbursement for the procedure.
Also in a descriptive perspective, KDSV22/KDV22 doesn’t fit very well in DRG 718O/M72O. Most of the other procedures that lead to DRG 718O/M72O are purely diagnostic procedures that differ from the above described treatment of incontinence. So both from a medical and a cost perspective, the procedure code KDSV22/KDV22 should be moved from DRG 718O/M72O to DRG 716O/M70O (Therapeutic endoscopy of the urinary tract, outpatient/Terapeutisk endoskopi av urinvägar, öppenvård).
There are some other procedures in DRG 718O/M72O that also could be regarded as therapeutic, like KCSV22/KCV22 'Transluminal endoscopic evacuation of blood clots from bladder'(Transuretral blåsevakuering vid blödning), KCSV31/KCV31 'Electric stimulation of bladder for urinary incontinense'(Elektrisk stimulering av blåsan vid inkontinens) and KDSE22/KDE22 'Urethroscopic removal of foreign body from urethra'(Transuretral extraktion av främmande kropp från uretra) but they are not expensive enough to fit in DRG 716O/M70O.
The Swedish National Board of Health and Welfare and it´s Swedish collaboration partners suggest that KDSV22/KDV22 should be moved from DRG 718O/M72O (Endoscopy of the lower urinary tract, outpatient/Endoskopi av nedre urinvägar, öppenvård), to DRG 716O/M70O (Therapeutic endoscopy of the urinary tract, outpatient/Terapeutisk endoskopi av urinvägar, öppenvård).
The technical changes are in the Excel-file Appendix C340.
The Swedish National Board of Health and Welfare and it´s Swedish collaboration partners want the suggested change to be introduced in NordDRG SWE 2016.
Minor. The few outpatient cases with procedure code KDSV22/KDV22 will be mover from DRG M72O to M70O.
The procedure code KDV22 should have procpro 11E18, 12E18, 17E18 removed and should instead have the procpro 11E16. See the Excel-file Appendix C340.
#5 Updated by Ralph Dahlgren over 6 years ago
- File C340 Appendix updated.xlsx added
At the Expert meeting Martti suggested that the procedure code KDSV22/KDV22 (Transluminal Endoscopic submucosal urethral injection/Transluminal endoskopisk submukös uretral injektion) should also get the procpro 12E16 and 17E16, not only 11E16. This case included these procpro together with the original suggestion and was accepted. This means that the technical changes for this case has to be updated.
Include updated technical Changes from Sweden in the Excelfile "C340 Appendix updated".