Case #375

Injection Treatment of Urinary Incontinence

Added by Anonymous over 6 years ago. Updated over 4 years ago.

Status:AcceptedStart date:2015-02-06
Priority:MinorSpent time:-
Assignee:Mats Fernström
Category:-
Target version:Expert Group 2015
Initiator:Sweden Target year:2016
MDC: Owner / responsible:National organisations
Target Grouper:SWE Old forum status:

Description

National ID: CPK ID C340
Initiated: 2009-12-10
Initiator: Mats Fernström
Responsible at National organization: Mats Fernström, Ralph Dahlgren
Sent to NordDRG Forum: 2015-01-27
Status: ACTITEM - Active item
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Problem
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.

Suggestion
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.
DRG change
Minor. The few outpatient cases with procedure code KDSV22/KDV22 will be mover from DRG M72O to M70O.
Technical change
The procedure code KDV22 should have procpro 11E18, 12E18, 17E18 removed and should instead have the procpro 11E16. See the Excel-file Appendix C340.

C340 Appendix.xlsx (17.5 KB) Anonymous, 2015-02-06 13:04

C340 to Forum.docx (17.6 KB) Anonymous, 2015-02-06 13:04

C340 Appendix updated.xlsx (18.1 KB) Ralph Dahlgren, 2015-03-25 08:40

Case #375 Technical changes.xlsx - U (18 KB) Martti Virtanen, 2015-03-31 13:27

History

#1 Updated by Anonymous over 6 years ago

#2 Updated by Anonymous over 6 years ago

  • Target year 2016 added

#3 Updated by Martti Virtanen over 6 years ago

  • Description updated (diff)

2015-02-10 Martti Virtanen
I support this proposal

#4 Updated by Martti Virtanen over 6 years ago

  • File Case #375 Technical changes.xlsx added

2015-03-13 Expert group/MV
The case was accepted as proposed.

#5 Updated by Ralph Dahlgren over 6 years ago

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".

#6 Updated by Martti Virtanen over 6 years ago

2015-03-31 Martti Virtanen
True, the technical changes has been updated accordingly.

#7 Updated by Martti Virtanen over 6 years ago

  • File deleted (Case #375 Technical changes.xlsx)

#8 Updated by Anonymous over 5 years ago

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

#9 Updated by Martti Virtanen over 5 years ago

  • Status changed from Active to Accepted

#10 Updated by Anonymous about 5 years ago

  • Status changed from Accepted to Active

#11 Updated by Martti Virtanen over 4 years ago

  • Status changed from Active to Accepted

2017-03-13 Expert group
Changes already done

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