Case #387

Measurement of bone density, respirtatory interventions, longterm monitoring, soft tissue incision and orthopaedic bandage.

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

Status:AcceptedStart date:2015-02-11
Priority:MinorSpent time:-
Assignee:Ralph Dahlgren
Category:-
Target version:Expert Group 2015
Initiator:Sweden Target year:2016
Case type:Minor Owner / responsible:National organisations
MDC: Old forum status:
Target Grouper:SWE

Description

National ID: NPK C469
Initiated: 2015-01-02
Initiator: Ralph Dahlgren The Swedish National Board of Health and Welfare Responsible at National organization: The Swedish National Board of Health and Welfare
Sent to NordDRG Forum: 2015-02-05
Status: ACTITEM - Active item
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Problem
This is a problem that the clinicians points out concerning the procedure code XXDX00 'Determination of body composition with DEXA method' (AV068 'Bestämning av kroppssammansättning med DEXA').

For example:

M8000'Postmenopausal osteoporosis with pathological fracture' (Osteoporos efter menopausen med patologisk fraktur) + XXDX00 is assigned in NordDRG SWE to DRG X42O/900V 'Major examination of body composition, short therapy' (Bestämning av kroppssammansättning, besök).

M8000 alone is assigned to DRG H54O/239O 'Doctor visits in malignant tumors of muscle, connective tissue, bone and pathological fractures' (Läkarbesök vid maligna tumörer i muskel, bindväv och skelett samt patologiska frakturer).

When procedure XXDX00/AV068 is added the case will be assigned to DRG X42O/900V.

M8000 + ZZ2230 'Professional nurse' (XS919 Sjuksköterska besök) is assigned to DRG Y83O/970V 'Other nursing contact, short therapy' (Övriga sjuksköterskebesök).

We are concerned about the way the NordDRG SWE describes these patients.
In our thinking it is more important to describe the medical problem than the procedure in this case.
The fact is that doctors in Sweden never do the actual procedure XXDX00/AV068 even if they might look and also describe the results.

This is a hierarchy problem but also a medical problem description. The rule for DRG X42O/900V is located before all DRG's for medical visits for orthopaedic problems (f. ex. H54O/239O)

Analysis
The Swedish National Board of Health and Welfare – 2015-01-02
A doctor visit is demands more resources than the bone density measurement since the latter is mostly performed by a nurse on a separate visit. (Nurse contact probably does not increase the cost in the same manner as medica doctor contact).

Suggestion
The Swedish National Board of Health and Welfare – 2015-01-02

Sweden wants this change to NordDRG SWE 2016

Technical change

The rule DRG X42O/900V shall be moved below all doctor visits for orthopaedic problems (HxxO group in NordDRG SWE or more exactly below the rule for H99O/821V 'Doctor visits in malignant tumors of muscle, connective tissue, bone and pathological fractures' (Läkarbesök vid maligna tumörer i muskel, bindväv och skelett samt patologiska frakturer).

For technical changes see Excel file Decision C469 Measurement of bone density

DRG change

Patients with bone density measurement will be assigned to Medical contacts DRG's, typically DRG H54O/239O instead of DRG X42O/900V.

C469 Measurement of bone density to Forum.docx (17.4 KB) Anonymous, 2015-02-11 11:07

C469 Measurement of bone density.xlsx (13.4 KB) Anonymous, 2015-02-11 11:07

Case #387 Technical changes.xlsx (13.1 KB) Martti Virtanen, 2015-03-18 17:06

Decision #387.xlsx (14.4 KB) Anonymous, 2016-01-25 11:45

Appendix #387.xlsx (30.2 KB) Anonymous, 2016-01-25 11:45

History

#1 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

2015-03-03 Martti Virtanen

This case is only for NordDRG SWE since the other versions do not use the rules at issue.

The proposal is obvious continuation of case #215 'Splitting of the 900-series DRGs'. The splitting created a number of problem specific outpatient DRG's for medical visits but left a number of situations where a nurse intervention is located before these DRG's. This is one of those cases.
In this specific case 5 other intervention contacts are left before the medical visits. Should one consider them also, as we are now making the correction. X42O/900V has been the first (most resource itensive?) of these DRG's and now it becomes the last (least resource intesive?)
A further analysis should include examination of the weights in all these groups.

#2 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

#3 Updated by Ralph Dahlgren almost 5 years ago

Sweden don´t want to do any further analysis now. We will make a new case about the rest.

#4 Updated by Martti Virtanen almost 5 years ago

2015-03-13 Expert group/MV
The case was accepted without modifications. Sweden will consider the questions raised.
Technical changes and DRG changes as proposed.

#5 Updated by Anonymous about 4 years ago

2016-01-12 Susan Berggren

The analysis is done on the Swedish cost database for 2014 grouped with NordDRG 2015 SWE.
On the expertmeeeting in Oslo mars 2015 Martti Virtanen pointed out that there were an additional 5 DRG which came before the doctor's appointment where the weight was lower. Our case 472 concerning bone densitometry went through, but we decided to take a closer look on the other five DRGs that came before medical consultation.

A new search is in the Excel file in the folder with these 5 DRGs and their procedure codes that are involved:
C80O ÖNH-åtgärder, övriga, DRG should remain (27 153 cases with the mean cost 2 527 skr).
D77O Lungmedicinska åtgärder, should be moved below X42O.
E80O Långtidsmonitorering, should be moved below X42O (8 485 cases with the mean cost 1 387).
H79O Mjukdelsincisioner, DRG should remain (1 005 cases with the mean cost 3 561).
H83O Ortopedisk bandagering med gipsskena, should be moved below X42O (17 704 cases with the mean cost 2 804).
All technical changes are specified in decision #387

See attachments appendix and decision.

#6 Updated by Anonymous almost 4 years ago

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

#7 Updated by Martti Virtanen almost 4 years ago

  • Subject changed from Measurement of bone density to Measurement of bone density, respirtatory interventions, longterm monitoring, soft tissue incision and orthopaedic bandage.

2016-03-15 Expert group (MV)
The SWE proposal for SWE logic was accepted.
The content of the case is now quite diffrent and the title is modified to include the new parts.

#8 Updated by Anonymous over 3 years ago

  • Status changed from Active to Accepted

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