Case #388

Colonoscopy with gynecological diagnosis

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 C472
Initiated: 2015-01-02
Initiator: Ralph Dahlgren The Swedish National Board of Health and Welfare
Responsible at National organization: Ralph Dahlgren The Swedish National Board of Health and Welfare
Sent to NordDRG Forum: 2015-02-05
Status: ACTITEM - Active item
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Problem
From the clinicians questions has come about the fact that if you have an outpatient with gynecological diagnosis (from MDC 13 'Diseases of the female genital'/'Sjukdomar i kvinnliga könsorgan) with colonoscopy (JFE032/UJF32 'Koloskopi') the case will be assigned one of outpatient DRG's in MDC 13 (DRG's of type OxxO in Sweden) such as DRG O99O/852V 'Other doctor visit in diseases of the female genitalia' (Övriga läkarbesök vid sjukdomar i kvinnliga könsorgan) instead of DRG F71O/710O 'Colonoscopy' (Koloskopi).
This is not a correct way for describing the care of the patient.

Other involved DRG's in NordDRG SWE are:
DRG O40O/367O 'Malignancy, female reproductive system, short therapy' (Läkarbesök vid maligna tumörer i kvinnliga genitalia)
DRG O45O/368O 'Läkarbesök vid infektioner i kvinnliga genitalia'
DRG O99O/852V 'Other medical contact for gynecological probelm, short therapy' (Övriga läkarbesök vid sjukdomar i kvinnliga könsorgan)

Analysis
The Swedish National Board of Health and Welfare – 2015-01-03
No economic analysis needed. Colonoscopy has higher resorce need thatn gynecological endoscopies that have higher resource need than visits without interventions.

Suggestion
The Swedish National Board of Health and Welfare – 2015-01-03
Cases with MDC 13 principal dx and colonoscopyshould be assigned to DRG F71O/710 'Colonoscopy' (Koloskopi).

Sweden wants these changes for the NordDRG SWE 2016.
Technical change
A new rule for DRG F71O/710O is created before the rules for DRG O70O/719O 'Endoscopy of female genital tract, short therapy' (Endoskopi av kvinnliga genitalia, öppenvård) in MDC 13 (currently ord 113D1310). The position is due to the fact colonoscopy has higher resource need than gynegological endoscopies.
The new rule will have be a copy of current rules for DRG F710/7100 but MDC will be 13 and procrop1 17E10
DRG change
A few cases will be assigned to DRG's for otpatient visits in MDC 13 (O40O/367O, O45O/368O, O99O/852V) to DRG F71O/710O 'Colonoscopy'.

See Excel file “Decision C472 Colonoscopy with gynecological diagnose to Forum

C472 Colonoscopy with gynecological diagnoses to Forum.docx (18.9 KB) Anonymous, 2015-02-11 11:14

C472 Decision C472 Colonoscopy with gynecological diagnose.xlsx (12.8 KB) Anonymous, 2015-02-11 11:14

Colonoscopy_in_MDC13.xls (19.5 KB) Martti Virtanen, 2015-03-03 14:58

Colonoscopy_in_MDC13.jpg (142 KB) Martti Virtanen, 2015-03-03 15:30

Case #388 Technical changes.xlsx - Updated 2015-05-06 (26.4 KB) Martti Virtanen, 2015-05-06 11:59

History

#1 Updated by Martti Virtanen over 4 years ago

  • Subject changed from Colonoscopy with gynecological diagnose to Colonoscopy with gynecological diagnosis
  • Description updated (diff)

2015-03-03 Martti Virtanen
This is an obvious problem, interesting that nobody has taken it up earlier.

The proposal has a small problem. For the endoscopic problems we created a system with MDC specific rules although the DRG's are the same for all MDC's. This is because some of the interventions are specified so that they are for example not applicable for MDC 13 cases.

An alternative proposal is that we great a new property 13E10 that is given to the 2 last codes on the list. Possibly some other codes may also be included but obviously not all. The rule would then use this property 13E10 instead of 17E10.

#2 Updated by Martti Virtanen over 4 years ago

#3 Updated by Martti Virtanen over 4 years ago

  • File deleted (Colonoscopy_in_MDC13.jpg)

#5 Updated by Martti Virtanen over 4 years ago

  • Description updated (diff)

#6 Updated by Ralph Dahlgren over 4 years ago

Martti has a point in his proposal. However, it is easier to do as suggested in the original proposal since most of the procedures can be made at a gynecologic diagnosis. So we do not support Martti in this.

#7 Updated by Martti Virtanen over 4 years ago

  • File Case #388 Technical changes.xlsx added

2015-03-13 Expert group/MV
The case was accepted with the modification that 13E10 will be used instead of 17E10 since the case is about gynecological problems.

Technical changes
New property 13E10 'Colonoscopy for gynecological problems' is created.
This property is given to all listed codes except JFSA12/JFA12.
A new rule is created as proposed but with the property 13E10 instead of 17E10.

DRG change
The listed codes will be accepted in gynecological cases and assigned to DRG F71O/710O

#9 Updated by Martti Virtanen over 4 years ago

  • File deleted (Case #388 Technical changes.xlsx)

#10 Updated by Anonymous almost 4 years ago

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

#11 Updated by Martti Virtanen over 3 years ago

  • Status changed from Active to Accepted

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