Case #390

Vein ligation & stripping (E30/119) - assignment should be based on principal dx on varicose veins

Added by Anonymous almost 5 years ago. Updated almost 4 years ago.

Status:AcceptedStart date:2015-02-11
Priority:MinorSpent time:-
Assignee:Mats Fernström
Category:-
Target version:Expert Group 2015
Initiator:Sweden Target year:2016
Case type:Minor Owner / responsible:National organisations
MDC:MDC05 Old forum status:
Target Grouper:COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE

Description

National ID: C457
Initiated: 2012-09-20
Initiator: Denise Olsson, Skånes universitetssjukhus, Sweden
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Problem
If a patient with peripheral arteriosclerosis (e.g. I7020 'Atherosclerosis of arteries of extremities') is operated with arterial surgery (e.g. PDSP30 'Percutaneous plastic repair of iliac artery'), the case is assigned to DRG E35C-E/478-479 'Other vascular procedures w cc - w/o CC' (Övriga kärloperationer, komplicerat – ej komplicerat) with a rather high DRG weight. But if a secondary diagnosis with the property 05X21 ‘Varicose vein disorder’ also is registered, the case will be grouped to DRG E30/119 'Vein ligation & stripping' (Invasiva åtgärder vid perifer venös insufficiens) with a much lower weight. This is not good, neither from a descriptive (nothing is done against the vein disorder) or economic perspective.

It is strange that a secondary diagnosis has a greater impact on the grouping than the principal diagnosis. We should therefore introduce that “Varicose vein disorder” should be the primary diagnosis in order to get DRG E30.

Suggestion
NPK, Sweden – 2015-01-22
The 11 ICD codes that currently have DGPROP 05X21 (Varicose vein disorder) are instead given a new PDGPRO 05P21 (with the same text as 05X21) and in the four rules for DRG E30 where it is now required 05X21, the requirement is changed to 05P21 instead of 05X21. The property 05X21 is then no longer needed and can be inactivated from the table dg prop.

Sweden wants this change in NordDRG SWE 2016.
Technical change
The ICD codes that currently have DGPROP 05X21 are instead given a new PDGPRO 05P21 (with the same text as 05X21) and in the four rules for DRG E30 where it is now required 05X21, the requirement is changed to 05P21 instead of 05X21. The property 05X21 is then no longer needed and is inactivaed from the table dg prop.
DRG change
A number of cases will be grouped to DRG E35/478-479 instead of DRG E30/119 and vice versa.
The procedure property for TPH10 is changed from 05S15 to 05S18.
See Decision C457.xlsx for details.

NPK C457 Decision C457.xlsx (25.9 KB) Anonymous, 2015-02-11 11:24

NPK C457 to Forum.docx (17.2 KB) Anonymous, 2015-02-11 11:24

Case #390 Technical changes.xlsx (21.2 KB) Martti Virtanen, 2015-03-18 16:08

History

#1 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

2015-03-02 Martti Virtanen
This case included discussion about TPH10 'Sclerotherapy' that is a revision of case #348. I have moved that part to case #348, since it it is a part of that discussion.

The property 05X21 was created in 2005 based on a swedish proposal (Case 2003-MDC05-02)not yet available on the new forum. We have since then expanded the use of principal diagnosis property.

The basic problem is that the rule for DRG E30/119 assing's cases to a group with lower resource need than following groups. This is because the interventions cannot be identified with certainty. This setting causes a problem, since 'forgetting' to code correct dx will result in a group with higher weight.
The proposal about changing 05X21 to principal diagnosis property 05P21 and thus stating that only cases with principal dx of varicose veins are assigned to the DRG E30/119. This diminishes the problem of 'forgetting' and therefore I support the idea and I think we should accept it for all versions. The basic point is that cases with other principal dx than varcicose veins should not belong DRG for 'Vein ligation & stripping' (E30/119).
If further analysis is needed one could be concerned if any cases of true varicose vein treatment with low cost will be assigned to DRG E35C-E/478-479.

#2 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

#3 Updated by Martti Virtanen almost 5 years ago

  • Subject changed from Changing the logic for DRG E30/119 to Vein ligation & stripping (E30/119) - assingment should be based on principal dx on varicose veins

#4 Updated by Martti Virtanen almost 5 years ago

  • Subject changed from Vein ligation & stripping (E30/119) - assingment should be based on principal dx on varicose veins to Vein ligation & stripping (E30/119) - assignment should be based on principal dx on varicose veins

#5 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

#6 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

#7 Updated by Martti Virtanen almost 5 years ago

  • Target Grouper COMMON, DEN, EST, FIN, ICE, LAT, NOR added

2015-03-13 Exper group/MV
Accepted according to the proposal.

#9 Updated by Anonymous almost 4 years ago

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

#10 Updated by Martti Virtanen almost 4 years ago

  • Status changed from Active to Accepted

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