Case #394

Transoesophageal ultrasound examination of mediastinum

Added by Anonymous almost 5 years ago. Updated over 3 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:GEN Old forum status:
Target Grouper:COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE

Description

National ID: C521-first part
Initiated: 2014-01-16
Initiator: Mats Fernström The Swedish National Board of Health and Welfare
Responsible at National organization: Mats Fernström The Swedish National Board of Health and Welfare
Sent to NordDRG Forum: 2015-02-05
----------------------------------------------------------------------------------------------------------------
National ID: C521-second part, see case #402

Problem
The procedure code JDDE02 'Ultrasound in upper gastrointestinal endoscopy' (XJD02 'Ultraljudsundersökning vid övre gastrointestinal endoskopi') leads to the DRG F72O/711O 'Endoscopy of the upper gastrointestinal tract, outpatient' (Endoskopi av övre gastrointestinalkanalen, öppenvård) if you have a main diagnosis in MDC 03, 06, 07, 10, 13, 14, 16, 17, 21, 22 or 23, but there is no rule for DRG F72O/711O in MDC 04. A clear indication for the procedure code JDDE02/XJD02 could be to investigate a tumor in the mediastinum, such as ICD-code D3830 'Malignant neoplasm of unspecified part of mediastinum' (Malign tumör i icke specificerad del av mediastinum) that belongs in MDC 04.
The combination of ICD-code D3830 and JDDE02 will be assigned to DRG D35O/082O 'Doctor visits at tumors of the respiratory system' (Läkarbesök vid tumörer i andningsorganen) Thus, we can conclude that a rule for DRGF72O is needed in MDC 04.

Suggestion
The Swedish National Board of Health and Welfare – 2015-01-16
A rule for DRG F72O in MDC 04 should be constructed. This rule has in the Swedish NORDRG to be located immediately after the rule to the DRG D70O Endoskopi av nedre luftvägar, öppenvård (Endoscopy of the lower respiratory tract, outpatient) with ORD-value 104D0402 because DRG D70O have higher weight.

These changes should be introduced to the Swedish NordDRG for 2016.

DRG change
A number of outpatient visits will be assigned to DRG F720/711O instead of DRG D35O/082O.

Technical change
• A new procedure property, 04E11 (Endoscopy of upper gastrointestinal tract for diseases of the respiratory system) is constructed and added to the properties of procedure code XJD02.
• A new rule for DRG F72O is inserted after the rule with ORD 104D0402. The ORD value of the new rule is 104D040400. It is a copy of the Swedish DRG-logic rule with ORD 103D17021 but with a change of column MDC to 04 and the column PROC1 to 04E11.

For technical changes see Excel-file “Decision C521 to Forum”.

C521 Decision C521.xlsx (19.5 KB) Anonymous, 2015-02-11 12:31

C521 Endoscopy of the upper gastrointestinal tract in outpatient care in diseases of the mediastinum to Forum.docx (17.8 KB) Anonymous, 2015-02-11 12:31

Oesophageal_ultrasound.jpg (74.9 KB) Martti Virtanen, 2015-02-24 10:35

XGX02-GEDE1B-properties.jpg (58.6 KB) Martti Virtanen, 2015-02-24 10:42

Case #394 Technical changes.xlsx (18.8 KB) Martti Virtanen, 2015-03-18 13:23

History

#1 Updated by Martti Virtanen over 4 years ago

2015-02-24 Martti Virtanen
The original Swedish case has two mostly independent problems that need to be presented and discussed separately, since they need separate solutions.

All versions of NCSP have a code for transoesophageal ultrasound examinatin of mediastinum. The problem is that this does not indicate wether the examination is done with endoscopic device or with "blind" ultrasound device.

The resulting images should be quite similar, since the "blind" ultrasound device can see with ultrasound. However, it is obvious that sometimes the result of an gastroesophagoscopy (with ultrasound) is a finding in mediastinum. Thus JDDE02 should be usable in this kind of cases.
The GEBE1B/XGX02 has the property 04E02 'Endoscopy of respiratory tract and organs for respiratory problems' i.e. it is regarded as endoscopy.

One option is that JDDE02 is given the property 04E02 instead of a new propety.
This would result in assignment to DRG 702O/D70O 'Endoscopy of lower respiratory tract, short therapy'. This is one of the somewhat misleading names in NordDRG since it already now contains cases with mediastinal problems.

#2 Updated by Ralph Dahlgren over 4 years ago

Sweden thinks the original propasal is better for principal reasons and for this reason do not support Marttis suggestion. Gastrointestinal endoscopy must not be grouped to endoskopy of airways.

#3 Updated by Martti Virtanen over 4 years ago

2015-03-13 Expert group/MV
The proposal was accepted for all versions.

#4 Updated by Anonymous almost 4 years ago

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

#5 Updated by Martti Virtanen over 3 years ago

  • Status changed from Active to Accepted

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