Case #402

Combination of GEXX00 'Needle biopsy of mediastinum' and gastrointestinal endoscopies

Added by Martti Virtanen over 4 years ago. Updated about 3 years ago.

Status:AcceptedStart date:2015-02-24
Priority:MinorSpent time:-
Assignee:-
Category:-
Target version:Expert Group 2015
Initiator:Sweden Target year:2016
Case type:Minor Owner / responsible:
MDC:MDC04, MDC06 Old forum status:
Target Grouper:SWE

Description

National ID: C521-second 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
Status: ACTITEM - Active item
---------------------------------------------------------------------------------------------------
National ID: C521-first part see case #394
Problem
Cases with GEXX00 'Needle biopsy of mediastinum' (TGE00 Punktionsbiopsi av mediastinum) in combination are assigned to the DRG D76O/778V 'Thorax puncture' (Toraxpunktion, öppenvård).
Cases with combination of GEXX00 and JDDE02 'Ultrasound in upper gastrointestinal endoscopy' (XJD02 'Ultraljudsundersökning vid övre gastrointestinal endoskopi') are assigned to DRG F72O/711O 'Endoscopy of the upper gastrointestinal tract, outpatient' (Endoskopi av övre gastrointestinalkanalen, öppenvård).
DRG D76O is a Swedish DRG that requires more resources than DRG F72O/711O.
This means that in Sweden using the combination of procedure codes the patient groups to a DRG requiring less resource.
This problem is due to the hierarchy in the Swedish DRGlogic.
We should avoid situations were more correct coding results in assignment of less resource intensive DRG than leaving out some of the codes. This is obviously wrong also from clinical point of view. The system should not encourage bad primary coding by giving more reimbursement.

Suggestion
The Swedish National Board of Health and Welfare – 2015-01-16
The rule for DRG D76O/778V 'Thorax puncture') should be moved up to just before the first rule for DRG F72O/711O .

The change should be introduced to the Swedish NordDRG for 2016.

DRG change
A number of outpatient visits will be grouped into DRG D76O instead of other outpatient DRG.

Technical change
• In the Swedsih DRGlogic the rule for DRG D76O is changed. The old ORD-value 200D037 is changed to ORD 104D040300.
For technical changes see Excel-file “Decision C521 to Forum”.

Introduction: NordDRG [SWE] [2016]

04V02-interventions.jpg (369 KB) Martti Virtanen, 2015-02-24 13:20

04V02-interventions.jpg (365 KB) Martti Virtanen, 2015-02-24 13:44

Case #402 Technical changes.xlsx - Updated version (18.9 KB) Martti Virtanen, 2015-03-31 11:59

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.

This case is about moving the rule for DRG D76O/778V from position ord 200D037 to ord 104D040300. It is moved from the group of rules for independent interventions DRG's (of NordDRG SWE) to the group of MDC specific outpatient DRG's. It means that the cases inf DRG D76O/778V take precedence over all surgical outpatient DRG's in MDC's 05 to 23 and all independent intervention DRG's with ord 190D0099 to ord 200D03. If two types of interventions are coded the interventions with property 04V02 define the DRG assignment.

Procedures with property 04V02:

The current principal is that the MDC specific intervention DRG's usually demand correct principal Dx for the MDC at issue.
By adding the MDC to the rule the risk of taking precedence of other more relevant grouping is somewhat diminished but not totally removed.
Depending on the resource demand the DRG D76O/778V could be combined with DRG D19O/077O or retained as separate DRG.

Further analysis
It is usefull to check the resource need for DRG's bypassed in the move and and compare DRG D76O/778 with DRG D19O/077O

#2 Updated by Martti Virtanen over 4 years ago

  • Description updated (diff)

#5 Updated by Anonymous over 4 years ago

  • Target version set to Minor-Proposals-for-2016
  • Case type set to Minor
  • Target Grouper SWE added

#6 Updated by Ralph Dahlgren over 4 years ago

According to Swedish KPP data, it is a 30% cost difference between DRG D76O / 778V and DRG D19O / 077O and therefore they can not be combined. This proposal can therefore not be accepted by Sweden.

#7 Updated by Ralph Dahlgren over 4 years ago

Sweden accept that MDC = 04 is added to the rule of DRG D76O in DRGlogic.

#8 Updated by Martti Virtanen over 4 years ago

  • File Case #402 Technical changes.xlsx added

2015-03-13 Expert group/MV
The expert group accepted the Swedish proposal. Sweden will analyze the other DRG's that wer bypassed in this process.

Technical change
As proposed by Sweden but MDC 04 is added to the rule for DRG D76O/778V

#9 Updated by Ralph Dahlgren over 4 years ago

Martti´s technical changes are good. But we do not accept the ord value. We want the rule to have ord 104D040300. This due to the fact that this rule should be placed among the other MDC 04 rules.

#10 Updated by Martti Virtanen over 4 years ago

  • File Case #402 Technical changes.xlsx added

2015-03-31 Martti Virtanen
OK, the technical changes is modified accordingly

#11 Updated by Martti Virtanen over 4 years ago

  • File deleted (Case #402 Technical changes.xlsx)

#12 Updated by Martti Virtanen over 4 years ago

  • File deleted (Case #402 Technical changes.xlsx)

#14 Updated by Anonymous almost 4 years ago

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

#15 Updated by Anonymous about 3 years ago

  • Status changed from Active to Accepted

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