Case #404

Intracranial stereotactic radiosurgery (SRS)

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

Status:AcceptedStart date:2015-02-26
Priority:MinorSpent time:-
Assignee:Kristin Dahlen
Category:-
Target version:Expert Group 2015
Initiator:Norway Target year:2016
Case type:Minor Owner / responsible:National organisations
MDC: Old forum status:
Target Grouper:COMMON, DEN, EST, ICE, LAT, NOR, SWE

Description

National ID: HD-0093
Initiated: 2015-02-25
Initiator: Norwegian Directorate of Health
Responsible at National organization: Ruth Foseide Flenning
Sent to NordDRG Forum: 2015-02-25
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Problem
Intracranial stereotactic radiosurgery (SRS) is a technique that delivers a high dose of precisely targeted radiation to a specific area in the brain to treat tumors, vascular malformations etc. In Norway the procedures are performed either by gamma radioknife surgery or linear acceleration radiation surgery. The procedure is coded AAG50 - Stereotactic intracranial radiotherapy. If the patient is admitted to hospital the case will be further assessed to DRG 1E – Other craniotomy except for trauma. On the contrary it is assessed to DRG 3P – stereotactic intracranial radiotherapy.
Inquires indicate that admittance to hospital is unnecessary as the procedure is performed on a daily basis and does not require observation time longer than 1-2 hours. Complications are unusual.
We consider DRG 1E is a misleading code as craniotomy is not performed. Nor is the procedure performed in an operational theatre.

Analysis
Economic analysis from Sweden, see comment.

Suggestion
Norwegian directorate of health – 2015-02-25
We suggest that AAG50 should not be assigne to DRG 1E/011E-A.
OR=1 property must be removed from AAG50.
Intracranial stereotactic radiosurgery (AAG50) as day treatment shall group to DRG 3P.
DRG 3P shall not be considered as a surgical DRG.

404Ralph.Dahlgren.Comment2.jpg (94.7 KB) Anonymous, 2015-03-12 12:00

SWE Technical_changes_#404_C596.xlsx (20 KB) Mats Fernström, 2015-04-01 17:47

Case #404 Technical changes.xlsx - Updated 2015-04-15 (25.8 KB) Martti Virtanen, 2015-04-16 13:19

History

#1 Updated by Ralph Dahlgren almost 5 years ago

The suggested change is that inpatient cases with AAG50 (Stereotactic intracranial radiotherapy) must not be grouped to DRG A11/001E. The most likely alternative DRG for these cases will then be A43 (former 010/011) ‘Nervous system neoplasm’. Here are Swedish cost data (KPP 2013):

It is obvious that the cases with AAG50 don’t fit very well in DRG A11/001E. In DRG A11E (without CC) the total average cost (89 785 SEK) is 70 % higher than the cost for the cases with AAG50 (52 805 SEK). In DRG A11A (with major CC) it is even worse with a difference that is 274 %.
Thus we support the suggestion to move the cases with AAG50 out of DRG A11/001E but we want to discuss where to put them. We can see three alternatives:
1. To DRG A43E/011 without CC. The cost for the AAG50 cases (52 805 SEK) is 21 % higher than the average cost in DRG A43E (43 570 SEK) however, and therefore alternative 2 (see below) can be considered.
2. To DRG A43C/011 with CC even though no CC factor is present. This alternative can be motivated by the very similar costs for the AAG50 cases (54 503 SEK or 52 805 SEK) and for the cases in DRG A43C (53 811 SEK).
3. To a new DRG A16N/003N ‘Stereotactic intracranial radiotherapy’. In Sweden there will be almost 500 cases per year in this DRG and the average cost will be 52 932 SEK.
Sweden prefer the third alternative.

#2 Updated by Anonymous almost 5 years ago

  • File 404Ralph.Dahlgren.Comment.jpg added

#3 Updated by Anonymous almost 5 years ago

  • File deleted (404Ralph.Dahlgren.Comment.jpg)

#4 Updated by Anonymous almost 5 years ago

#5 Updated by Martti Virtanen almost 5 years ago

  • Description updated (diff)

#6 Updated by Martti Virtanen almost 5 years ago

  • File Case #404 Technical changes.xlsx added

2015-03-13 Expert group/MV
The expert group accepted the Swedish proposal. Finland will not use the new DRG

Technical description
A new DRG 003N 'Stereotactic intracranial radiotherapy' is created. The name of the existing DRG 003P has to be corrected from 'Stereotactic intracranial radiotherapy' to 'Stereotactic intracranial radiotherapy, short therapy'
A new rule is created for the new DRG 003N before current rules for DRG 007X, current ord would be 401D07000. The new rule is a copy of current rule ord 101D010 for DRG 003P but disch and dur are empty.
The procedure AASG50 'Stereotactic intracranial radiotherapy' shall no more have property 01S01 'Craniotomy or intracranial procedure' which is inactivated.

DRG change
Cases with AASG50 will be assigned to the new DRG as inpatients. Arrangement is similar to outpatients.

#7 Updated by Martti Virtanen almost 5 years ago

  • Target Grouper COMMON, DEN, EST, ICE, LAT, SWE added

#8 Updated by Mats Fernström almost 5 years ago

Mats Fernström, NPK, Sweden 2015-04-01
It seems to be a mistake in the file "Case #404 Technical changes.xlsx". The ORD value 101D010 should be 401D07000 as suggested in the Technical description by Martti dated 2015-03-13 (or even better 401D070000 to get 10 characters). Furthermore, there should be one more rule for the new DRG. This rule should be a copy of the present rule with ORD 117D022999 but ORD is changed to 417D111003 and DRG is changed to A16N/003N and disch and dur are empty. The ORD 417D111003 will place the rule before the rules for DRG R40 (former 409) which is OK, because according to Swedish cost data the average cost for the cases with AAG50 is 33 % higher than the mean cost for cases in DRG R40E.
All details are in the enclosed file "SWE Technical_changes_#404_C596.xlsx".

#9 Updated by Martti Virtanen almost 5 years ago

2015-04-16 Martti Virtanen
I agree with Mats. The technical change ord is a misstake and it should be corrected.
The other rule was actually not discussed (at least not registered) but it is obvious and we should introduce it as proposed by Mats.
I have corrected the Technincal changes (even TC2016), so that there will be no discrepancy

#10 Updated by Martti Virtanen almost 5 years ago

  • File Case #404 Technical changes.xlsx added

#11 Updated by Martti Virtanen almost 5 years ago

  • File deleted (Case #404 Technical changes.xlsx)

#12 Updated by Martti Virtanen almost 5 years ago

  • File deleted (Case #404 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 Martti Virtanen almost 4 years ago

  • Status changed from Active to Accepted

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