Case #437

Check-up of cochlear implant - not an OR-procedure

Added by Martti Virtanen almost 6 years ago. Updated over 4 years ago.

Status:AcceptedStart date:2015-11-16
Priority:Error correctionSpent time:-
Target version:Expert Group 2016
Initiator:Nordic Casemix Centre Target year:2016
MDC:MDC03 Owner / responsible:Nordic Casemix Centre
Target Grouper:NOR Old forum status:



Initiated: 2015-11-16
Initiator: Martti Virtanen, NordCase
The intervention DFXA02 'Check-up of cochlear implant' (and all national codes linked to it) has property OR=1 and procedureproperties 03S24 'Insertion of cochlear implant' and 14S90 'Significant operation for obstetrical patient' and resulting form 03S24 the generated property 99S90 'Extensive OR-procedure'.
None of the linked national codes seems to be an operation room procedure and neither very resource intensive.
DFXA00 'Connecting cochlear implant' has OR=0 and there is no reason to regard DFXA02 as more resource intensive.

In Norwegian version even the codes linked to DFXA02 has been OR=0 and no other properties. . Thus a correction is obligatory in either Norwegian version or other versions.

Decided changes
I propose that DFXA02 is changed to OR=0 and ther other properties are removed.
This will be performed in 2016 versions of NordDRG

Technical change
DFXAF02 will have OR=0 and no other properties in all versions on NordDRG 2016.

DRG change
The case with only DFXA02 will be assigned to conservative DRG's.

case.437.Norway.xlsx (10.1 KB) Anonymous, 2015-12-21 17:10

SWE codes associated with cochlear implant.xlsx (11.6 KB) Mats Fernström, 2016-04-20 14:16

2016_08_08_Cochlear_implantation_related_codes_properties.xlsx - Appendix 1 (16.7 KB) Kristiina Kahur, 2016-08-08 11:00


#1 Updated by Martti Virtanen almost 6 years ago

  • Description updated (diff)

#2 Updated by Kristiina Kahur almost 6 years ago

2015-11-16 Kristiina Kahur

This change seems reasonable. Nevertheless, in Finnish version this code (DFX02) is given only one property 00X99 and the proposed change would not change anything in Finnish version. There has been no use of this NCSP code (DFX02) in Finland in 2014.

#3 Updated by Mats Fernström almost 6 years ago

*NPK, Sweden 2015-11-17
We don't accept this change. The corresponding Swedish code is DD010 (Postoperativ elektrodkontroll efter kokleaimplantat). It has no OR but procpro 03V09 and that property mustn't be withdrawn.

#4 Updated by Anonymous almost 6 years ago

Comment from Kristin Dahlen


We don’t accept the proposed change as it is described. The Norwegian code DXGT10 “utskifting eller oppgradering av taleprosessor for cochleaimplant” must be grouped to DRG 49B together with the “primary” cochleaimplants as described in our earlier notes. As Martti describes in case # 437 the properties_ OR=1 and procedureproperties 03S24 'Insertion of cochlear implant' and 14S90 'Significant operation for obstetrical patient' and resulting form 03S24 the generated property 99S90 'Extensive OR-procedure' (text taken from case #437)_ corresponds to that.

It don’t seem right that Norwegian codes DXGT10 and the codes on “check-up of cochlear implant” is linked together? Our code DXGT10 describes a procedure where you replace the prosessor. The prosessor will have a cost of approximately 40000-60000 NOK.
It might be wise to see if the mapping of the above codes is suitable, though it is a bit difficult to understand exactly the meaning of each code in the different countries.

Best regards

#5 Updated by Mats Fernström almost 6 years ago

Mats Fernström, NPK, Sweden 2015-12-22
I agree with Kristin. Replacement of the processor is very expensive also in Sweden but we don't have any procedure code for it. There should be a new NCSP+ code for replacement of the processor and that new code should not be mapped to DFXA02. The existing Swedish procedure codes mapped to DFXA02 are not that resource intensive so they mustn't have OR or any surgical procedure property but we want to keep the national Swedish property 03V09.

#6 Updated by Anonymous over 5 years ago

  • Target version set to Expert Group 2016

#7 Updated by Martti Virtanen over 5 years ago

2016-03-09 Nordcase - Martti Virtanen
The codes in this area seem to be misunderstood at least by me.
In the Norwegian version:
DFE00 'Innlegging av cochleaimplantat'
DFU10 'Implantasjon av sekundær hørselsprotese i indreøre'
DXGT10 'Utskifting eller oppgradering av taleprosessor for cochleaimplantat'
DXGT20 'Oppgradering av ytre prosessor for aktive implantater'

NCSP+ has now:
DFSE00 'Insertion of cochlear implant'
DFXA00 'Connecting cochlear implant'
DFXA02 'Check-up of cochlear implant'

DFSE00 includes implantatation of secondary hearing prosthesis (NOR DFU10)which to me means exchange since one cannot possibly have two devices at the same time?

What is 'talking processor of cochlear implant' is not clear to me but I would expect it to me some softeware in the system.

As at very many instances, the collaboration demands that participants read and correct the links in NCSP+ and that we understand the language used. An english translation is not only usefull for the mapping but also for the national development of the classification.

#8 Updated by Martti Virtanen over 5 years ago

2016-03-15 Expert group (MV)
The case was discussed by the expert group. There is an obvious need for change. The NCSP+ mapping needs a correction that the centre will be responsible for. For that work we need English translation of the national codes to create a complete list of the different interventions in this area.

#9 Updated by Mats Fernström over 5 years ago

Mats Fernström, NPK, Sweden 2016-04-20
The existing Swedish procedure codes associated with cochlear implant are listed in the Excel file “SWE codes associated with cochlear implant”. We don’t want any change of the grouping properties for these listed codes. As can be seen, we don’t have any code for processor replacement and none of our codes can be mapped to such a code.

#11 Updated by Kristiina Kahur about 5 years ago

2016-08-08 Finnish National DRG-Centre

In Appendix 1 are the Finnish codes related to CI. There are three currently.
Code DFX02 (DFXA02 Check-up of cochlear implant) has the OR=1 in 2016 Finnish version. In 2015, it had only 00X99.
The property of DFX02 should be corrected in Finnish version to OR=0 according to Martti’s initial suggestion in November 2015.

#12 Updated by Kristin Dahlen almost 5 years ago

  • Target Grouper deleted (DEN, EST, FIN, ICE, LAT, NOR, SWE)
  • MDC MDC03 added

According to a question about English text on the different codes related to cochlea implants, we suggest the following names.

DFE00 Insertion of cochlear implant
DXGT10 Replacement or upgrading of the speech processor for cochlear implant
DXGT20 Upgrading of the external processor for active implants

DFU10 Secondary implantation of auditory prosthesis in inner ear

We will also like to stress that DXGT10 and DFE00 shall both be grouped to DRG 49B Cochlea implant. The Speech prosessor of the cochlea implant shall be replaced every 6-7 years and do have a high cost. DXGT20 should be separated from this codes as it is far from the costs of the procedures DFE00 and DXGT10. When it comes to DFXA00 "connecting the cochlear implant" I do not think we have any code for this is Norway.

#13 Updated by Martti Virtanen over 4 years ago

  • Status changed from Active to Accepted
  • Target Grouper NOR added

2017-03-13 Expert group
"The problem and solution are about mapping. Since last year the mapping fullfills the Norwegian wishes.
Further question: Is speach prosessor in wrong place?
All these devices are expensive. They are kept together. Check up is separately.
New codes in future? Currently no further changes. "

Also available in: Atom PDF