Case #454

Merge of DRGs 482 and 482O

Added by Kristiina Kahur over 4 years ago. Updated over 2 years ago.

Status:AcceptedStart date:2016-01-26
Priority:MinorSpent time:-
Assignee:Kristiina Kahur
Target version:Expert Group 2016
Initiator:Finland Target year:2017
Case type:Minor Owner / responsible:National organisations
MDC:MDC03 Old forum status:
Target Grouper:SWE


DRG 482O (Face, mouth or neck disease, requiring tracheostomy, short therapy; Trakeostomi, kort vård) has very few cases (five cases in 2013) and taking into account the content and severity of cases which should group in DRG 482O there must be an error in coding or any other reason why the cases group into this DRG. The mean cost of the cases of DRG 482O reveals that the cases are relatively cheap compared to ones in 482 (Face, mouth or neck disease, requiring tracheostomy; Trakeostomi vid öron-, näs- och halssjukdomar). We suggest merging DRGs 482 and 482O, so that the length of stay has no effect on grouping and the cases matching the grouping rules of DRG 482 or 482O will be grouped in DRG 482 (see the cost data in appendix 1).

482+482O.docx - Appendix 1 (22.8 KB) Kristiina Kahur, 2016-01-26 22:14

Technical changes case #454.xls (44 KB) Martti Virtanen, 2016-03-30 07:24

Appendix #454.xlsx (16.2 KB) Mats Fernström, 2017-03-01 09:31

Technical changes case #454-2.xlsx (16.2 KB) Martti Virtanen, 2018-01-09 15:31


#1 Updated by Anonymous over 4 years ago

  • Target version set to Expert Group 2016
  • Case type set to Minor

#2 Updated by Mats Fernström over 4 years ago

Mats Fernström, NPK, Sweden 2016-02-03
The corresponding Swedish DRGs are C01E (not complicated), C01C (complicated) and C01O (outpatients) and we do not want to merge these groups. As a basic principle we don’t want to have the same DRG codes (on four digit level) for inpatients and outpatients. Also in Sweden there are very few cases in DRG C01O (outpatients) and they have unrealistic low costs so we also suspect an error in coding. An alternative to merge outpatients and inpatients to the same groups is to let the outpatients go to the outpatient rest group in the current MDC.

#3 Updated by Kristiina Kahur over 4 years ago

Finnish National DRG-Centre 2016-2-25

Thank you for your comments and feedback.
We agree on and respect the principle of not merging the outpatient and inpatient DRGs. Therefore we suggest to remove the rules of DRG 482O (100D400000 and 100D400100) instead of merging them with ones of DRG 482.
The few cases which potentially may group to DRG 482O will be grouped to other outpatient DRGs according to diagnosis and procedure codes of given case.
We are not in favor of creating the rest group in current case.

#4 Updated by Mats Fernström over 4 years ago

Mats Fernström, NPK, Sweden, 2016-03-01
There are in principle two, for Sweden acceptable, ways to get rid of infrequent surgical outpatient DRGs. One way is to keep the rule(s) but change the DRG result to another existing DRG in the current MDC. If no better group in terms of costs and medical description is available, one can chose the rest group that already exists in all MDCs. The other way is to delete the rule(s) as suggested here but then it is difficult to foresee the effect. If no other DRG ruling procedure is present, the cases will be grouped to conservative (non-surgical) DRGs. One cannot generalize and say that one method always is better than the other. It must be decided from case to case by comparing the cost for the cases in the DRG that is to be deleted with the costs for the alternative DRGs. We have no time to do that analysis before the coming expert meeting so we still don’t want the suggested change to be done in the Swedish version.

#5 Updated by Kristiina Kahur over 4 years ago

Finnish National DRG-Centre 2016-3-2

We will do the case-by-case analysis and present the results in the expertnetwork meeting.

#6 Updated by Kristin Dahlen over 4 years ago

Norwegian Directorate of Health, 10.03.2016

We agree with Sweden in the principle of not merging the outpatient and inpatient DRGs. We suggest to postpone this case, unless Finland presents a good analysis and solution for grouping these cases.

#7 Updated by Martti Virtanen over 4 years ago

2016-03-15 Expert group (MV)
The case was postponed for further analysis. At least Finland and Sweden expressed their interest.

The latest proposed Finnish change would remove DRG 482O (C01O) and result in the assingment of the cases to outpatient DRG's Cases with only tracheostomy would quite often be assigned to DRG 477O. Cases assioated with other interventions would be assinged based on the MDC of the principal dx and the intervention to different outpatient surgical DRG's (mot often in MDC 04)
If this is OK for Finland the change can be done form NordDRG FIN alone.

#8 Updated by Kristiina Kahur over 4 years ago

Finnish National DRG-Centre 2016-3-30

Finland is interested in getting a good solution and therefore we agreed to postpone the case for further analysis.
Thus, no changes will be done in FIN 2017 version alone. Thanks.

#9 Updated by Mats Fernström over 3 years ago

Mats Fernström, NPK, Sweden, 2017-03-01
The number of cases in DRG C01O/482O in the Swedish cost database (KPP) is still very low which supports the idea to delete the group. KPP for 2015 had only three cases but now the costs seems to be more realistic, 15 964 SEK (see Appendix #454 SWE 2017.xlsx). This fits rather well with the average of DRG C29O/063O ‘Other major ear, nose, mouth & throat o. r. procedures, short therapy’ that was 15 473 SEK (trimmed). Cost data with such few observations is of course uncertain and on the whole it is rather unimportant what we do with such few cases but we think that it is OK to let them go to DRG C29O/063O. This will not happen, however, by just deletion of the two rules for DRG C01O/482O. One of these rules handles the combination of PROCPRO 00S03 and 00S05. 00S05 stands for laryngectomy, a procedure hardly done on outpatients, so we can ignore that rule and delete it without any problems. The other rule handles PROCPRO 00S03 alone (in combination with principal diagnoses with 00P11). 00S03 stands for tracheostomy which can be done on outpatients before sending them to another clinic or hospital. The procedure codes with 00S03 have no other procedure property so the cases will end up in DRG Z60O/477O ‘Non-extensive o. r. procedure unrelated to principal diagnosis, short therapy’ if we delete the rule, as already mentioned by Martti. This can be avoided by adding PROCPRO 03S12 to the codes that have 00S03 but we are missing all the cases with PDGPROP 00P11 that don’t belong to MDC 03. There are 90 ICD codes in the SWE version with 00P11 outside MDC 03 (see Appendix #454 SWE 2017.xlsx). Thus, it is best to keep the rule with 00P11 and 00S03 and just change the DRG from C01O/482O to C29O/063O. One could consider moving the rule to a place adjacent to the rules for DRG C29O/063O further down in Drglogic but the effect of this is unknown.
We support the deletion of DRG C01O/482O due to the very low number of patients but we don’t want the cases to go to an inpatient DRG of principal reasons. We suggest that the cases are grouped to the rest outpatient DRG in MDC 03, which is DRG C29O/063O. (You can call that a merging of DRG C01O/482O and C29O/063O if you like.)
The easiest way to achieve that without surprising and possibly unwanted side-effects is to change the DRG outcome in the present rule for DRG C01O/482O based on PDGPROP 00P11 (ORD 100D400000 in SWE version) to C29O/063O. The same change can be done in the other present rule for DRG C01O/482O (ORD 100D400100 in SWE version) but it can also be deleted.

#10 Updated by Kristiina Kahur over 3 years ago

Finnish National DRG-centre 2017-3-6

Thanks providing this alternative solution. The Finnish cost data would support that change.
The mean cost of 063O is 1569 EUR (after trimming 1% 1456 EUR), V% 109% (65%), # of cases 1105 (1093).
The mean cost of 482O is 2758 EUR (2279 EUR), V% 92% (76%), # of cases 16 (15).
By merging DRGs 063O and 482O we would get a DRG with mean cost of 1586 EUR (1467 EUR), V% 109% (66%) and # of cases 1121 (1108).
As seen, the trimming makes the V% a desired one or very close to it.

#11 Updated by Martti Virtanen over 3 years ago

  • File Technical changes case #454-2.xlsx added

2017-03-09 Martti Virtanen
Technical changes according to proposal from Mats

#12 Updated by Martti Virtanen over 3 years ago

  • File Technical changes case #454-2.xlsx added

2017-03-13 Expert group
Accepted merging DRG C01O/482O to C29O/063O according to Swedish proposal
Technical changes updated for combined NordDRG Com

#13 Updated by Martti Virtanen over 3 years ago

  • File deleted (Technical changes case #454-2.xlsx)

#14 Updated by Martti Virtanen over 3 years ago

  • File Technical changes case #454-2.xlsx added

2017-05-29 Martti Virtanen
The change was accpeted for all versions. However, Estonia and Latvia do not have the previous rule for DRG 482O but they have rules for DRG 063O.
It is logical that the same principle applies for Estonia and Latvia and we have thus included them in the new rule. The practical effect is that cases with thracheostomy for patients with ENM-problems are assigned to DRG 063O as in other countries. The economical analysis from Sweden should be valid.
The technical changes are uppdated accordingly.

#15 Updated by Martti Virtanen over 3 years ago

  • File deleted (Technical changes case #454-2.xlsx)

#16 Updated by Anonymous over 3 years ago

  • Target Grouper SWE added

20170530 Susan Berggren
When we went through the tecknical changes, we discover that Martti has not changed the duration in table drglogic. In Sweden "dur" should be <1.

#17 Updated by Martti Virtanen over 2 years ago

#18 Updated by Martti Virtanen over 2 years ago

  • File deleted (Technical changes case #454-2.xlsx)

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