Case #456

Merge of DRGs 481O and 481A

Added by Kristiina Kahur over 5 years ago. Updated over 4 years ago.

Status:RejectedStart date:2016-01-26
Priority:MinorSpent time:-
Assignee:Kristiina Kahur
Target version:Expert Group 2016
Initiator:Finland Target year:2017
MDC:MDC17 Owner / responsible:National organisations
Target Grouper:FIN Old forum status:


There have been no cases in DRG 481O (Other stem cell transfer, short therapy; Annan stamcellstransplantation, kort vård) in 2013 in five Finnish University hospital. Unlikely there will be any (or if there will be any then very few) mainly due to the clinical characteristics of the patients in need of stem cell transfer.
We suggest merging the DRGs 481O and 481A (Other stem cell transfer; Annan stamcellstransplantation) so that the length of stay has no effect on grouping anymore.
There have been 201 cases in DRG 481A in 2013, mean cost 22 510 EUR, stdev 13 811 EUR and V% 61%.


#1 Updated by Anonymous over 5 years ago

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

#2 Updated by Ralph Dahlgren over 5 years ago

Out of Swedish perspective we do not accept this suggestion. And we do not want it to be done for the Swedish NordDRG system.
First of all we do not want the out-patients and incare patients to be grouped to the same DRG. That is one rule that we follow. If other countries wants to do differently that is up each and everyone to decide.
Second in Sweden the DRG 481 are equal to the Swedish DRG R23O, R23E and R23C Annan stamcellstransplantation.
First of all we have 57 visits in DRG R23O, mean cost ~25 800 SEK, DRG R23C 173 cases for incare, mean cost ~173 000 SEK, DRG R23C 227 cases for incare, complicated cases, mean cost ~208 000 SEK. This means also that there in the Swedish cost data is a significant cost differens between visits and incare patients which makes this merge impossible.

#3 Updated by Kristiina Kahur over 5 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 rule of DRG 481O (100D200010) instead of merging it with one of DRG 481A.
As there have been no cases in DRG 481O so far, this change should not cause any changes in DRG grouping. Nevertheless, in unlikely event the cases which may group to DRG 481O will be grouped to other outpatient DRGs according to diagnosis and procedure codes of given cases.

#4 Updated by Kristin Dahlen over 5 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 as we need to discuss a good solution for grouping these cases.

#5 Updated by Martti Virtanen over 5 years ago

  • Status changed from Active to Further active

2015-03-15 Expert group (MV)
The case was postponed for further analysis by Finland.

#6 Updated by Mats Fernström over 4 years ago

Mats Fernström, NPK, Sweden, 2017-03-01
In our KPP for 2015 the number of cases in DRG R23O/481O has increased to 73 and we see no problem with that DRG. Then it is worse with DRG R22O/481P ‘Allogen stamcellstransplantation, öppenvård’/’Allogenic stem cell transfer, short therapy’. The number of cases is small:
•2013 – 5 cases with average cost approx. 3 500 SEK
•2014 – 4 cases with average cost approx. 6 200 SEK
•2015 – 10 cases with average cost approx. 12 000 SEK which is almost the same as the average cost for the 73 cases in DRG R23O/481O. The median cost was just 5 300 SEK, however, indicating a very wide cost distribution.
One could consider merging DRG R22O/481P to DRG R23O/481O due to the low numbers and the medical similarity but the difference in costs seems too big. More about that in case #457.
In summary – Sweden does still not want any change for DRG R23O/481O, which of course does not prevent the other nations to do what they want.

#7 Updated by Martti Virtanen over 4 years ago

  • Status changed from Further active to Rejected

2017-03-13 Expert group
Merging inpatient and outpatient DRG's is not acceptable.

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