Case #459

Splenectomy, short therapy

Added by Kristiina Kahur almost 3 years ago. Updated 8 months ago.

Status:Further activeStart date:2016-01-27
Priority:MinorSpent time:-
Assignee:Kristiina Kahur
Category:-
Target version:Expert Group 2016
Initiator:Finland Target year:2017
Case type: Owner / responsible:
MDC:MDC16 Old forum status:
Target Grouper:

Description

We would like to disuss in expert network meeting the topic related to splenectomy as short therapy case.
In 2013 there has been ca 60 cases in DRGs 393 (Splenectomy age 0-17) and 392 (Splenectomy age > 17). In DRG 393O (Splenectomy, short therapy) only two.
We would be glad to hear from others what your data show when it comes to splenectomy, short therapy.

Appendix1_techincal_changes_393O_Splenectomy.xlsx - Appendix 1 (12.7 KB) Kristiina Kahur, 2018-01-03 17:57

Appendix_#459_1_2018.xlsx (12.3 KB) Mats Fernström, 2018-01-17 15:49

TC_#459_2018.xlsx (24.1 KB) Mats Fernström, 2018-01-17 15:49

Technical changes case #459.xlsx (35.7 KB) Martti Virtanen, 2018-03-09 14:56

History

#1 Updated by Tiina Pasanen almost 3 years ago

  • Target version changed from Expert Network Meeting to Expert Group 2016

Target version changed to Expert Group 2016.

#2 Updated by Tiina Pasanen almost 3 years ago

  • Target year 2017 added

#3 Updated by Ralph Dahlgren almost 3 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 to each and everyone to decide.
Sweden has the corresponding DRG R01O Mjältextirpation, öppenvård (393O splenectomy, daycare) and R01N Mjältextirpation (392 Splenectomy age > 17), but we do not have a group for children splenectomy.
In DRG R01O we have few cases and quite low cost compared to R01N that has a much higher number of cases with a mean cost of 100 822 SEK.
We have a few cases in DRG R01O and we will look into what to do with DRG R01O and the involved cases. Due to the fact that the cases in R01O are very inexpensive we definitely do not want the outpatiens to be grouped to the same DRG as inpatients.
We will come back with a new case concerning this.

#4 Updated by Kristiina Kahur over 2 years ago

Finnish National DRG-Centre 2016-2-25

Thank you for your comments and feedback.
We are happy to have further discussions in Expert Group meeting and then come up with reasonable solution in cooperation with other countries.

#5 Updated by Kristin Dahlen over 2 years ago

Norwegian Directorate of Health - 09.03.2016

We support the comment from Sweden about not grouping out-patients and incare patients to the same DRG. We do also have few cases in DRG 393 and 393O, and await Swedens new case concerning this.

#6 Updated by Martti Virtanen over 2 years ago

2016-03-15 Expert group (MV)
The question was discussed. Since there is no proposal in the case nothing was decided On the request of Sweden the case was postponed to next year.

#7 Updated by Mats Fernström over 1 year ago

Mats Fernström, NPK, Sweden 2017-03-08 (NPK ID C638)
The number of cases in DRG R01O/393O in KPP for 2015 has increased somewhat and we have now 10 cases in this group. An analysis on individuals shows that two of the patients had gone through a splenectomy as inpatients some weeks before the outpatient visit and one patient was reported as an outpatient splenectomy twice and one patient was reported as an outpatient splenectomy four times. Splenectomy can only be done once so six of the ten cases were clearly wrong coding. All cases had zero SEK reported costs in the cost categories “operation” and “anesthesia” so the remaining four cases are probably also wrong coded unless cost data is wrong.
To find out what is wrong, we have to contact the hospitals that report cases in DRG R01O/393O and we have not had time to do that, so we want to postpone this case once more. As it involves so few cases per year, it is not a disaster to wait to solve the problem.

#8 Updated by Kristiina Kahur over 1 year ago

Finnish National DRG-centre 2017-3-8

The number of cases of 393O has remain on the same level in 2015 as in previous year, there has been two cases in DRG 393O. One case costs 852 EUR and the other one 1125 EUR. Both cases have procedure JMW97/ JMSW97 Other laparoscopic operation on spleen which necessarily does not mean splenectomy.
In this light we would suggest to revise the procedure codes which have given the property 16S01 Splenectomy. Currently there are nine codes with this property. The ones starting with JMA/JMSA refer clearly to splenectomy (partial or total) and are ok.
The rest starting with JMB/JMSB are biopsy codes and repair of spleen (whatever method it may mean). The ones starting with JMW/JMSW are other laparoscopic operation and other operation codes. Two latter groups (JMB and JMW) should not have property 16S01. Instead perhaps 16S02 Other OR procedure of the blood forming or immunological organs which would lead to DRG 394/O Other o. r. procedures of the blood and blood forming organ/short therapy.
It does not solve the problem of how the get rid of DRG 393O though. Nevertheless, clinically it is almost impossible that splenectomy would be done in outpatient settings. In case we eliminate the cases of wrong coding, in best case other than splenectomy has been performed in outpatient settings and that would logically lead to suggestion to merge 393O with 394O.

#9 Updated by Martti Virtanen over 1 year ago

2017-03-13 Expert group
Postponed for another year for analysis of primary coding at least by Sweden.

#10 Updated by Kristiina Kahur 11 months ago

Finnish National DRG-Centre 3-1-2018

The case was analysed once again, and we suggest changing the PROCPRs of certain procedure codes which currently have PROCPR 16S01 Splenectomy.
There is no use of codes staring with JMB in Finnish data. JMW97 has been used twice in outpatient settings and once in inpatient one but the cost of the cases are not comparable with the ones of real splenectomy.

Thus, we suggest that the following codes will be removed the PROCPR 16S01 Splenectomy and the new one, 16S02 Other OR procedure of the blood forming or immunological organsm will be added instead:
JMB00 JMSB00 Biopsy of spleen
JMB01 JMSB01 Laparoscopic biopsy of spleen
JMB10 JMSB10 Repair of spleen
JMW96 JMSW96 Other operation on spleen
JMW97 JMSW97 Other laparoscopic operation on spleen

PROCPR leads to DRG 394/O Other o. r. procedures of the blood and blood forming organ/short therapy. As the number of cases with abovementioned codes is very small, the impact of the change is minimal.
With this change we keep DRG 393O for unlikely case the splenectomy will be performed in outpatient settings. No need to remove it or merge with DRG 393.
The suggested technical changes are added in Appendix 1.

#11 Updated by Martti Virtanen 10 months ago

  • Status changed from Active to Further active

#12 Updated by Mats Fernström 10 months ago

Mats Fernström, NPK, Sweden 2018-01-17 (Swe ID C638)
The number of cases in DRG R01O/393O (Mjältextirpation O/ Splenectomy, short therapy) in the Swedish cost database (KPP) for 2016 was only two, one with the procedure code JMA11 (Laparoscopic splenectomy) and one with JMW96 (Other operation on spleen). Like in previous KPP data, no costs for operation or anesthesia were reported and the total costs were only 2769 SEK and 3412 SEK respectively.
This is the same pattern as we have noticed previous years and we are convinced that all cases in DRG R01O/393O are miscoded. It is not unusual that the procedure code from the previous inpatient stay is incorrectly reported when the patient is coming back on an outpatient visit for control. This is of course a misunderstanding – it is the diagnosis, not the procedure that shall be reported on the control visit. We report cost data for the three years 2014-2016 in the Excel file Appendix_#459_1_2018 and compare the average costs for the DRGs R01O/393O (Mjältextirpation O/ Splenectomy, short therapy), R05O/394O (Andra op blodbildande organ O/ Other o. r. procedures of the blood and blood forming organ/short therapy) and R98O/916O (Läkarbesök blodsjukdom O/ Disease or disorder of blood forming organs or immunological disorder, short therapy w/o significant procedure).
Based on our observations we suggest that DRG R01O/393O (Mjältextirpation O/ Splenectomy, short therapy) is deleted by deletion of the rule for that DRG. In the Swedish version the patients will instead be grouped to DRG R98O/916O (Läkarbesök blodsjukdom O/ Disease or disorder of blood forming organs or immunological disorder, short therapy w/o significant procedure) which is much better in a cost perspective. Deletion of the rule for DRG R01O/393O in other national versions will probably result in DRG 468O (Extensive o. r. procedure unrelated to principal diagnosis, short therapy) for these patients because neither DRG 816O nor 916O permits OR=1 and to avoid DRG 468O, the present rule for DRG 393O must be retained but the DRG outcome is changed to 916O. The rule must also be transferred a bit further down, adjacent to the rules for DRG 816O and 916O, to allow another grouping result if other significant procedures than spleen interventions are reported in the same case. Detailed technical changes are described in the Excel file TC_#459_2018.
We do not want the Finnish suggestion to let some procedures have PROCPRO 16S02 (leading to DRG R05O/394O) instead of PROCPRO 16S01 because they are also typical inpatient procedures, hardly possible to do on outpatients because of the risk for postoperative bleeding. Thus, we are convinced that all cases in DRG R01O/393O are miscoded and they are much cheaper than the cases in DRG R05O/394O. But if Finland still wants the proposed procedures to go to DRG 394O it is possible by adding a new PROCPRO (16S03) to the codes and construction of a new rule in Drglogic based on that PROCPRO leading to DRG 394O. This new rule is placed immediately before the present rule for DRG 393O. This special solution is also described in the Excel file TC_#459_2018.

#13 Updated by Kristiina Kahur 8 months ago

Finnish National DRG-Centre 9-3-2018

The solution Sweden is providing seems fine for us when it comes to the deletion of the rule of DRG 393O. Letting the cases to group to DRG 468O would make sense because this way we could catch the cases with potential incorrect coding (splenectomy in outpatient settings).
However, we would like the expert group to consider the change of PROCPROs of abovementioned procedure codes. At least the codes of biopsy of spleen (JMB00/JMSB00 and JMB01/JMSB01) are not clinically, but also economically equal to codes expressing the splenectomy (which is the case in the current logic).

#14 Updated by Martti Virtanen 8 months ago

2018-03-09 Martti Virtanen
Sweden and Finland (at least) seem to agree that outpatien splenectomy is not possible. They agree on removing the rules for that DRG 116D011000 and 116D011001.
If the DRG 393O is retained for some versions, the rule 116D011000 is retained active for thos countries.

Finland would like to move the smaller interventions on spleen to procedure property 16S02 that would move cases with such interventions to DRG 394 (R05N) / 394O (R05O) from 393 (R01N) / 393O (R01O)
This would demand the change procedure property 16S01 to 16S02 for the 5 codes at issue (see technical changes)
If this is not accepted by all countries we need the new property 16S03 for the Finnish version as proposed by Mats Fernström.
See technical changes for details

#15 Updated by Mats Fernström 8 months ago

Mats Fernström, NPK Sweden 2018-03-28 (Swe ID C638)
Despite our comment 2018-01-17 Sweden accepts the Finish suggestion to change the procedure property from 16S01 to 16S02 for the 5 codes at issue. We need a message quite soon from the other countries in order to be able to write correct technical changes.

#16 Updated by Mats Fernström 8 months ago

Mats Fernström, NPK Sweden 2018-04-04 (Swe ID C638)
Ignore my request for message from other nations dated 2018-03-28. I see in Maisa's protocol that the case was ”agreed to everybody”.

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