Case #462

Peripheral nerve blockades on fingers and toes should not have 00X10

Added by Mats Fernström almost 4 years ago. Updated 12 months ago.

Status:AcceptedStart date:2016-01-28
Priority:MinorSpent time:-
Assignee:Mats Fernström
Category:-
Target version:Expert Group 2016
Initiator:Sweden Target year:2017
Case type:Minor Owner / responsible:National organisations
MDC:GEN Old forum status:
Target Grouper:SWE

Description

It is unreasonable that the simple peripheral nerve blockades for anesthesia of fingers and toes have the same grouping properties as general anesthesia and regional anesthesia, such as plexus anesthesia. The simple peripheral nerve blockades do not require the presence of anesthesia staff and they do not cause post-operative monitoring. Peripheral nerve blockades on fingers and toes have no separate procedure codes in Sweden but all other more complicated nerve blockades have separate codes. Therefore, if the primary coding is done correctly, there will be nothing else but peripheral nerve blockades included in the unspecified codes ZXH20 “Ledningsanestesi” and SK999 “Ledningsanestesi UNS”. These codes are mapped to the NCSP+ code WAA290 “Other blockade of nerve”. Thus we want that DGPROP = 00X10 is removed from the code WAA290 and all national codes linked to it. If WAA290 is mapped also to more complicated nerve blockades the mapping has to be changed.

Analysis
NPK, Sweden – 2016-01-28

It is so obvious that the simple peripheral nerve blockades for anesthesia of fingers and toes shouldn’t have the same grouping properties as general anesthesia that an economic analysis is unnecessary.

Suggestion
NPK, Sweden – 2016-01-28

DGPROP = 00X10 is removed from the code WAA290 and all national codes linked to it. Specified technical changes are in Suggestion NPK ID C614.
Cases with only procedure codes with a procedure property with the character S but without OR, combined with any of the codes ZXH20 or SK999, will no longer be grouped to surgical DRGs. Inpatients will instead be grouped to conservative DRGs, decided by the diagnoses. Outpatients will be grouped to national procedure related groups (true for Sweden) or conservative groups.

Suggestion NPK ID C614.xlsx (14.9 KB) Mats Fernström, 2016-01-28 16:45

Decision NPK ID C614.xlsx (15.6 KB) Mats Fernström, 2016-03-17 10:54

Technical changes case #462.xls (66 KB) Martti Virtanen, 2016-03-29 13:23

Technical changes case #462-new.xls (72 KB) Martti Virtanen, 2017-11-20 12:42

TC_C614_#462_2018.xlsx (14.6 KB) Mats Fernström, 2018-01-18 14:47

Technical changes case #462-2.xls (72 KB) Martti Virtanen, 2018-12-03 10:37

History

#1 Updated by Anonymous almost 4 years ago

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

Target version changed to Expert Group 2016.

#2 Updated by Martti Virtanen over 3 years ago

2016-03-09 Nordcase - Martti Virtanen
I agree with the title, not quite with the proposal.
The problem is that the codes differ in the countries. Even for Sweden this change is not possible without a new mapping to NCSP+ since a significant number of codes are linked to WAA290 'Other blockade of nerve' where both discussed codes are linked to. Additionally, one needs not to be an expert in anatomy to find something that does not fit in existing code and end up in this group.
If fingers and toes are the problem, they should have their own codes instead of 'other'.
This is a typical example of a problem where we need to start the discussion from the mapping to NCSP+ before proposing changes!

#3 Updated by Mats Fernström over 3 years ago

Mats Fernström, NPK, Sweden, 2016-03-17
This case was discussed at the Expert Network meeting 2016-03-14 – 15 and we agree with Martti that there should be own codes for finger and toes but the unit for primary classifications at “Socialstyrelsen” has denied to create such codes. They mean that all other more complicated nerve blockades have separate codes and therefore there are nothing else but peripheral nerve blockades included in the unspecified codes ZXH20 “Ledningsanestesi” and SK999 “Ledningsanestesi UNS”.
We think that Martti can solve the problem by creating a NCSP+ code for “minor peripheral nerve blockades” without DGPROP = 00X10 and then the Swedish codes ZXH20 and SK999 can be mapped to that NCSP+ code. Irrespective of how we solve the problem we don’t want the Swedish procedure codes ZXH20 and SK999 to have 00X10 in version 2017 (see the attached file Decision NPK ID C614.xlsx).

#4 Updated by Martti Virtanen over 3 years ago

2016-03-15 Expert group (MV)
The proposal was modified as explained by Mats Fernstöm.
The technical changes list all related codes to illustrate what are the codes that exist in each country.
The new created code WAA299 will not have any properties i.e. 00X10 is removed from the linked codes.

#5 Updated by Anonymous about 3 years ago

  • Status changed from Active to Accepted

#6 Updated by Martti Virtanen about 2 years ago

2017-11-20 Martti Virtanen
Kristiina Kahur noted that some anaesthesia codes had lost property 00X10 and ther was no decission on it.
It turned out the the technical changes of this case had an error. The mapping for ZXH20 to WAA290 'Other blockade of nerve' had not been marked for deletion in NCSP+ and assumably because of that the property 00X10 has bee removed from from ZAA290 which was not intended. This affects all version (including SWE). In the NCSP+ ZXH20 and SK999 (SWE codes) are correctly mapped to WAA299 'Other minor blockade of peripheral nerve' and the intended changes have been performed. However, WAA299 has retained the property 14S04 'Procedure of normal delivery' not included in the decission.

To correct the groupers according to decission WAA290 shall still have 00X10. However, if removal is not demanded by Sweden the 14S04 will be retained.
The maintenance of 00X10 will affect the codes mapped to WAA290 of the Swe version, which was the original decission.

#7 Updated by Mats Fernström almost 2 years ago

Mats Fernström, NPK Sweden 2018-01-18 (SWE ID C614)
Martti asked if WAA299 'Other minor blockade of peripheral nerve' still shall have the property 14S04 'Procedure of normal delivery'. WAA299 is mapped to the Swedish anesthesia codes ZXH20 and SK999 which in practice stands for nerve blockades on fingers and toes and such blockades have nothing to do with delivery. So the answer is “delete 14S04 from WAA299”. The technical changes needed for our SOS version are specified in TC_C614_#462_2018.xlsx.

#8 Updated by Mats Fernström almost 2 years ago

Mats Fernström, NPK Sweden 2018-01-18
I was confused by Marttis text above. The code is not ZAA299, it is WAA299. Sorry!

#9 Updated by Martti Virtanen almost 2 years ago

2018-02-20 Martti Virtanen
Sorry for the W/Z. I corrected it in the original comments.

#10 Updated by Martti Virtanen 12 months ago

2018-03-13 Expert group
The case was accepted. In practice affects only Sweden.
The property 14S04 is removed from the code new code WAA299 (Swe codes SK999 and ZXH20)

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