Case #469

Revision of properties of cytostatic and radiotherapy procedure codes

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

Status:AcceptedStart date:2016-02-25
Priority:MinorSpent time:-
Assignee:Kristiina Kahur
Category:-
Target version:Expert Group 2016
Initiator:Finland Target year:2017
MDC: Owner / responsible:National organisations
Target Grouper:FIN Old forum status:

Description

Problem
In Finland there have been developed the grouping logic for cytostatic and radiotherapy cases where the driver for grouping are respective procedure codes. It mainly concerns outpatient DRGs but in some cases also the inpatient ones.
Based on the feedback from Finnish university hospitals and given the fact that the development of coding guidelines for coding the cytostatic and radiotherapy cases is under development, Finnish national DRG-center has revised the properties of cytostatic and radiotherapy procedure codes.
As a result, we see lack of consistency in how the properties have been given certain procedure codes. This has created the situation where the cases with cytostatic or radiotherapy procedure codes do not group to respective short therapy DRGs of cytostatic or radiotherapy but instead to DRGs of short therapy without significant procedure. This is not correct from clinical and cost perspective point of view.

Analysis
For analysis the data of five Finnish university hospitals of 2013 was used.
The cost analysis shows that the cases with cytostatic and radiotherapy are more expensive than the cases without significant procedure. In some cases the cost analyses was not possible to undertake as some codes have not been used yet.

Suggestion
To make the grouping rules consistent we suggest adding certain PROCPR to cystostatic and radiotherapy procedures.
It concerns four different procedure properies:
1) PROCPR 99S80 (Standard cytostatic therapy)
2) PROCPR 90T05 (Radiotherapy)
3) PROCPR 90D91 (Dose design for radiotherapy of malignancy)
4) PROCPR 90D92 (Demanding dose design for radiotherapy of malignancy)

The procedure codes and properties to be added are listed in Appendix 1.

Related to this case we would also like to revise the mapping of radiotherapy codes in next version of NCSP+

DRG changes
After the implementation of the suggested changes the cases with cytostatic and radiotherapy interventions will be grouped according to the main diagnosis to respective cytostatic or radiotherapy DRGs and not to the ones without significant procedure anymore.

This change concerns only Finnish grouper and should not affect the other ones.

Appendix1.xlsx - Appendix1 (13.5 KB) Kristiina Kahur, 2016-02-25 10:10

469.xlsx - Appendix A (9.42 KB) Kristiina Kahur, 2016-03-11 13:18

Technical changes case #469 updated.xls (64.5 KB) Martti Virtanen, 2016-05-19 19:40

History

#1 Updated by Martti Virtanen over 5 years ago

2016-03-09 Nordcase - Martti Virtanen
This is obviously only a Finnish modification but it would be intrensting to see the economical statistics behind it.

#2 Updated by Kristiina Kahur over 5 years ago

Finnish National DRG-Centre 2016-3-11

In appendix A are indicated the comparison of mean cost of DRGs without significant procedures (900-series) when only cytostatic therapy codes without specific PROCPR appear (column C) and ALL cases in respective DRG (column D). We can see some differences in mean cost.

#3 Updated by Martti Virtanen over 5 years ago

  • File Technical changes case #469.xls added

2016-03-15 Expert group
The proposal was accepted. It affects only FIN. The NCSP+ sheet of technical changes shows the codes that will have the properties. Since the other version do not use to properties at issue, this will not affect other versions.

#4 Updated by Martti Virtanen over 5 years ago

  • File deleted (Technical changes case #469.xls)

#5 Updated by Martti Virtanen over 5 years ago

  • File Technical changes case #469 updated.xls added

3016-05-04 Martti Virtanen
There were mistakes in the Finnish proposal that I missed i my checkup.
1) The property 99S80 starts increase one by one from WC201 to WC502. This is not logical and all of the properties do not exist. This is obviously an error caused by the Microsoft system that sometimes does this when you automatically copy codes to lines below. All codes shall have 90S80.
2) Similarly the 90T05 'Radiotherapy' code has increases from XX7GT to ZX080 one by one. All codes hal have 90T05.
3) Similarly the property 90D91 increases from YX8AD to YX9CD one by one which is neither logical. All codes will have 90D91
In all cases the text of the proposed property is the same although the code changes.
4) XXD3DW 'Time consuming IT work' is obviously not 90T05 'Radiotherapy' but rather 90D91 'Dose design for radiotherapy of malignancy'
This is corrected in the updated technical changes list.

#6 Updated by Kristiina Kahur over 5 years ago

Finnish National DRG-Centre 2016-5-17

Thanks for update and sorry for the misunderstanding with copy-paste function.
In original proposal there was two more codes which are missing the new proparty:
1) XX7GT Radioyttrium SIRT - hoito, which should have the property 90T05 Radiotherapy
2) XX1AD Other CT-examination, proposed property was 90D91 Dose design for radiotherapy of malignancy

Is there any reason those two code were left without changes?

#7 Updated by Martti Virtanen over 5 years ago

2016-05-19 Martti Virtanen
The XXIX99 /(XX7GT) should have the property, see technical changes document, also the CSP sheet.
XXDD9X (XX1AD) I seem to have left outof the list, probably because there are 6 other Finish codes that are affected. Also the codes for 'other CT' can be for quit small interventions.

#9 Updated by Martti Virtanen over 5 years ago

  • File deleted (Technical changes case #469 updated.xls)

#10 Updated by Anonymous about 5 years ago

  • Status changed from Active to Accepted

Also available in: Atom PDF