Case #473

Case #451: Stereotactic intracranial radiotherapy only for neurological problems

Cases coded with the procedure AAG50 (Intracranial stereotactic radiosurgery) will in some cases be grouped to DRG 468 or DRG 468O

Added by Kristin Dahlen over 5 years ago. Updated over 4 years ago.

Status:AcceptedStart date:2016-02-25
Priority:MinorSpent time:-
Assignee:Kristin Dahlen
Category:-
Target version:Expert Group 2016
Initiator:Norway Target year:2017
MDC:MDC01 Owner / responsible:
Target Grouper:NOR Old forum status:

Description

Subject: Cases coded with the procedure “AAG50 Intracranial stereotactic radiosurgery” will in some cases be grouped to DRG 468 or DRG 468O

Description:

National ID: HD-128
Initiated: 2016-02-24
Initiator: The Norwegian Directorate of Health – 2016-02-24

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Problem
We have received comments in Norway that refers to the coding of metastatic brain tumors that is undergoing treatment by either surgery or radio knife surgery. If the primary tumor is not removed, the primary tumor will, with correct coding, be the main diagnosis and the metastatic tumor the secondary diagnoses. The problem with this coding and the DRG result, is that all the patients with untreated primary tumors, treated with the procedure AAG50 (Intracranial stereotactic radiosurgery) because of metastatic brain tumor will be grouped to DRG 468 or DRG 468O.

Analysis
The Norwegian Directorate of Health – 2016-02-24

By 2.tert 2015 there are 21 cases in DRG 468 and 2 cases in 468O with the procedure code AAG50. In 20 of these cases the main diagnosis is C349.

The quantity of cases that is affected by this is not large, but there might still be a potential to improve the logic of grouping these cases.

Suggestion
The Norwegian Directorate of Health – 2016-02-24

Because of the table above which shows that most cases related to this problem has a main diagnosis in MDC 4, we suggest to add main diagnosis in MDC 4 as a possibility in DRG 3N. We are aware that other MDCs also can be affected by this problem. We will also like to refer to the case #451, where MDC 17 is suggested. We would like to implement rules for MDC 17 according to the suggestions as well.

Technical change
MDC 04 is added in the drglogic for DRG 3N (Stereotaktisk intrakraniell strålebehandling).

AAG50_DRG468.png (5.35 KB) Kristin Dahlen, 2016-02-25 14:12

Decisions Helsedir HD-128 Intracranial stereotactic radiosurgery.xlsx (15.4 KB) Anonymous, 2016-02-26 13:26

Technical changes #473.xlsx (15.5 KB) Martti Virtanen, 2016-03-23 16:55

History

#1 Updated by Anonymous over 5 years ago

  • File deleted (HD-128_DRG 468 og DRG 468O.doc)

#2 Updated by Anonymous over 5 years ago

Changed a excel file according to a request from Anja Fagervold.

#3 Updated by Mats Fernström over 5 years ago

Mats Fernström, NPK, Sweden, 2016-03-01
We don’t have the problem in Sweden because we have a different principle to choose the principle diagnosis. The Swedish principle is based on a “here and now-thinking”. If the patient has both lung cancer and cerebral metastasis and the main treatment is made on the metastasis, then the metastasis also is selected as the principle diagnosis. For outpatients we have some special coding rules for radiotherapy and chemotherapy for neoplasm. If the main purpose of the visit is to treat the metastasis with radiotherapy, then Z510 (Radiotherapy session) must be used as the principle diagnosis. Z510 belongs to MDC 17 and we have grouping rules for DRG A16/003 that handles these cases, as well as cases in MDC 01.
Thus, there is no need for a rule for cases in MDC 04 in Sweden, and we don’t want it, but we support that it is introduced in the Norwegian version because that will compensate for the different principles to choose the principle diagnosis – the DRG will be the same in Norway and Sweden.

#4 Updated by Kristiina Kahur over 5 years ago

Finnish National DRG-Centre 2016-3-2

In Finland there is no DRG 003N for inpatient cases. We have DRG 003P and it concerns only outpatient cases.
According to Finnish data, there have been two cases in 2013 in inpatient settings with the procedure intracranial stereotactic radiosurgery (AAG50) and the cases were grouped to DRG 468. Not sure, this is the best solution for those cases. Same time there is so few cases in inpatient settings with code AAG50 and creating the separate DRG for single cases only does not seem reasonable either. But this is not the case at the moment.

In outpatient settings there is no problem with cases with AAG50 and they group to DRG 003P (see also the comments on case #451)
As for the NOR proposal we support adding MDC04 to 003N unless the coding guidelines will solve the problem.

#5 Updated by Martti Virtanen over 5 years ago

2016-03-09 Nordcase - Martti Virtanen

In the NorDRG Nor DRG 3P and 3N have identical rules. 3N did not exist in 2015 version, thus there seems to be a mistake. Possibly 3N was meant to be inpatient group but it has wrong rule and wrong place.

I agree with Mats that this coding is in principal wrong. The main problem is the metasthasis in brain if the the only intervention is in the brain. Therefore the metasthasis should be the main diagnosis.

If any malignancy is allowed as the principal dx a new rule should be created in the postMDC area to catch these cases. Otherwise the grouping will the precedence over more specific groups.

#6 Updated by Martti Virtanen over 5 years ago

2016-03-15 Expert group
Accepted for NOR. New logic rule in MDC 4 (404D0300?)only NordDRG NOR

#7 Updated by Martti Virtanen over 5 years ago

  • Target Grouper NOR added

#8 Updated by Martti Virtanen over 4 years ago

  • Status changed from Active to Accepted

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