Case #482

Prostate biopsy

Added by Kristin Dahlen over 3 years ago. Updated almost 2 years ago.

Status:AcceptedStart date:2016-04-13
Priority:MinorSpent time:-
Assignee:Kristin Dahlen
Category:-
Target version:Target version 2017
Initiator:Norway Target year:2017
Case type:Minor Owner / responsible:National organisations
MDC:MDC12 Old forum status:
Target Grouper:NOR

Description

Problem

A needle biopsy of the prostate can be done in various indications, for example malignant tumor of the prostate. Along with procedure code KEX06 Needle biopsy of the prostate together with ZXM00 image-guided technique using ultrasound the DRG is 812P Minor procedures on male genitals. This seems logical.
A needle biopsy of the prostate can also be performed in a contact were the indication will be R74.8 abnormal serum levels of other specified enzymes. The contact will then group to DRG 923O. This seems illogical, as long as we are talking about the same procedure.

Suggestion
Norwegian Directorate of Health – 2016-04-11

We want these cases with main condition R74.8 and procedure codes KEX06 needle biopsy of the prostate to group to DRG 812P as well as the cases with main diagnosis malignant tumor of the prostate.

DRG change
The mentioned cases will move from DRG 923O to DRG 812P.

Technical change
A new rule for DRG 812P with for example ORD 123D01015 (in between former rule 123D01003 and 124D000000), with MDC=23 and PROCPR=12O01.

HD-97_FORUM_Prostatabiopsi.xlsx (20.2 KB) Kristin Dahlen, 2016-04-13 15:10

Technical changes case #482.xls (262 KB) Martti Virtanen, 2016-05-23 15:35

Technical changes case #482 new.xlsx (35.8 KB) Martti Virtanen, 2017-05-12 14:53

History

#1 Updated by Martti Virtanen over 3 years ago

2016-05-23 Martti Virtanen - Nordic Casemix Centre
This case was sent too late to be discussed at Expert group meeting 2016.
The change will, however, only affect NordDRG Nor.

The proposal is somewhat incomplete. It affects all cases with a combination of interventions with the property 12O01 and principal dx from MDC 23. They are listed in the proc (and NCSP+) and dg (and ICD+)sheets of the technical changes. Although the number of codes is huge, the combinations are quite rare. Some of the combinations may actually be relevant in the light of this case but others may cause unwanted effects.

Since the change affects only logic table, it will only affect NordDRG Nor. Thus we will do the change, but I hope Norway will check the effects in the light of this discussion.
The case will remain ope to allow discussion about it.

#2 Updated by Susann Berggren over 2 years ago

Susan Berggren NPK, Sweden 2017-03-01
Sweden does not have this problem, any biopsy regardless of diagnosis leads to N75 O (Male genitalia px O)

#3 Updated by Anja Fagervold over 2 years ago

This change is already implemented in the Norwegian 2017 version.

#4 Updated by Kristiina Kahur over 2 years ago

Finnish National DRG-centre 2017-3-6

It is not clear how the change has been implemented in NOR version without any discussion in Expert group.
Nevertheless, we would be interested in discussing the case and possible change in Finnish version.
In Finnish data the # of cases with code KEX06/KEXX00/TKE00 Prostate needle biopsy is 147, out of which 134 cases in DRG 923O, mean cost 635 EUR.
Mean cost of DRG 923O (all cases) is 235 EUR.
Mean cost of DRG 812O (812P in Norway) where the KEX06 cases would possibly be moved to is 523 EUR.
So it would make sense to move the cases with KEX06 to 8-series group.

#5 Updated by Kristiina Kahur over 2 years ago

Finnish National DRG-centre 2017-3-29

After checking the case thoroughly we will not implement this change in Finnish 2018 version.

#6 Updated by Martti Virtanen over 2 years ago

2017-03-13 Expert group
The change was accepted as proposed for NordDRG Nor
The new technical change document shows that the change will only affect NordDRG Nor

#7 Updated by Martti Virtanen almost 2 years ago

  • Status changed from Further active to Accepted

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