Case #506

New DRG in MDC22 for outpatient cases with Dressing of major burn

Added by Kristiina Kahur almost 5 years ago. Updated almost 4 years ago.

Status:AcceptedStart date:2017-01-17
Priority:NormalSpent time:-
Assignee:Kristiina Kahur
Category:-
Target version:Expert Group 2017
Initiator:Finland Target year:2018
MDC:MDC22 Owner / responsible:National organisations
Target Grouper:COMMON Old forum status:

Description

Problem
Procedure code QXD00/QXSD00 Dressing of major burn of unspecified region has the PROCPROP 22S02 Wound debridement or other OR procedure for burns, but no OR=1 property. According to current logic the cases with PROCPROP 22S02 group to DRG 472/O Extensive burns w o. r. procedure/short therapy or 459/O Non-extensive burns w wound debridement or other o. r. procedure/short therapy, if the procedure has: a) additionally OR=1 property, or b) the anesthesia is performed and coded.
In Finland, vast majority of cases with QXD00 procedures are performed in outpatient settings and most of them end up in DRG 922O Burns, short therapy w/o significant procedure. The coding practice shows that the no anesthesia code is coded (does not mean that the procedure is not performed in anesthesia though).
Nevertheless, given the significance of procedure code QXD00 the grouping to DRG 922O does not seem correct. It was also pointed out by clinicians who would support the separate group of dressing of major burns.
The cost analysis was carried out to find appropriate DRG for outpatient cases with procedure code QXD00.

Analysis
The cases with QXD00 in DRG 922O have the mean cost almost twice as much as the cases in DRG 922O without QXD00 (ca 500 EUR vs ca 250 EUR). Same time, from cost point of view the QXD00 cases are not comparable with cases of DRGs 459O or 472O (ca 500 EUR vs 2 400-3 000 EUR).
Thus, the cases with QXD00 cannot be grouped into DRGs 459O or 472O, same time they cannot be remain in DRG 922O either.
95-97% of QXD00 cases are grouped to 922O which means that creating own group for the cases with QXD00 would have minimal impact on other DRGs they cases currently group.

Suggestion
If QDX00 will be given OR=1 property, the cases would group to DRGs 459O or 472O which from cost point of view would not appropriate.
Therefore, based on the cost analysis the cases with procedure code QXD00 should have a new PROCPROP in order to be grouped to new short therapy group.
The ord of new group will be located between 122D025101 and 122D029980

DRG change
After the suggested changes the cases will be grouped to a new short therapy DRG 922N Dressing of major burn, short therapy.

Technical changes
Appendix 2. The technical changes may contain mistakes and have to be used with caution.

Cost analysis
Appendix 1. Cost analysis is based on five university hospital data of 2015, grouped with Finnish 2017 grouper, and data of 2014, grouped with 2016 grouper.

MDC22_Burns_newDRG_QXD00_Appendix1.xlsx - Appendix 1 (11.3 KB) Kristiina Kahur, 2017-01-17 14:58

MDC22_Burns_newDRG_QXD00_Appendix2.xlsx - Appendix 2 (25.6 KB) Kristiina Kahur, 2017-01-17 14:58

Technical changes case #504&506.xlsx (88.7 KB) Martti Virtanen, 2017-05-03 14:12

History

#1 Updated by Kristiina Kahur almost 5 years ago

  • Subject changed from New DRG for outpatient cases with procedure QXD00/QXSD00 Dressing of major burn of unspecified region to New DRG in MDC22 for outpatient cases with procedure QXD00/QXSD00 Dressing of major burn of unspecified region

#2 Updated by Kristiina Kahur over 4 years ago

  • Target Grouper COMMON added

#3 Updated by Mats Fernström over 4 years ago

Mats Fernström, NPK, Sweden 2017-03-02
This change is impossible in SWE because we don’t have this procedure code. Probably we have not introduced that code in the Swedish classification because it is a bad description. It leaves up to the user to decide what is “major”. There are in ICD codes for a more objective description, both of the size of the burn and the depth.

#4 Updated by Martti Virtanen over 4 years ago

2017-03-09 Marti Virtanen
Sweden does not have any code corresponding to QXSD00 but it has the other codes in the QxSD00 (A/B/C/D)
Why did not Finland propose a change for the other codes? Is QXSD00 used instead of the specified codes?

#5 Updated by Kristiina Kahur over 4 years ago

Finnish National DRG-centre 2017-3-10

This proposal is based on cost analysis of Finnish data. Code QXD00/QXSD00 was the most used procedure code in DRG 922O and that what the analysis based on. We checked also other procedure codes in DRG 922O but there was no code which would have caught our eyes in terms of cost.
The case was discussed with trauma specialist specialized on burns and with a plastic surgeon and their opinion about creating separate group based on that particular procedure code was supportive from clinical point of view. Otherwise the patients with that procedure get lost in DRG 922O. Same time, the cases are not as severe and expensive compared to ones performed in general anesthesia. That was seen also in the results of cost analysis.
Might be that there are other/different codes in other countries used for that procedure which have different properties and the cases group according this to appropriate DRGs with no problem.

#6 Updated by Kristiina Kahur over 4 years ago

Finnish National DRG-centre 2017-3-29

It was decided in Riga meeting that QXD00 will be created a new NCSP+ code and given the new property (or existing one). Hopefully Martti can suggest a new free code for QXD00 according to the logic of creating new NCSP+ codes.
Other than that we would be glad to make the suggested change in Finnish 2018 version.

#7 Updated by Martti Virtanen over 4 years ago

2017-03-13 Expert group
Expert group accepted the change in principal. However the changes have to be checked for more general applicability.

#8 Updated by Martti Virtanen over 4 years ago

  • File Technical changes case #506.xlsx added
  • Subject changed from New DRG in MDC22 for outpatient cases with procedure QXD00/QXSD00 Dressing of major burn of unspecified region to New DRG in MDC22 for outpatient cases with Dressing of major burn

2017-05-02 Martti Virtanen
This change is to get a more correct grouping for outpatient cases with extensive dressing of burn. These cases are resource intesive than a usual controll of a burn patient without any intervention.

Currently the cases with the interventions QxSD00 'Dressing of major burn of ...' (x=A/B/C/D/X) are assigned in short therapy with anaesthesia to DRG 472O 'Extensive burns w o. r. procedure, short therapy' and without anaesthesia to DRG 922O 'Burns, short therapy w/o significant procedure' since the procedures do not have any OR-property (OR=0)

In Finland thecode QXSD00 'Dressing of major burn of unspecified region' indicats in practise treatment on an extensive area and the other codes of the group are used for minor area interventions. This is not correct usage of the code since 'unspecified' does not mean 'extensive'. More correct coding is combination of any QxSD00 code combined with a diagnosis or a intervention Z-code. Sweden does not have the QXSD00 at all and we dot not about it's usage in other countries.

The technical changes are now modified to fullfill the Finish needs and allow other countries to consider their usage.
In addition to the new procedure property 21S03 'Dressing of major burn' another new property is added 21S04 'Dressing of burn'.
The new DRG is as proposed by Finland 822P 'Dressing of major burn, short therapy' but the code is not 922N. 922 would indicate a contact without any intervention and therefore 822 based code is mor logical.
The new DRG has two rules one based on 22S03 and other based on 22S04 + 22X01 'Extensive burn or corrosion (more than 50%)'.
22X01 is an old diagnosis property available in all countries for selected dx's.
The procedure code ZQXX08 'At least 50% of the skin' indicates the same extension as the dx codes at issue and that has now been given the property 22X01 also.
Procedure propety 22S02 cannot be removed from QXSD00 it would affect other versions and even inpatient DRG assignment of NordDRG Fin.

The new rules are now marked for NordDRG Fin only. The first rule should probably not affect other versions but the second rule can be adopted by other versions.

#9 Updated by Martti Virtanen over 4 years ago

  • File deleted (Technical changes case #506.xlsx)

#10 Updated by Martti Virtanen over 4 years ago

2017-03-05 Martti Virtanen
Since the cases #504 and #506 are closely related the Technical changes are combined.

#11 Updated by Martti Virtanen almost 4 years ago

  • Status changed from Active to Accepted

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