Case #514

DRG 041O Other interventions for problems in eye region, short therapy– splitting into two groups– with and without anesthesia

Added by Kristiina Kahur over 3 years ago. Updated over 2 years ago.

Status:AcceptedStart date:2017-01-20
Priority:MajorSpent time:-
Assignee:Kristiina Kahur
Category:-
Target version:Expert Group 2017
Initiator:Finland Target year:2018
Case type: Owner / responsible:National organisations
MDC:MDC02 Old forum status:
Target Grouper:COMMON

Description

Problem
The variation coefficient of DRG 041O has acceptable V% value (73-77%) but within the group there are different peaks which show the uneven distribution of cost in the group. To understand and solve the problem, more thorough analysis was undertaken.

Analysis
The analysis reveals that the main drivers of cost differences are different anesthesia procedures. The main codes used for anesthesia were WX140/WAA140 Parabulbar anesthesia, WX142/WAA142 Sub-tenon anesthesia and WX408/WAA408 Balanced anesthesia.
The cases where any of three anesthesia codes was used were twice as expensive as the cases without anesthesia in DRG041O, i.e. 1 013 EUR vs 1 983 EUR in 2014 and 1 100 EUR versus 2 187 EUR in 2015.
The variation coefficient of split groups would decrease compared to the current V% of DRG 041O:

• 2014 – the V% of DRG 041O was 77%, with anesthesia 56%, without anesthesia 75%.
• 2015 – the respective values were 74%, 64% and 69%.

After trimming 1% of high-end cases the V% improves both years.

Suggestion
Given the remarkable difference of mean cost between two groups of cases within DRG 041O depending on presence of anesthesia we propose to split DRG 041O into two:

a) Other interventions for problems in eye region, with anesthesia, short therapy
b) Other interventions for problems in eye region, without anesthesia, short therapy

Given that the procedure codes WX140 and WX142 do not have anesthesia property they first have to be given one which would refer to eye anesthesia. The same property should be added to code WX408. Thus we suggest to introduce new diagnosis property 02X10 Eye anesthesia and add it to codes WX408, WX140 and WX142.

DRG change
After the suggested changes the cases currently in DRG 041O will be grouped to separate DRGs depending on whether or not the anesthesia has been performed.

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 Finnish 2016 grouper.

MDC2_Oftalmology_DRG041O_split_Appendix1.xlsx - Appendix 1 (10.8 KB) Kristiina Kahur, 2017-01-20 13:12

MDC2_Oftalmology_DRG041O_split_Appendix2.xlsx - Appendix 2 (19.7 KB) Kristiina Kahur, 2017-01-20 13:13

Technical changes case #509-517-2.xlsx (66.4 KB) Martti Virtanen, 2017-06-15 14:07

Technical changes case #509-517-3.xlsx (67.2 KB) Martti Virtanen, 2017-12-14 16:30

History

#1 Updated by Mats Fernström over 3 years ago

Mats Fernström, NPK, Sweden 2017-03-04 (NPK ID C678)
We don’t have the anesthesia codes that are mentioned in the suggestion so we are unable to analyze this case. My principal view is that we should be cautious splitting groups into with and without anesthesia. It can become great many groups, perhaps too many. When it comes to reimbursement, you can of course have two types of bills, one with anesthesia and one without.
I know that we have suggested a similar split in case #518 (Clinical examination requiring general anesthesia) but then it is about conservative DRGs where the anesthesia is the only significant procedure.

#2 Updated by Martti Virtanen over 3 years ago

2017-03-09 Martti Virtanen
Sweden does not have codes for parabulbar or sub-tenon anaesthesia. The situation would be coded with other local anaesthesia, which is not usable for this purpose. Balanced anaesthesia is obviously the most usual anaesthesia form and Sweden has hundreds of anaesthsia codes (SA to SG groups).

#3 Updated by Anja Fagervold over 3 years ago

We agree with Sweden in the principal view that we should be cautious splitting DRGs into groups with and without anesthesia.

#4 Updated by Martti Virtanen about 3 years ago

  • File Technical changes case #514.xlsx added

2017-03-13 Expert group
Expert group accepted the change only for NordDRG Fin.
The principal of of DRG definition based on registered anaesthesia was regarded as suspicious.

#5 Updated by Martti Virtanen about 3 years ago

  • File Technical changes case #514-517.xlsx added

2017-04-25 Martti Virtanen
The cases #509, #514, #515, #517 and #517 are all about ophtalmology and the changes are related. Therefore the technical changes are now combined for those cases. For the changes the cases are referenced in the tables. The tables include extraneous information for checkup of the process. Those lines are not linked to any case and have '---' in IN/OUT column.
In the process I found a few errors in the common logic structure and I have corrected the at the same time.
In case #517 the proposed removal of 02S03 and 02S04 is a misstake. It is marked with yellow and with 'No' in IN/OUT column.

#6 Updated by Martti Virtanen about 3 years ago

  • File deleted (Technical changes case #514.xlsx)

#7 Updated by Martti Virtanen about 3 years ago

  • File Technical changes case #514-517.xlsx added

2014-04-26 Martti Virtanen
Correction to the Technical changes.
DRG 041O is inactivated in the Finnish version, not removed.
102D071010 and 102D0710101 are about 041P not 041O

#8 Updated by Martti Virtanen about 3 years ago

  • File deleted (Technical changes case #514-517.xlsx)

#9 Updated by Martti Virtanen about 3 years ago

  • File deleted (Technical changes case #514-517.xlsx)

#10 Updated by Martti Virtanen about 3 years ago

  • File Technical changes case #509-517.xlsx added

#12 Updated by Martti Virtanen about 3 years ago

  • File deleted (Technical changes case #509-517.xlsx)

#13 Updated by Martti Virtanen over 2 years ago

2017-12-14 Martti Virtanen
Rule 190D0203011 was included in the Nor version, which is incorrect. Norway does not use anaesthaesia coding in DRG assignment
Correct technical changes included.

#14 Updated by Martti Virtanen over 2 years ago

  • Status changed from Active to Accepted

Also available in: Atom PDF