Case #515

DRG 802O Non-extensive procedure of eye, short therapy– separating the cases puncture of vitreous body with injection of medication

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

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

Description

Problem
Procedure code CKD05/CKSD05 Puncture of vitreous body with injection of medication has the PROCPROP OR=2 and no other properties which groups the outpatient cases with CKD05 to the 800-series DRGs. Vast majority of the cases (ca 20 000) with CKD05 is in DRG 802O Non-extensive procedure of eye, short therapy. Compared to other cases in DRG 802O, the CKD05 cases have ca 1,5 times higher mean cost and it would make sense to separate the cases of CKD05 from DRG 802O and create a separate DRG.

Analysis
The cases with CKD05 in DRG 802O have mean cost 545 EUR in 2015 and 442 EUR in 2014. Same time the mean cost of other cases in DRG 802O is 318 EUR and 300 EUR, respectively.
The variation coefficient of DRG 802O in 2015 is 106% (in 2014 103%). After separating the cases with CKD05, the V% of rest cases would decrease and amounts to 90% (84%) The V% of cases with CKD05 decreases as well and amounts to 103% (104%). Trimming improves the values of V% in all instances.

Suggestion
Given the difference of mean cost within DRG 802O between the cases with CKD05 and without CKD05, we propose to separate from DRG 802O the cases with CKD05 and create the new group for that purpose.

DRG change
After the suggested change the cases with procedure code CKD05 currently in DRG 802O will be grouped to separate/new DRG (802P). CKD05 will be given new PROCPROP 02S25 (unless it is taken already in other versions)
The name of the new DRG will be provided after discussion the case in Expertnetwork meeting. For testing period the name of the CKD05 is used.

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_DRG802O_CKD05_Appendix1.xlsx - Appendix 1 (10.9 KB) Kristiina Kahur, 2017-01-20 14:18

MDC2_Oftalmology_DRG802O_CKD05_Appendix2.xlsx - Appendix 2 (21.1 KB) Kristiina Kahur, 2017-01-20 14:18

Case 515_Norwegian DRG solution.xlsx (10.2 KB) Kristin Dahlen, 2017-03-06 15:47

Technical changes case #509-517-2.xlsx (66.4 KB) Martti Virtanen, 2017-06-15 14:05

Technical changes case #509-517-2.xlsx (66 KB) Martti Virtanen, 2017-06-17 00:03

History

#1 Updated by Mats Fernström over 3 years ago

Mats Fernström, NPK, Sweden 2017-03-04 (NPK ID C679)
We do not have this DRG. Ten years ago we divided all 800-series DRGs into a bit more than 130 procedure related groups. One of these is DRG B78O Läkemedelstillförsel i ögonregionen (there is no official English text but it could be “Drug administration in the eye region”). Procedure codes included in this DRG are:
CKD05 Injektion av läkemedel i glaskropp
TCA15 Retrobulbär injektion av läkemedel i orbita
TCA20 Peribulbär injektion av läkemedel i orbita
TCB20 Injektion av läkemedel i ögonlock
TCE00 Injektion av läkemedel i ögonmuskel
TCF00 Subkonjunktival injektion av läkemedel
In our KPP for 2015 we had almost 56 000 cases (average cost 4 500 SEK) in this DRG and 95 % of them had the procedure code CKD05 so one can say that we already have a DRG that is rather similar to what you desire.

#2 Updated by Kristin Dahlen over 3 years ago

In the Norwegian version there are already a split of DRG 802O into a
DRG 802P Treatment of AMD or macular edema with local drug injection or photodynamic method and a
DRG 802U other outpatient diagnostic and therapeutic minor procedures in eye.

DRG 802P do include some expensive drugs defined by a Norwegian "særkode" based on the ATC-code. This is implemented in the DRG Logic.

#3 Updated by Martti Virtanen over 3 years ago

2017-03-09 Martti Virtanen
3 different models int the same area!
The Swedish model is actually fairly close the Finnish proposal. The resource use of the related interventions should be analyzed.
The Norwegian model is getting inactivated because critical related codes are inactivated??

#4 Updated by Kristiina Kahur over 3 years ago

Finnish National DRG-centre 2017-3-29

We have checked the Swedish and Norwegian model from cost point of view.
The results show that cost of cases other than CKD05 differ from CKD05 cases both directions, some are twice cheeper and vice versa. It might be that the cost of medication in different countries create the differences.
Thus, we suggest that the changes in Finnish 2018 version will be made according to original Finnish proposal. And so we end up with three different models in the same area.

#5 Updated by Martti Virtanen about 3 years ago

  • File Technical changes case #515.xlsx added

2017-03-13 Expert group
Expert group accepted the case for NordDRG Fin only.
As illustrated by the technical changes tables, this will not affect other versions.

#6 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.

#7 Updated by Martti Virtanen about 3 years ago

  • File deleted (Technical changes case #515.xlsx)

#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 Technical changes case #514-517.xlsx added

#10 Updated by Martti Virtanen about 3 years ago

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

#11 Updated by Martti Virtanen about 3 years ago

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

#13 Updated by Martti Virtanen about 3 years ago

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

#15 Updated by Martti Virtanen about 3 years ago

2017-05-17 Martti Virtanen
DRG code changed to 802FP - national code in Finland 802P.

#16 Updated by Martti Virtanen over 2 years ago

  • Status changed from Active to Accepted

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