Questions and answers #519
Endovascular coiling of cerebral arteries
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The procedure of endovascular coiling for ruptured cerebral aneurysm and AV-malformation was started here in Iceland last year. We are not exactly sure how to code this procedure. The physician who performs this procedure is using the NCSP code AASC20 (anastomosis to intracranial vessel). We wonder if the codes AAXC20 (endovascular occlusion of intracranial aneurysm) and AACX22 (endovascular occlusion of intracranial arterio-venous malformation) are more appropriate. Does this endovascular procedure fit in the same DRG group as open brain surgeries?
When for example the ICD10 code for subarachnoid bleeding I60* is used the case goes into the DRG group 001B (other intracranial vascular surgery) regardless of whether the NCSP code AAXC22 or AASC20 is used. Does this endovascular procedure fit in the same DRG group as open brain surgeries?
We would appreciate any comments from you on how this procedure is coded and grouped in your country.
#1 Updated by Kristiina Kahur over 2 years ago
Finnish National DRG-Centre 2017-2-10
Seems that the procedure codes AAXC20/AAXC22 are more relevant here (there is probably a typo in the text, AACX22->AAXC22) since endovascular coiling is a minimally invasive technique, which means an incision in the skull is not required to treat the brain aneurysm (thanks Dr Google).
What is the approximate cost of new procedure (in case you have data available)? That would facilitate the analysis based on Finnish data.
#2 Updated by Lilija Tararina over 2 years ago
About case 519.
Endovascular coiling of cerebral arteries in Latvia provide endovascular radiologists.
The NCSP procedures cods for unruptured cerebral aneurysm, ruptured cerebral aneurysm ,arterio-venous malformation in Latvia :
AAL00- Endovascular occlusion of intracranial aneurysm;
AAL20- Endovascurar occlusion of intracranial arterio- venous malformation.
Cases with ICD 10 diagnosis I67.1-Cerebral aneurysm, nonrupted- grouping result is 001C-Surgery of intracranial aneurysm, vascular anomaly or hemangioma.
Cases with diagnosis I60.1,I60.2,I60.3,I60.4,I60.6,subarachnoid bleeding-grouping result is 001B-Other intracranial vascular surgery.
In terms of costs- endovascular coiling embolisation surgery is expensive due to the following :
Surgery-endovascular occlusion of intracranial aneurysm using microcatheter/ or Endovascular occlusion of intracranial malformation.
metal platin coils ( different number ),
balloon (assisted coiling),
stent (assisted coiling),
liquid embolic ONYX (rarely).
Mentioned items are included in Latvia existing information system and tariffs.
(Actually we use both system-this and NCSP).
It may be necessary to create separate DRG group for the endovasal occlusion after careful analysis ?
Looking forward to seeing you all in Rīgā!
#3 Updated by Veronika Stemme about 2 years ago
In Sweden the procedure codes AAL00 (NCSP AAXC20) ‘Endovascular occlusion due to intracranial aneurysm’ and AAL20 (NCSP AAXC22) ‘Endovascular occlusion due to intracranial A-V malformation’ lead to DRG A04N (NDMS-DRG 001CN) ‘Intervention of intracranial vascular abnormality or infarction’ or A08 (NDMS-DRG 001B) ‘Other intracranial vascular surgery’ dependent on diagnosis. Cases with ICD-10-code I67.1 Cerebral aneurysm, not ruptured will go to DRG A04 and cases with ICD-10-code in I60 Subarachnoid haemorrhage or I61 Intracerebral haemorrhage go to DRG A08. We think this gives acceptable medical description and the coding/DRG-grouping is supported by Swedish cost data.