Case #527

Plastic surgery after excessive weight loss (incl post bariatric surgery)

Added by Hanne Osnes-Ringen almost 5 years ago. Updated almost 4 years ago.

Status:AcceptedStart date:2017-01-27
Priority:MajorSpent time:-
Assignee:Hanne Osnes-Ringen
Target version:Target version 2018
Initiator:Norway Target year:2018
MDC:MDC09 Owner / responsible:
Target Grouper:NOR Old forum status:


From 2016 we introduced four new procedure codes for post bariatric surgery. These four codes replaced a single procedure code. These procedures represent differences according to resources and time acquired. The actual procedures are listed below. Until now the post bariatric surgery has been included in the main diagnostic group 10.
We think that it is more natural that these procedures belong to main diagnostic group 9, skin. Therefore we now would like to develop new DRG groups for these procedures. Two new DRG groups for postbariatric surgery are acquired for these procedures according to meaningfulness and homogeneity.
QBJ00 Fettsuging i trunkus
QBJ10 Minibukplastikk Ekskl.: Flytting av umbilicus. Se QBJ 15
QBJ15 Full bukplastikk Inkl: Flytting av umbilicus
QBJ20 Full bukplastikk med vertikal komponent
QBJ25 Belteplastikk
QBJ99 Other cosmetic correction on skin on truncus

Number of surgery:
2016 (første 2 tertial?) 2015
QBJ 00 487
QBJ 10 131
QBJ 15 581
QBJ 20 114
QBJ 25 15
QBJ 99 198 214
QBJ30 283 1619
Totalt 1809 1823

To establish two new DRGs in the main diagnostic group 9, instead of DRG 288O in the main diagnostic group 10.
QBJ00, QBJ10 and QBJ99 in one DRG for minor post bariatric surgery and one DRG for major post bariatric surgery whcich includes QBJ15, QBJ20 and QBJ25.

Technical changes case_527.xls (76.5 KB) Kristin Dahlen, 2017-03-01 14:26

Technical changes case #527-2.xlsx (33.6 KB) Martti Virtanen, 2017-05-05 12:36

Technical changes case #527-3.xlsx (36.5 KB) Martti Virtanen, 2017-12-14 17:33


#1 Updated by Kristiina Kahur almost 5 years ago

Finnish National DRG-centre 2017-2-14

In Finland only two out of six codes mentioned in the proposal are used and mapped to NCSP+ codes:
QBJ00/QBSJ00 Liposuction in trunk, and
QBJ99/QBSJ99 Other aesthetic correction of skin of trunk.

The rest of the codes provided by Norway are linked to NCSP+ code QBSJ05 Other correction of loose or redundant skin of trunk and there are no respective codes in Finnish NCSP version.

All QBJ codes in Finnish version have MDC10 and MDC9 properties and the grouping depends on the main diagnosis. That said, there seems to be no need to change the properties, rather it is up to coding guidelines.
As for creating the new DRGs it may make sense if the cost data support it and the # of cases is sufficient.

#2 Updated by Kristin Dahlen over 4 years ago

  • File Technical changes case_527.xls added
  • Subject changed from Post bariatric surgery to Plastic surgery after excessive weight loss (incl post bariatric surgery)
  • MDC deleted (MDC10)

We have modified the case somewhat to take into account also other major weight loss (i.e. do not need to be post bariatric surgery). This will be reflected through the "technical changes" including the DRG names of the suggested new DRGs.

#3 Updated by Mats Fernström over 4 years ago

Mats Fernström, NPK, Sweden, 2017-03-05
This change is not possible to do in the Swedish version because we don’t have the procedure codes QBJ10, QBJ15, QBJ20 and QBJ25. We only have
  • QBJ00 Fettsugning på bål
  • QBJ30 Korrektion av hängbuk
  • QBJ35 Annan korrektion av hudöverskott eller lös hud på bål
  • QBJ99 Annan operation av estetiska orsaker på bål
    They all have PROCPR 09S02 leading to DRG J20/268 (Skin & subcutaneus tissue plastic procedures) if the principal diagnosis is in MDC 09 and they are never grouped to DRG 288 (Gastrointestinal procedure for obesity).

#4 Updated by Martti Virtanen over 4 years ago

2017-03-08 Martti Virtanen
DRG 288O 'Gastrointestinal procedure for obesity, short therapy' or 288A 'Gastroinstestinal procedure for obesity' are clearly wrong DRG's for cases with skin interventions in the gropu QxJxx. DRG 293O is possible if the principal dx is obesity (from MDC 10). In principle 288B 'Other procedure for obesity' could be possible with MDC 10 principal dx but the interventions at issue do not ahve the property 10S04. Instead they have 10S08 resulting in 292/3 'Other endocrine, nutritional or metabolic disease o. r. procedure with or without cc'.
The proposed changes would give a number of unwanted effects in all versions of NordDRG and it thus not possible.
It would be possible to create specific rules connected to the treatment of obesity. Then probably the principle dx should be from the E66 -group.
It is important to note that postbariatric situation is not the only reason to do these interventions.

#5 Updated by Martti Virtanen over 4 years ago

2017-03-13 Expert group
Expert group recommended acceptance of the case for Norway. The technical changes need to be rewritten though.

#6 Updated by Martti Virtanen over 4 years ago

  • File Technical changes case #527.xlsx added

2017-04-19 Martti Virtanen
The technical changes are now rewritten. The Norwegian proposal has several problems if the groupers of the other counties may not change.
1.) To make liposuction (QBSJ00) to OR=1 intervention affects all versions. Therefore I have removed it curently. If this is necesary there must be a separate code for Norway.
2.) The property 00X99 cannot be removed and it is neither necesary. It only indicates, that these interventions can be used without another intervention code.
3.) The property 09S02 cannot not be removed since it affects the other versions. However, it does not affect the NordDRG Nor DRG assignment, since the rules for 09S02 are after 09S10/09S11.
4.) for this mode the QBJ10 'Minibukplastik'/'Minor abdominal plastic' is linked to QBSJ00 'Liposuction in trunk'.

The OR=1 property of liposuction needs either to be accepted by the other participants or Norway needs an own code in NCSP+ for this intervention.

#7 Updated by Kristiina Kahur over 4 years ago

Finnish National DRG-centre 2017-4-20

In order to accept the OR property change OR=2 -> OR=1 of liposuction code QBSJ00/QBJ00 we need to analyze the impact of it. The change may cause some unwanted changes, especially in outpatient DRGs, and therefore we are not ready to accept the change without proper analyses.
Thus, we would suggest no changes of OR property of liposuction code in Finnish 2018 version.

#8 Updated by Martti Virtanen over 4 years ago

  • File Kopio Technical changes case #527-2.xlsx added

2017-05-05 Martti Virtanen
Because Finland does not accept th change of QBSJ00 'Liposuction of trunk' OR=2 to OR=1 we have to solve the problem in another way.
The Norwegian code QBJ00 'Fettsuging i trunkus' will be linked to QBSJ05 'Other correction of loose or redundant skin of trunk' that has the decided proberties.
In the NDMS the new DRG's have to be coded 530NX and 531NX. In the Norwegian DRGnames they will have the codes 530 and 531.

#9 Updated by Martti Virtanen over 4 years ago

  • File deleted (Technical changes case #527.xlsx)

#11 Updated by Martti Virtanen over 4 years ago

  • File deleted (Kopio Technical changes case #527-2.xlsx)

#12 Updated by Martti Virtanen almost 4 years ago

  • File Technical changes case #527-3.xlsx added

2107-12-14 Martti Virtanen

This case has been mixed with case #540. Both use proc. property 09S10 for different purposes.
To correct this, the property 09S10 of this case has been changed to 09S12 (PROCPRO, PROC and LOGIC tables).

In addition Norway wants to limit the rule to obesity only. Therefore the it is limited instead of MDC 09 (all skinn diseses) to principal diagnosis property 09P04 'Loose excessive skin'. The property is given to only one code L9870 'Loose excessive skin'. Demand on specified MDC is no more needed.

If other countries consider the updated change, it can also be discussed whether 'Obesity' in group E66 should also have the property 09P04.

The changes are inluced in the updated technical changes.

#13 Updated by Kristin Dahlen almost 4 years ago

A slight clarification for the technical change. The same criteria for diagnose and procedures should also be implemented for DRG 530O.

#15 Updated by Martti Virtanen almost 4 years ago

  • File deleted (Technical changes case #527-3.xlsx)

#16 Updated by Martti Virtanen almost 4 years ago

  • Status changed from Active to Accepted

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