Case #528

Delayed suture or wound revision with delayed suture

Added by Hanne Osnes-Ringen over 4 years ago. Updated over 4 years ago.

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

Description

The DRG weight of the skin procedures QxG30 Delayed suture compared to the DRG weight for QxB05 Wound revision with delayed suture is not logical.
The DRG weight for QxG30 is approximately 9 x the DRG weight for QxB05.
The following codes are affected:
QAG30 or QAB05
QBG30 or QBB05
QCG30 or QCB05
QDG30 or QDB05
QXG30 or QXB05

Eks.: Diagnostic code S00.8 or L98.4 with QAG30 DRG270O weight 0,237 HD 9
Diagnostic code S00.8 or L98.4 with QAB05 DRG809S weight 0,027 HD 9
Is this a problem for anybody else?

History

#1 Updated by Kristiina Kahur over 4 years ago

Finnish National DRG-centre 2017-2-14

In Finland the cases with QXB05 (Revision of wound of skin of unspecified region) group to DRG 909O (Cost-weight 0.27), the rest of QxB05 codes (Revision of wound of skin of specified region) -> DRG 809O (CW 0.66).

The cases with QxG30 (Delayed skin closure of surgical wound of other regions) group to DRG 270O (CW 0.53), excl. the cases with QCG30 (Delayed skin closure of surgical wound of upper limb) which group to DRG 266O (CW 3.20)
Thus, there is no such a difference between the CWs of DRGs 270O and 809O which would make us to concern.

#2 Updated by Kristin Dahlen over 4 years ago

Revision of wound of skin (QxB05) have OR=2 while delayed suture (QxG30) have OR=1 in the Norwegian version. This seem to be the case also in Finland according to Kristiinas comments. The difference in cost weight between a surgical DRG and a DRG for minor procedures on outpatients are quite high in Norway. The question is whether the difference in OR is logical in these cases.

Susan comment that Sweden do not have these codes. What are the codes for this kind of procedures in Sweden, and how will this cases be grouped?

#3 Updated by Martti Virtanen over 4 years ago

2017-03-08 Martti Virtanen
QxSG30 is 'Delayed skin closure of surgical wound..' and GxSB05 'Revision of wound of skin..' which mean quit different interventions.

Delayed skin closer of surcigal wound is done, when in an intervetion the wound cannot be closed (because infection, oedema or somthing similar) and it is a very complicated situation. Even the closure may be more complicated. It is a surgical wound i.e. a result of an operation.

Revision of wound is either an operation on a previously closed wound or a fresh wound the demands some 'cleaning'.

The rules are the same for both Finish and Norwegian version. Sweden has the same codes with the same properties.

The Norwegian translation actually misses the word 'surgical' which propably changes the meaning fo QxSG30 codes.

#4 Updated by Veronika Stemme over 4 years ago

Veronika Stemme, Sweden:
The codes do exist in Sweden except for QXG30 .The cases in Sweden are grouped like this: Together with diagnosis L98.4 the procedures QxG30 ‘Delayed skin closure of surgical wound’ are grouped to DRG J39O/270O ‘Other skin & subcutaneous tissue procedures, short therapy’(weight 0,179) except for QCG30 which is grouped to DRG J04O/266O ‘Skin graft &/or debrid for skin ulcer or cellulitis, short therapy’(weigth 0,244). Together with diagnosis L98.4 the procedures QxB05 ‘Revision of wound of skin’ are grouped to DRG J76O/824V ‘Skin procedures, major except excision/biopsy, short therapy’ (weight 0,045). When looking at cost data, the cases fits ok where they are. The cases of QxG30 in DRG J39O are few, 19 cases in 2015, and we think that is too few motivate a change in grouping.
We wonder about the text for the QxB05-codes written in the case by Norway ‘Wound revision with delayed suture’. Does Norway use that text? In Sweden the text for these codes is only ‘Revision of wound of skin’.

#5 Updated by Martti Virtanen over 4 years ago

  • Status changed from Active to Rejected

2017-03-13 Expert group
Problem in translation. Unclear what is needed. Case can be reactivated if necessary.

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