ENA Incision in palate
|Target version:||Target version 2018|
|MDC:||MDC03||Owner / responsible:|
|Target Grouper:||Old forum status:|
The procedure EHA00 incision in palate and the procedures ENA00 Incision in pharynx and EMA00 Incision in the tonsille are similar according to resources and time request. The indication for an incision in the palate or pharynx may be the same indication as for example abscess. However the procedures have quite different properties.
1 14S90 00X99 03S05
2 03O05 03S12 21S09 00X99
2 03O05 03S11 00X99
We would like the procedures to have the same properties. We suggest that EHA00 Incision in the palate gets the same properties as ENA00, which also includes a change from OR 1 to OR2 for this procedure.
#3 Updated by Mats Fernström over 4 years ago
Mats Fernström, NPK, Sweden, 2017-03-05
I agree that EHA00 (incision in palate) and ENA00 (incision in pharynx) are rather similar and that they can have the same properties but PROCPR 03S12 is not so good. It leads to DRG C29/063 ‘Other major ear, nose, mouth & throat o. r. procedures’ and this is not a procedure. Furthermore, our DRG C29O has an average cost > 15 000 SEK and the cases with EHA00 cost only 3 200 SEK. I think PROCPR 03S99 ‘Minor procedure in ear, nose and throat diseases’ is better.
#5 Updated by Kristiina Kahur over 4 years ago
Finnish National DRG-centre 2017-3-8
In Finland code EHA00 has been used only once (cost of the case 2694 EUR) and most probably the coding (dx or proc) has been incorrect because the case ends up in DRG 477 (main dx L028 Abscessus, furunculi sive carbunculi aliis hocis specificatis).
Number of cases of code ENA00 is 124, in outpatient settings the mean cost is 299 EUR (DRG 803O), and in inpatient settings 6877 EUR (DRG 063). The mean cost of DRG 063 (including all cases) is 7427 EUR (after trimming 1% 6618 EUR).
Due to the very low number of cases of code EHA00 we cannot adequately assed the suggestion. Either way (original Norwegian or modified Swedish) the impact on grouping of Finnish data would be non-remarkable.
#6 Updated by Ralph Dahlgren over 4 years ago
Ralph Dahlgtren, Department of Helath and Wellfare Sweden 2017-04-05
The two involved procedurecodes are:
ENA00 Incision i farynx eller närliggande mjukdelar (i)
EHA00 Incision av gom
In the case the wish was to let the 2 procedure codes get the same properties. At the Expert-groupmeeting 20170313-14 it was decided that they should be grouped to the same DRG. Mats Fenström suggested that the codes should have 03S99. Everyone agreed on this. This means also that the codes gets OR2. This since the procedures are minor. Martti Wirtanen has made Technical changes that has to be modified according to the decision, this technical changes were made before the meeting.
EHA00 Incision av gom has in Sweden grouping properties: OR 1, PROCPR 03S05, PROCPR 14S90. These should be changed to OR 2, PROCPR 03S99, PROCPR 03V05, PROCPR 21S09.
ENA00 Incision i farynx eller närliggande mjukdelar (i) should not have PROCPR 03S12 but PROCPRO 03S99. The rest of the properties for ENA00 will remain as before.
I have enclosed suggested technical changes, at least how they would look like in Sweden.
Please make corrections or comments if this is not correct.