Case #539

Diastasis recti

Added by Mats Fernström over 4 years ago. Updated over 3 years ago.

Status:AcceptedStart date:2017-02-22
Priority:MinorSpent time:-
Assignee:Mats Fernström
Category:-
Target version:Target version 2018
Initiator:Sweden Target year:2018
MDC:MDC06 Owner / responsible:National organisations
Target Grouper:SWE Old forum status:

Description

Problem
Diastasis between the rectus abdominal muscles is coded with M62.0 ‘Muskeldiastas (M6200 ‘Diastasis of muscle’). If operated, the procedure codes beginning with JAG are used, JAG10-JAG84 depending on technique. This leads to DRG Z60N ’Annan sällsynt, eller felaktig, kombination av huvuddiagnos och åtgärd’ (former DRG 477 ‘Rare or incorrect combination of diagnosis and other procedure’). Operation of diastasis recti is neither rare, nor incorrect. These cases should be grouped to DRG F20 (former DRG 159/160 ‘Hernia procedures except inguinal & femoral …’) like cases with ICD code K439 ‘Annat och ospecificerat främre bukväggsbråck utan inklämning eller gangrän‘ (Ventral hernia without obstruction or gangrene).
Analysis
NPK, Sweden – 2017-02-20
It is so obvious that these cases should be grouped to DRG F20 (former DRG 159/160 ‘Hernia procedures except inguinal & femoral …’) that an economic analysis is unnecessary. The easiest way to achieve this is to give M620 the same properties as K439, i.e. move it to MDC 06. Conservative cases with M620 as the principal diagnosis will then go from DRG H63 ‘Bursit, tendinit och myosit …’ (former DRG 248) to DRG F59 ‘Andra diagnoser i matsmältningsorganen …’ (former DRG 190). This is OK because the average costs for these DRGs are almost the same (H63E = 21 200 SEK, F59E = 22 000 SEK) and there were only two cases with the principal diagnosis M620 in DRG H63 in our cost data.
There might be a problem if there are cases operated for diastasis of muscle in the musculoskeletal system, they will be grouped to DRG Z60N/477, but I have never heard of such operations and if they should appear, we can then solve the problem with a PDGPROP leading to MDC 08.
Suggestion
NPK, Sweden – 2017-02-20
We suggest that the ICD code M62.0 ‘Muskeldiastas (M6200 ‘Diastasis of muscle’) shall have the same properties as ICD code K439 ‘Annat och ospecificerat främre bukväggsbråck utan inklämning eller gangrän‘ (Ventral hernia without obstruction or gangrene). Proposed technical changes are in Suggestion C655.xlsx.
DRG change
Cases operated for diastasis between the rectus abdominal muscles will go from DRG Z60N/477 to DRG F20 (former DRG 159/160). We have no numbers but the condition is rather frequent. Conservative cases will go from DRG H63 (former DRG 248) to DRG F59 (former DRG 190) but they are rare.

Suggestion C655.xlsx (12.2 KB) Mats Fernström, 2017-02-22 11:20

Technical changes case #539 new.xlsx (23 KB) Martti Virtanen, 2017-05-29 12:15

History

#1 Updated by Kristiina Kahur over 4 years ago

Finnish National DRG-centre 2017-3-3

There is one case in Finnish data with main dx M620 and JAG procedure (JAG96), cost 960 EUR, and it results in DRG 477 as mentioned in the proposal. In total, there are 50 cases with main dx M620.
In addition, there are 27 cases with main dx K439 + JAG procedure in Finnish data, mean cost 7889 EUR, 14 cases in DRG 160, six cases in DRG 160O, the rest in five other DRGs. In total there are ca 3000 cases with main dx K439.
The cost difference is huge but the M620+JAG can be causality or an coding error and therefore the comparison is irrelevant.

We support the proposal.

#2 Updated by Martti Virtanen over 4 years ago

2017-03-08 Martti Virtanen
I support the change.
An intresting feature is that 'Gastroschisis' is a specific congenital condition and therefore the intervention code used is actually not correct.
May be everybody should consider refrasing the name of the intervention.
And peculiar that we haven't notice before that this dx is really not a musculosceletal problem!

#3 Updated by Martti Virtanen over 4 years ago

2017-03-13 Expert group
Expert group accepted the proposal.

#4 Updated by Martti Virtanen over 4 years ago

  • File Technical changes case #539.xlsx added

2017-04-12 Martti Virtanen
When checking the technical changes document I realized that Norway has a number of subcategories to M620. It is unclear, to which extent the added codes in Norway are used, however we must take that possibility in account.
I hope this model solves the problem

#5 Updated by Ralph Dahlgren over 4 years ago

  • Target Grouper SWE added

2017-04-12. Sweden has looked att the technical Changes from 20170412 done by Martti. Martti gave us the possibility to keep PDGPRO 08P10. We would like to keep it, since it is used in the Swedish Rehabilitation. This means that PDGPRO 08P10 should not be removed from M6200 Diastasis of muscle in the table "dg".

#6 Updated by Martti Virtanen over 4 years ago

  • File Technical changes case #539.xlsx added

2017-04-12 Martti Virtanen
Technical changes modified as proposed by Sweden.

#7 Updated by Martti Virtanen over 4 years ago

  • File deleted (Technical changes case #539.xlsx)

#8 Updated by Martti Virtanen over 4 years ago

  • File Technical changes case #539 new.xlsx added

2017-05-04 Martti Virtanen
Technical corrections.

#9 Updated by Martti Virtanen over 4 years ago

  • File deleted (Technical changes case #539.xlsx)

#10 Updated by Martti Virtanen over 4 years ago

2017-05-29 Martti Virtanen
Column headings in ICD+ were in wrong order. Corrected now.

#11 Updated by Martti Virtanen over 4 years ago

  • File deleted (Technical changes case #539 new.xlsx)

#12 Updated by Martti Virtanen over 3 years ago

  • Status changed from Active to Accepted

Also available in: Atom PDF