Case #543

Dupuytren’s contracture treated with the procedure NDM06 Percutaneous needle fasciotomy should be grouped to DRG 808I Non-surgical treatment for Dupuytrens contracture.

Added by Anja Fagervold over 2 years ago. Updated almost 2 years ago.

Status:AcceptedStart date:2017-02-22
Priority:MinorSpent time:-
Assignee:Anja Fagervold
Category:-
Target version:Target version 2018
Initiator:Norway Target year:2018
Case type:Minor Owner / responsible:
MDC:MDC08 Old forum status:
Target Grouper:NOR

Description

Problem
Treatment of Dupuytren’s contracture can be done surgical, by medical injection (Xiapex) or by needle fasciotomy. The medical injection, Xiapex is a relatively expensive treatment and is grouped to the DRG 808I Non-surgical treatment for Dupuytren’s contracture (weight 0,215). Treatment by needle fasciotomy is grouped to DRG 877O (weight 0,047). According to the medical experts on this area, the indications to use Xiapex is nearly identical to the indications of using percutaneous needle fasciotomy. We therefore suggest that both treatments will group to the same DRG, DRG 808I.

Analysis
The Norwegian Directorate of Health – 2017-02-22
By 2.tert 2016 there are 632 cases in DRG 808I and 53 cases in DRG 877O with the ICD-10 code M72.0 as its main diagnosis. The quantity treated by percutaneous needle faciotomy is low compared to treatment by medical injection and there is regional differences in the use of procedure NDM06, Percutaneous needle fasciotomy .

The medical experts on the area equalize the two treatments when it comes to indications, the need of supplementary treatments and recurrence. In some cases one treatment is used first, and if the wanted result is not achieved it will be supplemented by the other treatment.

Suggestion
The Norwegian Directorate of Health – 2017-02-22
Since the more expensive treatment with medical injections is not a significant better first choice than the treatment with percutaneous needle fasciotomy we think they should group to the same DRG. We suggest that also the treatment by needle fasciotomy, procedurecode NDM06, is grouped to DRG 808I Non-surgical treatment for Dupuytren’s contracture.

DRG change
The cases with diagnosis M72.0 and procedure code NDM06 will group to DRG 808I instead of 877O.

Technical change
DGPROP 00X99 will be replaced with DGPROP 08O23 in the properties of NDM06.

Technical changes case _543.xls (45.5 KB) Anja Fagervold, 2017-03-02 13:59

Technical changes case #543.xlsx (20.5 KB) Martti Virtanen, 2017-04-11 13:39

History

#1 Updated by Anja Fagervold over 2 years ago

  • File Technical changes case _543.xls added

#2 Updated by Susann Berggren over 2 years ago

Susan Berggren The Swedish National Board of Health and Welfare 2017-02-28
Sweden has not DRG 808I, so it's not an issue for Sweden.
Would like to point out that the title of Technical changes are not consistent with this case, mixed with # 544 New born and # 543Dupuytren's contracture

#3 Updated by Anja Fagervold over 2 years ago

  • File deleted (Technical changes case _543.xls)

#4 Updated by Kristiina Kahur over 2 years ago

Finnish National DRG-centre 2017-2-28

The case is related to earlier case #272 (http://documents.norddrg.net/issues/272)
No respective code for NDM06/NDXM00 is used in Finland according to NCSP+.
The coding of the procedure in case of Dupuytren's contracture varies between the hospitals. Following codes are used for that purpose:
-NDM99/NDSM99 Other operation on fascia, ganglion, synovial sheath or bursa of wrist or hand
-TNX00/NXXX00 Puncture or needle biopsy of soft tissue; unspecified region
-NDM10/NDSM00 Fasciotomy or partial of total excision of fascia of wrist or hand combined with XX1XT/XXX1XT Other puncture with other radiological guidance
-TND10/NDXX10 Arthrocentesis; wrist and hand
-TQX20/QXXX20 Implantation of subcutaneous medicament implant
Same codes must be used for other purposes in other hospitals and therefore we cannot define the cases with Dupuytren's contracture and provide the cost data.
There are no DRGs like 808I or 877O in Finland and therefore the proposal does not concern Finland explicitly.

#6 Updated by Martti Virtanen over 2 years ago

  • File Technical changes case _543.xlsx added

2017-03-08 Martti Virtanen
Minor correction to technical changes.

#7 Updated by Martti Virtanen over 2 years ago

2017-03-13 Expert group
Norway want that these cases to be assigned to the same DRG as ZXXX98/WBGM45 'Other local administration' by property 08O23 'Non-surgery treatment of Dupuytrens contraktur'.
Sweden doese not want this, and Finland is not ready for it.
The property 08O23 is only used in NordDRG Nor and the change will not affect other versions.
The property 00X99 is autogenerated and cannot be edited.

#8 Updated by Martti Virtanen over 2 years ago

  • File deleted (Technical changes case _543.xlsx)

#9 Updated by Martti Virtanen almost 2 years ago

  • Status changed from Active to Accepted

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