Questions and answers #551

FNG05 and TFP00 lead to DRG 115A Removal of permanent cardiac pacemaker or defibrillator

Added by Malle Avarsoo about 2 years ago. Updated about 2 years ago.

Status:ActiveStart date:2017-04-05
Priority:MinorDue date:
Assignee:Malle AvarsooSpent time:-
Category:-
Initiator:Estonia Target year:
MDC: Owner / responsible:
Target Grouper:EST Old forum status:

Description

NCSP codes FNG05 and TFP00 seem to have clinically conflicting importance.
Please look into the following discovery in EST version and advise if this kind of logic is present in other versions too.

Code FNG 05 Percutaneous transluminal coronary angioplasty with insertion of stent ( FNSG05) must have more importance in grouping logic than code TFP00 Temporary use of transvenous or epicardial pacemaker ( FPXX00 ), as PTCA with stent is much more resouce consuming procedure and use of temporary pacemaker often is present in PTCA. In Estonian version, when TFP00 and FNG05 codes are both used in PTCA procedure case, the case will be grouped into DRG 115A Removal of permanent cardiac pacemaker or defibrillator, which is not clinically correct.

I have analysed our data ( not too many cases), such logic creates expensive subgroup of cases in 115A.
Use of temporary pacemaker and use of code TFP00 should not group PTCA cases to DRG 115A.
I am not ready to suggest the technical ORD change, but the sequence/importance needs to be evaluated and corrected.
I have attached analyse of cases from Estonia, where difference in costs and clinical essence is clearly seen.

In case there has been some earlier discussion on the matter or technical matter, I would be happy to know.

115A_question_2017.xlsx (11.4 KB) Malle Avarsoo, 2017-04-05 12:52

History

#1 Updated by Ralph Dahlgren about 2 years ago

20170411. We have looked at your question. In Sweden are all the PCI patients grouped to DRG 112E, 112F Swedish E18C E18E E19N.
These DRG are in our DRGlogic placed above the DRG´s concerning Pacemaker DRG 115A Swedish DRG E27E DRG 115A E27A.
This allows the PCI patients to always be grouped into a PCI DRG, regardless if they use external pacemaker or not.
We can't find any cases in our PCI DRG which also has external pace-maker.

#2 Updated by Kristiina Kahur about 2 years ago

  • File PCI_pacemaker_DRG112_115.xls added

Finnish National DRG-centre 2017-4-13

We had a look at this case too.

In Finnish DRG logic the rules of PCI DRGs come only after the rules of DRG 115A, which means the cases where in addition to PCI the procedures of pacemaker are performed, the cases end up in pacemaker DRG.
So the rules in Finland are different from Swedish ones and similar to Estonian ones. Also the Common and other countries’ versions' rules differ from Swedish ones.

In appendix “DRG112_115_all_countries” the current order of the grouping rules of DRGs 112 and 115 is presented (it’s part of the file Martti has put together and it combines definition tables of all countries)

We would suggest to make a new case about this topic for next year which would give everybody time for more proper analysis in order to find the proof for changes.

#3 Updated by Kristiina Kahur almost 2 years ago

  • File deleted (PCI_pacemaker_DRG112_115.xls)

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