Case #564

Lymph node procedures in malignant melanomas

Added by Mats Fernström over 2 years ago. Updated over 1 year ago.

Status:AcceptedStart date:2017-12-13
Priority:MinorSpent time:-
Assignee:Mats Fernström
Category:-
Target version:Target version 2019
Initiator:Sweden Target year:2019
Case type:Minor Owner / responsible:National organisations
MDC:MDC09 Old forum status:
Target Grouper:COMMON

Description

Problem
Most of the procedure codes for lymph node procedures that can occur in cases with malignant melanoma have the procedure property 09S07 (see Appendix C726.xlsx) leading to DRG J39 ‘Andra operationer vid sjukdomar i hud och underhud’ (former DRG 269/270 ‘Other skin & subcut tiss proc’) but there are three codes that don’t have that property:
PJSA10 Exploration of lymph nodes
PJSD97 Laparoscopic dissection of other lymph nodes
PJSD98 Other block dissection of lymph nodes
Cases with any of these three procedures together with malignant melanoma are grouped to DRG Z60 ‘Annan sällsynt, eller felaktig, kombination av huvuddiagnos och åtgärd’ (former DRG 477 ‘Non-extensive o. r. procedure unrelated to principal diagnosis’) which isn’t correct.
Analysis
NPK, Sweden – 2017-12-13
The three procedure codes at issue may be used in cases with malignant melanoma and other skin malignances and they should have the procedure property 09S07. This is about the medical description and an economic analysis is not necessary.
Suggestion
NPK, Sweden – 2017-12-13
PROCPRO 09S07 is added to the three procedure codes:
PJSA10 Exploration of lymph nodes
PJSD97 Laparoscopic dissection of other lymph nodes
PJSD98 Other block dissection of lymph nodes
DRG change
Cases with any of the three procedure codes at issue and a principal diagnosis in MDC 09 will be grouped to DRG J39 ‘Andra operationer vid sjukdomar i hud och underhud’ (former DRG 269/270 ‘Other skin & subcut tiss proc’) instead of DRG Z60 ‘Annan sällsynt, eller felaktig, kombination av huvuddiagnos och åtgärd’ (former DRG 477 ‘Non-extensive o. r. procedure unrelated to principal diagnosis’).
Technical change
PROCPRO 09S07 is added to the three procedure codes:
PJSA10 Exploration of lymph nodes
PJSD97 Laparoscopic dissection of other lymph nodes
PJSD98 Other block dissection of lymph nodes
See Technical changes C726.xlsx.

Appendix C726.xlsx (10.6 KB) Mats Fernström, 2017-12-13 15:02

Technical changes C726.xlsx (12 KB) Mats Fernström, 2017-12-13 15:02

Technical changes case #564.xlsx (14.9 KB) Martti Virtanen, 2018-02-26 15:20

History

#1 Updated by Kristiina Kahur over 2 years ago

Finnish National DRG-Centre 8-1-2018

In Finland, the code PJD97 has not been used, the code PJD98 has been used only twice, in one case the grouping result was DRG 468O.
The code PJA10 has been used more (# 299), 10% of the cases have ended up in DRG 477O. The main diagnosis of those cases is only once from chapter C. Vast majority of the cases have main diagnosis R22.1 or R22.0 'Localized swelling, mass and lump, neck' or 'Localized swelling, mass and lump, head'.
There is clinically no reason why the cases should end up in DRG 477/468. We support the change.

#2 Updated by Martti Virtanen over 2 years ago

2018-02-26 Martti Virtanen
It is obvious that the procedures should have the property 09S07 for skin diseases.
When looking at the list it strikes one that there are some other properties that are missing from the codes. They are marked in the technical changes and should probably also be added.

PJSD97 is the only one lacking 01S05 'Peripheral or cranial nerve or other nervous system procedure'. Although it is more rare to do laparoscopic excision of lymphnodes with neurolgical disesease, this is certainly not imposible.
None of these interventions has 02S03 'Extraocular procedure but not procedure of the orbit'. This should probably be added. Laparascopi is also here more rare but probably not impossible.
30S99 is a residual group of interventions for MDC 30 'Breast' (originally part of MDC 09) and it is obvious that the 30S99 should be added to PJSD97 also.
MDC 17 has no residual of interventions since all OR=1 procedures are counted in the residual DRG. Therefore 17S01 is not needed for PJSA10 or PJSD97 alhough PJSD98 has it.
The other MDC's not on the list have similarly rules for any OR=1 intervention (15, 18,19) or are otherwise not applicable (20,21,23) and do not need to have specific properties.

#3 Updated by Martti Virtanen over 1 year ago

  • Status changed from Active to Accepted

2018-03-13 Expert group
The proposal was accepted.

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