Case #569

Correction of the properties ABD32 Implantation of temporary spinal stimulation device

Added by Kristiina Kahur over 1 year ago. Updated about 1 month ago.

Status:AcceptedStart date:2018-01-02
Priority:MinorSpent time:-
Assignee:Kristiina Kahur
Category:-
Target version:-
Initiator:Finland Target year:2019
Case type: Owner / responsible:National organisations
MDC:MDC11 Old forum status:
Target Grouper:FIN

Description

Problem
The case concerns the procedure code ABD32/ABSD32 Implantation of temporary spinal stimulation device which exists only in Finnish NCSP version.
In many cases, while using the code ABD32 the cases end up in DRGs 468 or 468O although clinically there is no use of rear or unusual combination of procedure and diagnosis codes. To understand the problem, an analysis was carried out.

Analysis
The analysis is based on five university hospitals’ data of year 2015, grouped with Finnish 2018 grouper.
Currently, code ABD32/ABSD32 are given the following PROCPRs (# 13):
01S02 Spinal procedure
04S02 Other respiratory system OR procedure
05S15 Other vascular procedures
06S10 Other digestive system OR procedure
08S08 Back or neck procedure
09S07 Other skin, subcutaneous tissue or breast procedure
13S08 Other female reproductive system OR procedure
14S90 Significant operation for obstetrical patient
17S01 Major OR procedure in myeloproliferative diseases and disorders
21S09 Other OR procedure for injuries
21S10 OR procedure for trauma
30S99 Other breast procedure
99S90 Extensive OR-procedure.

Ca ¼ of the cases with ABD32 (59 out of 264) end up in DRG 468 or 468O although clinically there is no rear on unspecific combination of diagnosis and NCSP codes. The diagnosis codes mainly used in those cases are from MDC 11 (Diseases and disorders of the kidney and urinary tract). However, the code ABD32 is missing the PROCPR from MDC11 (e.g.11S15 Other kidney or urinary tract OR procedure) and therefor the cases group into DRGs 468/O.

The change is supported by analysis which is based on main diagnosis used together with code ABD32. It shows that:
-25% of the cases with ABD32 group to MDC 6 (Diseases and disorders of the digestive system),
-24% group to MDC 11 (Diseases and disorders of the kidney and urinary tract)
-23% group to MDC 8 (Diseases and disorders of the musculoskeletal system and connective tissue,
-13% group to MDC 1 (Diseases of nervous system),

Most of the cases (# 52) with main diagnosis from MDC 11 have grouped to DRG 468 (# 4) or 468O (# 47). The top 5 main diagnosis in those cases are as follows:
N3282 Non-neurogenic overactivity of bladder (# of cases 14)
N312 Flaccid neuropathic bladder, not elsewhere classified (9)
R33 Retention of urine (6)
N394 Other specified urinary incontinence (6)
N301 Interstitial cystitis (chronic) (4).

Suggestion
Based on the analysis, we suggest adding PROCPR 11S15 Other kidney or urinary tract OR procedure to the procedure code ABD32.

DRG change
After the suggested changes the cases with procedure code ABD32 and with main diagnosis from MDC 11 will be group according to the main diagnosis to respective MDC11 DRGs. Grouping to DRGs 468 or 468O should not happen anymore.

Technical changes
Appendix 1.

Cost analysis
There is no cost analysis carried out because the matter is mainly clinical.

Appendix1_techincal_changes_ABD32_Temp_spinal_stimulation_device - Copy.xlsx - Appendix 1 (12 KB) Kristiina Kahur, 2018-01-02 13:26

Technical changes case #569.xlsx (39.2 KB) Martti Virtanen, 2018-02-28 17:10

History

#1 Updated by Martti Virtanen about 1 year ago

2018-02-28 Martti Virtanen
There is a structural problem or indeed an error in the NCSP structure. There are two groups of codes that have codes for interventions of central nervous system electrodes:

ABSD (ABD) 'Operations on spinal cord and nerve roots for pain or impaired function'
AESA (AEA) 'Operations on stimulation and injection devices in the nervous system'

ABSD is part of the original NCSP and AESA has been added from the beginning of year 2001. As can be read from the rubric treatment of pain was in central role in the original codes but it includes 'impaired function'

The interventions on spinal electrodes and stimulation devices are divided between the two groups (see yellow marked lines in the NCSP sheet).

As indicated by Finland the spinal cord stimulation can be used for indications in several MDC's. ABSD32 has actually a broad spectrum of properties for several MDC's but it misses MDC 11 that is an obvious error. As indicated in case #570 the codes of AESA group have a similar problem.

Looking at all involved interventions there is a need for more changes than proposed by Finland.

#3 Updated by Martti Virtanen about 1 month ago

  • Status changed from Active to Accepted

2018-03-13 Expert group
The proposal was accepted at the expert group.
The discussion about this and related problems of the case #570 will continue as case #612

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