Revision the grouping rules of DRG 041Q
|Target version:||Target version 2019|
|Case type:||Owner / responsible:||National organisations|
|MDC:||MDC02||Old forum status:|
The case is related to case #514 from last year and concerns the use of anesthesia during the eye procedure. Previously, a special PROCPR 02X10 Eye anesthesia was given to three anesthesia codes:
WX140/WAA140 Parabulbar anesthesia
WX142/WAA142 Sub-tenon anesthesia
WX408/WAA408 Combination anesthesia/General anaesthesia, balanced.
This made possible to group the cases with procedure codes having PROCPR 02S03 Extraocular procedure but not procedure of the orbit into DRG 041Q Other interventions for problems in eye region, with anesthesia, short therapy.
However, the codes WX400/WAA400 Inhalation anaesthesia and WX404/WAA404 Intravenous general anaesthesia were not given this property.
The additional analysis shows that there are cases, where whether inhalation or intravenous general anaesthesia is used when it comes to performing the eye procedures.
Currently, the cases with WX400 and WX404 group mainly to DRGs 041R Other interventions for problems in eye region, without anesthesia, short therapy and 902O Disease or disorder of the eye, short therapy w/o significant procedure, which is not correct.
Related to the same issue, there is code XCD00/CDFD00 (also mapped to CXFA08) Clinical examination of eye in general anaesthesia, which by definition should be done in anaesthesia. In current grouping logic, the code XCD00 has no property at all, at least not in Finnish version. That creates the situation where the cases with XCD00 are grouped to DRG 902O, regardless the presence of any anaesthesia code.
For analysis, the data of five Finnish university was used.
The cases in MDC2 with procedure codes WX400 and WX404 cost 1427 EUR as average, V% 34%.
The mean cost of DRG 041Q Other interventions for problems in eye region, with anesthesia, short therapy is 1744 EUR, while the mean cost of DRGs 041R and 902O is 1059 and 188 EUR, respectively. From cost point of view, and also clinically, the cases with WX400 and WX404 belong to DRG 041Q rather than to DRGs 041R or 902O.
The vast majority of the cases with XCD00 are currently grouped to DRG 902O, because the procedure code has no impact on grouping. The mean cost of the cases with XCD00 is 1371 EUR, V% 35%.
The analysis shows, that the coding of anesthesia codes together with XDC00 differ, and not always the anesthesia code is present even though the procedure should be performed in anesthesia.
Based on the analysis, we suggest adding PROCPR 02X10 Eye anesthesia to three procedures codes:
WX400/WAA400 Inhalation anaesthesia
WX404/WAA404 Intravenous general anaesthesia, and
XCD00/CDFD00 Clinical examination of eye in general anaesthesia.
In addition, the code XCD00/CDFD00 Clinical examination of eye in general anaesthesia, which currently has no properties, should be added the PROCPR 02S03 Extraocular procedure but not procedure of the orbit.
After the suggested changes the outpatient cases with procedure codes having PROCPR 02S03 and same time anesthesia code WX400 or WX404 will end up in DRG 041Q Other interventions for problems in eye region, with anesthesia, short therapy.
Cost analysis is based on five university hospitals’ data of year 2015, grouped with Finnish 2018 grouper.
#1 Updated by Kristiina Kahur over 1 year ago
- Subject changed from Adding PROCPR 02X10 to WX400/WAA400 Inhalation anaesthesia, WX404/WAA404 Intravenous general anaesthesia and XCD00/CDFD00 Clinical examination of eye in general anaesthesia, and PROCPR 02S03 to XCD00/CDFD00 to Revision the grouping rules of DRG 041Q
- Target version set to Target version 2019
#2 Updated by Martti Virtanen about 1 year ago
- File Technical changes case #572.xlsx added
2018-02-28 Martti Virtanen
The eye anaesthaesia rule exists only in NordDRG Fin and the change will not affect other countries for that part.
However, 02S03 is used by several rules and by all versions.
The other countries have to accept the change.
#3 Updated by Mats Fernström about 1 year ago
Mats Fernström, NPK Sweden 2018-04-10 (Swe ID C747)
We have analyzed the effect of adding 02S03 and 00X10 ‘General anesthesia’ to the procedure code XCD00/CDFD00 ‘Clinical examination of eye in general anaesthesia’ because it is obvious that 00X10 also must be added, even though it is not mentioned in the original suggestion.
The grouping result will be better than the current in the sense that the average cost of the patients with XCD00 approaches the average cost of each DRG, especially for outpatients. See C747 KPP-data 2016.xlsx for details. Thus we support the Finnish suggestion provided that DGPROP 00X10 ‘General anesthesia’ also is added to the code XCD00/CDFD00. The file with technical changes for the Swedish SOS version (TC_C747_2018-04-10.xlsx) is included for information.
#5 Updated by Martti Virtanen 4 months ago
- File Technical changes case #572.xlsx added
- Status changed from Active to Further active
The proposal was accepted for all versions. Sweden has confirmed this (see above).
The addition of 00X10 proposed by Sweden is concidered as an addtional correction of error.
The case remains active to allow comments for that additional change.