Case #573

Procedures on embryo and ICSI

Added by Kristiina Kahur over 2 years ago. Updated over 1 year ago.

Status:AcceptedStart date:2018-01-15
Priority:MinorSpent time:-
Assignee:Kristiina Kahur
Category:-
Target version:Target version 2019
Initiator:Finland Target year:2019
Case type: Owner / responsible:National organisations
MDC:MDC13 Old forum status:
Target Grouper:FIN

Description

Problem
This case is linked to case #568 and concerns the different procedures on/with embryo and ICSI (Intracytoplasmic Sperm Injection). In Finnish NCSP version, there are six NCSP codes related to infertility procedures with following codes:
TLW00/LCXA00 Insemination
TLW10/LCXA10 Transfer of embryo
TLW11/LCXA11 Transmyometral transfer of embryo
TLW12/LCXA12 Insertion of stored embryo
TLW14/LCXA30 Intracytoplasmic Sperm Injection (ICSI)
TLW20/LCXA80 Medical ovulation induction

Two of them (TLW10 and TLW11) have currently OR=2 and PROCPR 13S02 Uterine or adnexal procedure and the cases group to DRG 359O Revision of DRG 359O Uterine and adnexal procedures for non-malignancy, short therapy (see case #568 with suggestion to change it).
The cases with TLW00, TLW12, TLW14 and TLW20 have no properties currently, and group to DRG 913O Disease or disorder of the female reproductive system, short therapy w/o significant procedure.
From cost point of view, the current grouping rules are not fair and should be revised and corrected.

Analysis
For analysis, the data of five Finnish university was used.
All cases with any of the six codes were analyzed.
Total number of the cases was 4 654, out of those the # of cases, mean cost and V% depending on the procedure code were as follows:
TLW00 – 1 337, 300 EUR, 23%
TLW10 – 1 254, 432 EUR, 40%
TLW11 – 3 240, 466 EUR, 49%
TLW12 – 1 653, 460 EUR, 46%
TLW14 – 334, 629 EUR, 61%
TLW20 – 77, 254 EUR, 23%

The mean cost of DRG 913O is 265 EUR which is significantly less than the mean cost of cases with TLW10, TLW11, TLW12 and TLW14 and therefore the cases with those codes should belong to a separate DRG (see also case #568, it is suggested to introduce a new DRG 359P Intervention on embryo or ICSI, short therapy).
Cases with TLW20 are suitable for DRG 913O.
Cases with TLW00 would fit better to DRG 813O Non-extensive procedure of female reproductive system, short therapy which has mean cost of 385 EUR.
Cases with the code TLW20 could remain in DRG 913O.

Suggestion
Based on the analysis, we suggest the following:
1) Codes TLW12 and TWL14 will be added the PROCPR 13S22 Intervention on embryo or ICSI (codes TLW10 and TLW11 will get the same PROCPR according to suggestion of case #568)
2) Codes TLW12 and TWL14 will be added OR=2
3) Code TWL00 will be added OR=2.

DRG change
After the suggested changes the outpatient cases with procedure code TLW12 and TLW14 (and TLW10 and TLW11) will be grouped to DRG 359P Intervention on embryo or ICSI, short therapy.
The outpatient cases with procedure code TLW00 will be grouped to DRG 813O Non-extensive procedure of female reproductive system, short therapy.

Technical changes
Appendix 1.

Cost analysis
Cost analysis is based on five university hospitals’ data of year 2016, grouped with Finnish 2018 grouper.

Appendix1_technical_changes.xlsx - Appendix 1 (18.4 KB) Kristiina Kahur, 2018-01-15 16:44

Technical changes case #568&573.xlsx (72.9 KB) Martti Virtanen, 2018-02-28 18:37

Technical changes case #568&573 - 2.xlsx (72.6 KB) Martti Virtanen, 2018-12-17 15:05

History

#1 Updated by Martti Virtanen over 2 years ago

2018-02-28 Martti Virtanen
This case is closely related to case #568 abd therefore I have combined the technical changes for them.
The procedure properties are used as in case #568.
The changes to the codes:
LCXA00 Insemination - OR=2
LCXA12 Insertion of stored embryo - OR=2 and 13S02
LCXA30 Intracytoplasmic Sperm Injection (ICSI)- OR=2 and 13S02
will affect all versions and all countries must accept them.

#2 Updated by Martti Virtanen over 1 year ago

2018-03-13 Expert group
Accepted for all versions. See Swedish modification in case #568.

#3 Updated by Martti Virtanen over 1 year ago

  • Status changed from Active to Accepted

Also available in: Atom PDF