Case #583

Division of DRG 209C 'Secondary prosthetic replacement in hip joint'

Added by Hanne Osnes-Ringen about 2 years ago. Updated about 1 year ago.

Status:AcceptedStart date:2018-01-26
Priority:MajorSpent time:-
Assignee:Hanne Osnes-Ringen
Category:-
Target version:Target version 2019
Initiator:Norway Target year:2019
Case type:Major Owner / responsible:
MDC:MDC08 Old forum status:
Target Grouper:COMMON

Description

Problem
The case concerns DRG 209C “Utskifting av hofteprotese” (Secondary prosthetic replacement in hip joint) which includes clinically heterogeneous patient groups despite mainly similar procedures. The main reason for the proposal is the difference in the cause of surgery which again creates economical heterogeneity within the group. There is a cost difference depending on the main diagnosis. Patients with infections (T84.5 Infeksjon og betennelsesreaksjon som skyldes innvendig leddprotese) who need a secondary prosthetic hip replacement have about double both length of stay in hospital and costs than patients undergoing surgery because of mechanic complications (T84.0 Mekaniske komplikasjoner ved innvendig leddprotese).
We would also like to solve another problem with our reconstruction hip prosthesis which are special replacements used mainly in cancer and trauma patients, and represent only a few cases a year. These patients have about the same time of stay in hospital as the patients undergoing surgery because of infection.

Costs and length of stay in hospital:
1. Secondary prosthetic replacement in hip joint because of mechanic complications (T84.0) Costs 150 000,- NKR, 5,5 days (length of stay in hospital), volum: ca.800
2. Secondary prosthetic replacement in hip joint because of infection (T84.5) Costs 305 000,- NKR, 18,4 days (length of stay in hospital), volum: ca.250
3. Reconstruction prosthesis 20 days (length of stay in hospital), volum: ca.10

Therefore we would like to split the DRG 209C into two new DRGs:
1. Utskifting av hofteprotese” (Secondary prosthetic replacement in hip joint)
Most of the revisions, including mechanic complications and most other causes except for the ones metions below in the “complicated” category
2. Komplisert utskifting av hofteprotese” (Complicated secondary prosthetic replacement in hip joint)
Including revisions because of infections and the reconstruction prosthesis

Technical changes will be added

Technical changes_case 583.xls (121 KB) Anja Fagervold, 2018-01-30 15:43

Technical changes case #583.xlsx (45.2 KB) Martti Virtanen, 2018-03-06 12:41

Technical changes case #583 & #584 .xlsx (59.5 KB) Martti Virtanen, 2018-12-19 12:09

History

#2 Updated by Kristiina Kahur about 2 years ago

Finnish National DRG-Centre 8-2-2018

DRG 209C is one of the quite rear DRGs where the Gauss distributions is almost symmetric. The V% of DRG 209C is 42%, after trimming 1% of the cases from expensive end V% becomes 35%.
Even though there are differences in LOS depending on what has been the cause of secondary hip replacement, the cost do not differ remarkably.
Therefore, and based on the analysis, this change is not necessary for Finland.

#3 Updated by Ralph Dahlgren almost 2 years ago

2018-03-01 Ralph Dahlgren
Sweden has grouped the KPP for Sweden with the Norwegian TC and the result did not change compare to present. DRG H01N Sekundära ledproteser i höft samt replantationer bäcken/höft/lår (Secondary joint prostheses in hip and replantations of pelvis / hip / thighs).
Sweden does not want this change.

#4 Updated by Martti Virtanen almost 2 years ago

2018-03-06 Martti Virtanen
This case is closely related to case #584 and therefore the technical changes are combined.
The cases are technically simple.
If done in a slightly modified way, it will not affect other versions and can be used in Norway if so decided.
For this reason the properties have to be used only for Norway The 08S93 may not be changed, instead we use two new properties 08O50 and 08O51. Logically 08O52 is used for case #854. The added diagnosis property is 08X80. For details see technical changes.
There are two codes in the proposal NFC74 and NFC76 that have been removed from CSP-NOR 2016/12/31, in principle they must not be included in Nor definition tables. They are anyway linked to NFSC99 as the other codes at issue.
The issue of a diagnosis indicating complex situation is a model that NordDRG uses at several occasions. This is however not a true CC-rule.

#5 Updated by Martti Virtanen almost 2 years ago

  • File Technical changes case #583 & #584.xlsx added

#6 Updated by Martti Virtanen about 1 year ago

  • Status changed from Active to Accepted

2018-03-13 Expert group
Expert group accepted the proposed changes.

#8 Updated by Martti Virtanen about 1 year ago

  • File deleted (Technical changes case #583 & #584.xlsx)

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