Case #615

Adding PROCPR 02S24 to codes CKD92/CKSD92, CKD93/CKSD93, CKD94/CKSD94, CKD95/CKSD95

Added by Kristiina Kahur 3 months ago. Updated about 1 month ago.

Status:AcceptedStart date:2019-01-18
Priority:MajorSpent time:-
Assignee:Kristiina Kahur
Category:-
Target version:-
Initiator:Finland Target year:2020
Case type: Owner / responsible:National organisations
MDC:MDC02 Old forum status:
Target Grouper:FIN, ICE

Description

Problem
The case concerns eye surgery. The codes under question are:
CKD92/CKSD92 Combined vitrectomy and retinal procedure
CKD93/CKSD93 Extended combined procedure on vitreous body and retina
CKD94/CKSD94 Combined vitrectomy and procedure on lens through pars plana
CKD95/CKSD95 Extended combined vitrectomy and lens procedure through pars plana
Those codes exist only in Finnish and Icelandic NCPS versions.

All four codes have following procedure properties (PROCPR):
OR=1
02S07 Procedure on vitreous
14S90 Significant operation for obstetrical patient
21S09 Other OR procedure for injuries
21S10 OR procedure for trauma

PROCPR 02S07 does not express the content of the codes entirely, given that the procedure codes include combined procedure on retina, lens and vitreous.

Analysis
Currently the inpatient cases with abovementioned codes group into DRG 042 Other intraocular procedures (based on PROCPR 02S07).
However, each of those four codes combine procedure on vitreous and retina or vitreous and lens and therefore the current PROCPR is not sufficient to reveal the content of the procedures which, in turn, creates inadequate grouping.

Suggestion
To add PROCPR 02S24 Major eye surgery to all following codes:
CKD92/CKSD92 Combined vitrectomy and retinal procedure,
CKD93/CKSD93 Extended combined procedure on vitreous body and retina,
CKD94/CKSD94 Combined vitrectomy and procedure on lens through pars plana and
CKD95/CKSD95 Extended combined vitrectomy and lens procedure through pars plana

PROCPR 02S07 Procedure on vitreous will be remained for short therapy cases.

DRG change
After the suggested changes the inpatient cases with codes CKD92/CKSD92, CKD93/CKSD93, CKD94/CKSD94 and CKD95/CKSD95 will group to DRG 036D Major eye procedure instead of DRG 042 Other intraocular procedures (unless glaucoma diagnosis codes with DGPROP 02X02 is indicated as primary or secondary diagnosis).

Cost analysis
Not carried out, it is about clinical judgment of correctness of the procedure properties.

Technical changes
Appendix 1. The technical changes may contain mistakes and have to be double-checked.

Appendix1_Change_PROCPRs_CKD92_CKD93_CKD94_CKD95.xlsx - Appendix 1 (28.1 KB) Kristiina Kahur, 2019-01-18 09:45

Technical changes case #615.xlsx (6.2 MB) Martti Virtanen, 2019-03-04 12:51

History

#1 Updated by Martti Virtanen about 1 month ago

2019-03-04 NCC
This proposal affects only NodrDRG Fin and Ice. See Technical changes.

#2 Updated by Martti Virtanen about 1 month ago

2018-03-11 Expert group
The proposal was accepted.

#3 Updated by Martti Virtanen about 1 month ago

  • Status changed from Active to Accepted

Also available in: Atom PDF