Nordic Casemix Centre

Problem
Code WD325 Demanding therapy of methastized malignancy with biomodifiers has PROCPR 99S71 Demanding biomodifier therapy which is correct but not in line with general logic of PROCPRs given to biomodifiers.
PROPPR 99S71 determines the grouping into DRG 299B Metabolic disorders, biomodifier therapy. There was no such cases in DRG 299B in 2017 where the code WD325 would have been coded.

At the same time, the outpatient cases with WD325 currently groupe to different short therapy DRGs w/o significant procedure.
Vast majority of them (72%) group to DRG 917O Malignant disease, short therapy w/o significant procedure. But depending on the main diagnosis they also group e.g. to DRG 904O Disease and disorder of the respiratory system, short therapy w/o significant procedure, DRG 9110 Disease or disorder of the kidney and urinary tract, short therapy w/o significant procedure and 909O Disease or disorder of the skin and subcutaneous tissue system, short therapy w/o significant procedure.
Code WD325 is used in Iceland and Finland only.

Analysis
For analysis, the data of five Finnish university was used from year 2017.
Outpatient cases with WD325 in DRG 917O have the mean cost 1418 EUR, whereas the mean cost of DRG 917O including all cases is 465 EUR. This is not correct from economic perspective.

Suggestion
Based on the analysis we suggest adding PROCPR 99S80 Standard cytostatic therapy to procedure code WD325 Demanding therapy of methastized malignancy with biomodifiers.

DRG change
After the suggested changes, the outpatient cases with procedure code WD325 will group to short therapy DRGs of cytostatic therapy depending on the main diagnosis (see Appendix 1).

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