Case #623

Fiberoendoscopic intubation and Tracheoscopy

Added by Mats Fernström over 2 years ago. Updated over 2 years ago.

Status:AcceptedStart date:2019-01-31
Priority:MinorSpent time:-
Assignee:Mats Fernström
Target version:NordDRG 2020
Initiator:Sweden Target year:2020
MDC:MDC04 Owner / responsible:National organisations
Target Grouper:SWE Old forum status:


Mats Fernström, NPK Sweden 2019-01-31 (Swe ID C582)
An outpatient case with the principal diagnosis in MDC 04 and a bronchoscopy is grouped to DRG D70O ‘Endoskopi av nedre luftvägar, öppenvård’ (former DRG 702O ‘Endoscopy of lower respiratory tract, short therapy’). If there also is performed a fiber endoscopic intubation (KVÅ code DG018, NCSP+ code WAA707) the case will be grouped to DRG D22O ‘Respiratorbehandling för sjukdomar i andningsorganen, öppenvård (former DRG 475O ‘Respiratory system diagnosis with ventilator support, short therapy’) with a lower DRG weight. Thus, addition of a supplementary procedure results in a DRG with lesser weight, which is highly unwanted in the hospitals and it creates an economic incentive to “forget” to report medical interventions to our national Patient Register (PAR). That DRG D22O is “cheaper” than DRG D70O seems to be constant, see Appendix_C582.xlsx with cost data for the years 2015-2017.
The problem is solved by a simple hierarchy change in the table Drglogic. The rule for DRG D70O with ORD 104D0402001 is moved just a few steps up to a position before the rule for DRG D22O with ORD 104D0300001 (see TC_C582.xlsx).
A spin-off in this investigation is that we noticed that cases with the procedure code DG018/WAA707 ‘Trakeal intubation, fiberendoskopisk’/’Fiberoendoscopic intubation’ are much more expensive than the average for DRG D22O/475O and so has it been for the last three years (see Appendix_C582.xlsx). The word “fiberendoskopisk” (fiberoendoscopic) says that there is actually an endoscopy done, so in a medical descriptive perspective it is rather OK to let the cases with DG018/WAA707 go to DRG D70O ‘Endoskopi av nedre luftvägar, öppenvård’ (former DRG 702O ‘Endoscopy of lower respiratory tract, short therapy’). The cases are more expensive than the average for DRG D70O as well, but the difference is less compared to the average for DRG D22O (see Appendix_C582.xlsx). Therefore we propose that the procedure code DG018/WAA707 shall have procedure property 04E02 that leads to DRG D70O. The existing procedure property 04S03 must be retained for the grouping of inpatients.

Appendix_C582.xlsx (13.1 KB) Mats Fernström, 2019-01-31 12:00

TC_C582.xlsx (17.7 KB) Mats Fernström, 2019-01-31 12:00

Technical changes case #623.xlsx (25.3 KB) Martti Virtanen, 2019-03-05 14:41


#1 Updated by Kristiina Kahur over 2 years ago

Finnish National DRG-Centre 2019-2-8

There are around 50 outpatient cases with proc code WAA707 (WX707 in Finnish version). None of them have WAA707 as main and only procedure. None of them are grouped to DRG 075O (D22O) either.
The grouping is affected by some other proc code and not by WAA707, in most cases by code EMSB10 Tonsillectomy, average cost of those cases 1600 EUR, which takes the cases into DRG 060O (Operations on tonsils or adenoids, short therapy). The rules of 060O are higher in the hiearchy than the rules of 075O.
The rest of the cases group into different DRGs, depending on other than WAA707 procedure.
To add PROCPR 04E02 to WAA707 would make sense, even though the impact would be very low in Finnnish version and probably the cases will be picked by rules above the rule for DRG 702O (D70O) and grouped to some other DRGs anyway.

#2 Updated by Martti Virtanen over 2 years ago

2019-03-05 NCC (MV)
This proposal seems to be based on clear economical evidence. If the economic data is valid for other countries as well, it should be done in all versions.
Technical changes shows the necessary changes.

#3 Updated by Martti Virtanen over 2 years ago

  • Status changed from Active to Accepted

2019-03-11 Expert group
The proposal was accepted.

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