Case #633

Liposuction

Added by Hanne Osnes-Ringen 2 months ago. Updated 29 days ago.

Status:Further activeStart date:2019-02-15
Priority:MinorSpent time:-
Assignee:Hanne Osnes-Ringen
Category:-
Target version:NordDRG 2020
Initiator:Norway Target year:2020
Case type:Minor Owner / responsible:
MDC:OR Old forum status:
Target Grouper:COMMON

Description

The NCSP codes for liposuction have different OR properties, we would like all the procedures for liposuction to have the OR property 1.

The NSCP procedures for liposuction:

HAD20 Fettsuging i mamma 1 14S90 30S04
QAJ00 Fettsuging på hode eller hals 2 09S02 10S08
QBJ00 Fettsuging i trunkus 1 09S02 09S11
QCJ00 Fettsuging på overekstremitet 2 09S02 10S08
QDJ00 Fettsuging i underekstremitet 2 09S02 10S08
QXJ00 Fettsuging i uspesifisert hudregion 1 09S02 14S90

After the change:

HAD20 Fettsuging i mamma 1 14S90 30S04
QAJ00 Fettsuging på hode eller hals 1 09S02 10S08
QBJ00 Fettsuging i trunkus 1 09S02 09S11
QCJ00 Fettsuging på overekstremitet 1 09S02 10S08
QDJ00 Fettsuging i underekstremitet 1 09S02 10S08
QXJ00 Fettsuging i uspesifisert hudregion 1 09S02 14S90

HAD20 belongs in MDC14 and QAJ00, QBJ00, QCJ00, QDJ00 and QXJ00 in MDC09.

Technical changes case #633.xlsx (31.6 KB) Martti Virtanen, 2019-03-07 12:43

History

#1 Updated by Kristiina Kahur 2 months ago

Finnish National DRG-Centre 2019-2-15

Seems that OR 1 has been given to HAD20 and QXJ00 because they also have PROCPR 14S90 Significant operation for obstetrical patient. However, there should not be difference whether the liposuction is performed on e.g trunk (QBJ00, OR=1) or on unspecified region (QXJ00, OR=2), which can be performed in any region having no specific code.
We checked if there is difference in cost depending on the procedure in MDC 9 and 30. The cost of the cases where one of the five codes is present varies between 1940-4481 EUR (mean cost of all cases 3697 EUR).
34% of the OR=2 cases have also anesthesia code coded at same time.
Based on this, we would consider to implement proposed change.

We also noticed a mapping discrepancy in NCSP+ (2019). Currently NOR code QBJ00 is mapped to QBSJ05. Whereas QBJ00 in EST, FIN, SWE, LAT versions is mapped to QBSJ00 which is also ICE code. Shouldn't they all be mapped to QBSJ00?

#2 Updated by Ralph Dahlgren 2 months ago

20190-02-23 Ralph Dahlgren
As to the suggested changes Sweden would from Norway like to see som data, involved numbers of patients, costdata and what happens when grouping with the new grouping properties compared to the old grouping. This is due to the fact that an OR change ’2’ to ’1’ will make a change in grouping both in outpatient and for inpatient.
In Sweden we have DRG J20O Plastikkirurgiska operationer i hud och underhud, öppenvård (Common version DRG 268O Skin & subcutaneus tissue plastic procedures, short therapy) but we also have DRG L75O Fettsugning, öppenvård (822O Liposuction, short therapy). The last DRG is only in Sweden.
With the suggested changes our cases with the procedure codes:
code NCSP english
QAJ00 QASJ00 Fettsugning i huvud-halsregion
QBJ00 QBSJ00 Fettsugning på bål
QCJ00 QCSJ00 Fettsugning, övre extremitet
QDJ00 QDSJ00 Fettsugning, nedre extremitet
Will be grouped differently.
Instead of be grouped to DRG L75O Fettsugning, öppenvård (822O Liposuction, short therapy) they will be grouped to DRG DRG J20O Plastikkirurgiska operationer i hud och underhud, öppenvård (Common 268O Skin & subcutaneus tissue plastic procedures, short therapy).
Sweden has alot of private practitioners that does these procedures and some are reimbursed by DRG so they would loose out.
The cost difference between the two DRG is 26%, L75O has a higher weight.
This diference is in Sweden above the level we have for splitting a DRG. Moving cases without knowing more is not so good.
For a start Sweden would have to be looking at the grouping before, after when it come to the outcome for both in-patient and out-patient in PAR (Swedish Patient data base), but also for in- and out-patient in KPP (Cost data base). This to see if we can make the change in a way that would not have such an inpact on our system.
This is alot of work and Sweden will not be able to do this right now, it cannot be done before the next Expert Group meeting in 2020.
So for now Sweden do not accept these suggested changes.

#3 Updated by Martti Virtanen about 1 month ago

2019-03-07 NCC (MV)
This case has a history. See case #527.
Liposuction is advertised to be be done with local anaesthesia, thus it is questionable if it should be considered as OR=1 intervention without registered anaesthesia. That again is a problem for Norway.
If there is a difference between liposuction of breast (HASD20 has OR=1) and other areas (QASJ00, QBSJ00, QCSJ00 and QDSJ00 have OR=2) is questionable. Even more questionable is that QXSJ00 has OR=1. By not telling where you did it you get better payment??
QBJ00 in Norway is mapped to QBSJ05 to give it different properties (see #527) – at that time we could neither agree!
I think there is reason to discuss this again. It seems that the techniques have evolved and the interventions are somewhat different now.

#4 Updated by Martti Virtanen 29 days ago

  • Status changed from Active to Further active

2019-03-11 Expert group
The case was postponed by demand from Norway who iniated the case.

Also available in: Atom PDF