Case #634

Removal of urethal sphincter prothesis

Added by Hanne Osnes-Ringen 4 months ago. Updated 3 months ago.

Status:AcceptedStart 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:MDC11 Old forum status:
Target Grouper:NOR

Description

Removal of urethal sphincter prothesis

Procedure KDK40 Removal of urethal sphincter prothesis has the same properties as insertion of a spinchter prothesis. However, the removal does not include the cost of the spinchterprotesis itself and does not belong in the DRG 307N/307O Insertion of spinchter prothesis. Therefore, we would like to remove the property 11S11 for this procedure (see the table below). The procedure can then group to DRG 313 Surgery on the urethra, which includes procedures with more similar costs.

KDK40 Fjerning av urethral sfinkterprotese 1 11S06 11S11 14S90 21S09
KDK40 Fjerning av urethral sfinkterprotese 1 11S06 14S90 21S09

Technical changes case #634.xlsx (59 KB) Martti Virtanen, 2019-03-07 13:07

Technical changes case #634-2.xlsx (59.8 KB) Martti Virtanen, 2019-03-28 10:15

History

#1 Updated by Kristiina Kahur 4 months ago

Finnish National DRG-Centre 2019-2-18

Very few cases (#3) where code KDK40 has been coded as main procedure. The average cost of such cases is ca 5000 EUR.
The cases of insertion of a spinchter prosthesis (KDK00 and KDK10) are about twice more expensive (ca 10000 EUR).
Average cost of DRG 313 is about 2600 EUR (# of cases 160).
As there are very few cases where KDK40 has been used for coding the main procedure, the change would have minimal impact. We would support this change.
After removal of PROCPR 11S11, the grouping of cases with KDK40 would happen according to remaining PROCPR 11S06 Urethra procedures to DRG 312 or 313 (depending on cc).

#2 Updated by Martti Virtanen 4 months ago

2019-03-07 NCC (MV)
Based on the Finish cost per patient data, it seems possible to remove the property 11S11 from KDSK40 'Removal of artificial urethral sphincter' in use on all NordDRG countries.
See technical changes.

#3 Updated by Ralph Dahlgren 3 months ago

2019-03-08 Ralph Dahlgren
The procedure code KDK40 Avlägsnande av artificiell sfinkter (KDK40 Removal of urethal sphincter prothesis) is grouped to DRG 'M08N Insättning/revision/uttag av artificiell uretrasfinkter', coresponds to Common DRG 307N Artificial urethral sphincter procedure.
The Swedish DRG text shows that it involves all three procedures, Insertion / Revision / Removal.
When this was discussed before in 2016(?) Sweden thought that it was a good idea to let all of these procedures be grouped to the same DRG. This for a medical description. It is the same surgeons that do the Insertion/Revision and Removal at least in Sweden. There is a cost difference also in Sweden but if we make the suggested changes from Norway the procedure code KDK40 would be grouped into DRG M20N Uretrala operationer (DRG 313 Surgery on the urethra). This DRG gives no information about what have been done except that there has been a surgery done on urethra. We think that the medical discription decreases and since it concerns not so many cases the cost is of second concern.
In Sweden the cost difference is 23% higher between the KDK40 cases and the average weight of DRG M20N.
So Sweden do not want this change.
But if Norway and Finland wants the change to be done it should be possible to be solved we think.
In that case Sweden wants a seperate solution to keep it like it is today. This might be done by Sweden adding a new procpro to the involved codes and we can then add these grouping properties to our DRGlogic. If Martti have a more simple solution, then that is welcome ofcourse.

#4 Updated by Martti Virtanen 3 months ago

  • Status changed from Active to Accepted

2018-03-28 Nordic Casemix Centre Martti Virtanen
As Sweden does not agree with the proposal we have to modify the solution.
To allow both solutions we need as Ralph already said a new property 11S21'Removal of artificial urethral sphincter'. It is given to the intervention KDSK40. The property 11S11 'Artificial urethra sphincter procedures' is removed from KDSK40. In the logic a new rule is created after the rule 411D032100 (id). The new rule is a copy of 411D032100 but procpro1 has the value 11S21. The rule is now only for sweden but other countries have to decide whether they follow the Norwegian or Swedish model. The countries using the Swedish model need to be added to the new row.

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