Case #635

Injection into the vocal cord

Added by Hanne Osnes-Ringen 4 months ago. Updated 3 months 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:MDC03 Old forum status:
Target Grouper:NOR

Description

DQE10 Injection into the vocal cord

The NCSP procedure DQE10 Injection into the vocal cord (Injeksjon i stemmebåndet) is a minor procedure and less expensive than the other procedures in DRG 55O (Diverse større operasjoner på Øre/nese/hals, dagkirurgisk behandling).

We would like the DQE10 Injection in the vocal cord to gorup to DRG 803N Annen poliklinisk utredning og behandling av ØNH-tilstander med spesifikke tiltak (Outpatient care, examination and treatment of other ear, nose and trouth with specific treatment) instead of DRG 55O.

DQE10 har the following properties: OR=1, 03S10 and 14S90.
We would rather like the procedure DQE10 to have the following properties: OR=2, 03S99 and 14S90.

Costanalyses:

We have cost analyses from one hospital which indicate that 1/3 of the episodes in DRG55O includes the procedure DQE10. The mean cost in the DRG 55O now (including the procedure DQE10) is appoximately 20 000 Nkr, if the procedure DQE10 is removed from the DRG55O the mean cost is appoximately 30 000 Nkr.

Appendix C800.xlsx (11.2 KB) Mats Fernström, 2019-02-21 16:36

Technical changes case #635.xlsx (32.8 KB) Martti Virtanen, 2019-03-07 13:49

History

#1 Updated by Kristiina Kahur 4 months ago

Finnish National DRG-Centre 2019-2-18

The average cost of the cases where DQE10 has been coded as main procedure is ca 1200 EUR. In some cases also anesthesia is coded in addition to DQE10 which increases the average up to 1750 EUR. In some cases endoscopic procedure has been coded, and the average cost of those cases is ca 1000 EUR.
The average cost of DRG 803O is ca 500 EUR and of DRG 055O 1430 EUR.
Based on the cost analysis we would rather keep the cases with DQE10 in DRG 055O.

#2 Updated by Mats Fernström 4 months ago

Mats Fernström, NPK Sweden 2019-02-21 (Swe ID C800)
Hanne, do you really mean DRG 803N? I wonder because the suggested property 03S99 does not lead to DRG 803N – it leads to DRG 55P (C16O in Swe version). But then the OR property must still be =1 because there is no rule for DRG 55P with OR = 2. Besides, an OR change from 1 to 2 will have the result that all our cases with QDE10, both inpatients and outpatients, will be grouped to conservative DRGs, i.e. DRGs without significant procedures. That may happen also in the Common version. It is of course possible to insert a new rule for DRG 55P with OR = P (and 03S99) but that will affect many more procedures and if that is good or bad has to be analyzed.
Our cost data show that outpatient cases with QDE10 fit better in DRG 55P (see Appendix C800.xlsx). For such a change it is enough to change the property 03S10 to 03S99 (as you suggest, but without any OR change) and that we can accept. In this context I can inform you that we are planning a larger revision of the DRGs C15O/55O and C16O/55P (Swe ID C391) because they are both very heterogeneous and then we will probably suggest many more changes in version 2021.
If you really mean DRG 803N, your technical changes must be revised. We cannot object to DRG 803N because we don’t have that DRG, but we think that you should consider DRG 55P instead for better consistency between the national versions.

#3 Updated by Martti Virtanen 4 months ago

2019-03-07 NCC (MV)
The national version are quite different in this area (see technical changes). DRG 055P/C16O is only used in Sweden. In Norway most of the cases would be assigned to DRG 803N 'Other outpatient examination of ear, nos and moth with specific interventions' (Nor - Annen poliklinisk utredning og behandling av ØNH-tilstander med spesifiserte tiltak) that only exists in NordDRG Nor. In Finland the cases would be assigned to DRG 803O 'Non-extensive procedure of ear, nose, mouth and throat, short therapy' that is not used in Norway.

And the area is heterogenous and has been discussed several times.

The Norwegian proposal cannot be performed as such. Before considering it further one should have total cost of the patient, not just the intervention cost.

#4 Updated by Hanne Osnes-Ringen 3 months ago

We do not have the total costs for these patients this year, we might have more costs on this next year. If Sweden are planning a larger revision(2021)of these heterogeneous DRGs, we would rather wait until 2021.

#5 Updated by Martti Virtanen 3 months ago

  • Status changed from Active to Further active

2018-03-11 Expert group
The case was postponed for further analysis by Sweden and Norway

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