Case #636

Removal and change of catheter for dialysis

Added by Ralph Dahlgren 9 months ago. Updated 8 months ago.

Status:Further activeStart date:2019-02-23
Priority:MinorSpent time:-
Assignee:Ralph Dahlgren
Category:-
Target version:NordDRG 2020
Initiator:Sweden Target year:2020
Case type:Minor Owner / responsible:National organisations
MDC:GEN Old forum status:
Target Grouper:SWE

Description

Problem
While working on another case (#622) the Swedish DRG-team discovered that the procedure code DK005 (mapped to PHXA52, Island has the code) Byte av tunnelerad hemodialyskateter (Exchange of venous dialysis catheter) does not have any OR property, Sweden suggest that it should get OR2.
The Swedish procedure code SB382 Avlägsnande av central venkateter för dialys, tunnelerad (i) (Mapped to DHX30 Removal of fixed intrave-nous catheter) has in Sweden no grouping properties at all.
Sweden wants SP382 to have OR 2 and Procpr 40V11.
Suggestion for Sweden is that both codes for Sweden get mapped to PHXA50 Implantation or exchange of double lumen dialysis catheter.
Island has to decide how they want to do with their code PHXA52, if Island agree or not, to let the code get OR 2.
Either way the Swedish procedure code SP382 should have a different mapping.
When trying to read the NCSP+ Excel file we think that a SP382 could be mapped to DHX50.
Island is naturally allowed to keep the grouping property for their code PHXA52 Exchange of venous dialysis catheter.
If so Sweden wants to get DK005 mapped to DXH50 which we think then will get the grouping properties OR2 and procpr 40V11.
Very important is to recognize that our mapping suggestion is very much a suggestion since the mapping configuration is hard to get an overview over.
Analysis
The Swedish Department of Health and Welfare 2019-02-05
In the Swedsih cost data base we can find a total number of 157 cases with the procedure code SP382 Avlägsnande av central venkateter för dialys, tunnelerad (i) (Mapped to DHX30 Removal of fixed intrave-nous catheter) . The total cost regardless of DRG of 921 483 SEK. This gives an average cost per procedure SP382 of 5 869 SEK.
The suggestion is to give SP382 grouping properties OR2 and procpr 40V11. This means that in open care the cases will be grouped to DRG X51O Venkatetrar, besök (Venous catheters, visit). The grouping propery in Sweden to group is procpr 40V11, disch N, Dur <1. See below.
drg english rtc procpro1 disch dur
X51O Venous catheters, visit 0 40V11 N <1
DRG X51O Venc catheters, visit has a cost in KPP 2016
Occupational category N mean cost
All 6 223 5 584 SEK
XS915 Doctor 1 388 6 121 SEK.
The average cost for procedure code SP382 is 5 869 SEK.
This means that for Sweden it fits quite well inte this DRG X51O.

Suggestion
The Swedish Department of Health and Welfare 2019-02-05
Sweden wants the procedure code DK005 (mapped to PHXA52, Island has the code) Byte av tunnelerad hemodialyskateter (Exchange of venous dialysis catheter) to get also OR2.
Sweden wants SP382 to have OR 2 and Procpr 40V11.
I have tried to read the NCSP+ Excel file.
Because of this the suggestion is from Sweden that both suggested codes (DK005, SP382) get mapped to ‘PHXA50 Implantation or exchange of double lumen dialysis catheter’.
Island is naturally allowed to keep the grouping property for their code PHXA52 Exchange of venous dialysis catheter.
In this case Sweden wants to get DK005 mapped to DXH50 which we think then will get the grouping properties OR2 and procpr 40V11.
As mentioned above it iws very important to recognize that our mapping suggestion is very much a suggestion since the mapping configuration is hard to get an overview over.

Decided changes
The Swedish Department of Health and Welfare 2019-02-05
Sweden wants this to be implemented for our definitiontables in PL 2020
DRG change
When grouping the Swedish Patient register on out-patient care we found out that the changes were a total of 105 cases out of ~15 million cases.
So our preliminary conclusion that there would be only a few cases that will be grouped differently was correct.
The following DRG are the ones that the cases were moved from.
E99O 05 Övriga läkarbesök vid sjukdomar i cirkulationsorganen 2 poster (SWE Com 795O Medical contact for circulatory problem, short therapy)
G38O 07 Läkarbesök vid sjukdomar i lever utom malign tumör, cirros och alkoholhepatit 1 post (SWE Com 206O Disorders of liver except malig, cirr, alc hepa, short therapy)
H55O 08 Läkarbesök vid bindvävssjukdomar och vaskuliter 1 post (SWE com 241O Läkarbesök vid bindvävssjukdomar och vaskuliter)
J79O 09 Hudingrepp, övriga, öppenvård 1 post (826O Minor dermatologic intervention, short therapy)
M31O 11 Läkarbesök vid njursvikt 64 poster (SWE com 316O Kidney failure, short therapy)
M99O 11 Övriga läkarbesök vid sjukdomar i njure och urinvägar 4 poster (842O Other medical contact for urogenital problem, short therapy)
N50O 12 Läkarbesök vid inflammation/infektion i pung, penis etc 1 post. ( SWE com 350O Läkarbesök vid inflammation i genitalia hos man) This case is a wrong typing of the ICD-10 code.
O40Q 13 Läkarbesök vid tumörer i området adnexa-vulva, ej komplicerat öppenvård 1 post (SWE com 376Q Läkarbesök vid maligna tumörer i genitalia hos kvinna, ej komplicerat )
U42O 21 Läkarbesök vid behandlingskomplikationer utan kirurgisk åtgärd 1 post (SWE com 453O Swe - Läkarbesök vid behandlingskomplikationer utan kirurgisk åtgärd)
W99O 23 Övriga läkarbesök vid andra problem 29 poster (SWE com 884O Other medical contact for other problems, short therapy )
The DRG above are only in Sweden. Cannot say how the changes would affect Island.

We excpected the cases with new properties to be moved to DRG X51O Venkatetrar, besök (Com 898O Cannulation and cathetrisation of vein, short therapy) which they were.

Technical change
The code DK005 (mapped to PHXA52, Island has the code) Byte av tunnelerad hemodialyskateter (Exchange of venous dialysis catheter) gets OR2.
The code SP382 gets OR 2 and Procpr 40V11.

Suggestion Technical Changes for C775 Removal of catheter for dialysis.xlsx (14.7 KB) Ralph Dahlgren, 2019-02-23 14:22

Technical changes case #636-2.xlsx (61.5 KB) Martti Virtanen, 2019-03-28 16:36

History

#1 Updated by Martti Virtanen 9 months ago

  • File Technical changes case #636.xlsx added
  • Description updated (diff)

2019-03-18 NCC
This is a fairly straigth forward case. If Iceland does not disagree we keep the mappings and add the properties proposed by Sweden.
I would expect the Swedish cost accounting is valid for Iceland too.
The property 40V11 only affects Sweden.

#2 Updated by Martti Virtanen 8 months ago

2019-03-11 Martti Virtanen
I realize that I promised too much. I must have been in a harry and missed some features.
PHXA52 'Exchange of venous dialysis catheter' has only one linked code in Sweden (DG005) and one in Iceland (PHXA52).
PHXB30 'Removal of fixed intravenous catheter' has nowever several linked codes in Sweden but not in the other countries.

We can easily create a new NCSP+ code for SP382 'Removal of tunneled dialysis catheter'. However one must ask why SP381 i.e. removal of not tunneled dailysis catherter is handled diffently or why SP282 'Removal of tunneled multi lumen catheter' is different. Please look at techinical changes NCSP+ sheet to see all linked codes.

We need a confirmation from Sweden if possible within next 2-3 weeks, what is the solution that suits them best. This will not affect other countries.

#3 Updated by Martti Virtanen 8 months ago

  • File deleted (Technical changes case #636.xlsx)

#4 Updated by Martti Virtanen 8 months ago

  • Status changed from Active to Further active

#5 Updated by Mats Fernström 8 months ago

Mats Fernström, NPK Sweden 2019-04-04 (Swe ID C775)
Yes, we want both PHXA52/DK005 and PHXB30/SP382 to have OR=2 instead of OR=0 and for PHXB30/SP382 we want PROCPR 40V11 to be added.
The reason why SP381 and SP282 are handled differently in our suggestion is that SP381 is not tunneled and SP282 is a thinner catheter, not used for dialysis, at least not in Sweden.

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