Case #64

Case 2013-MDC05-01 - Endovenous treatment of varicose veins

Added by Anonymous almost 6 years ago. Updated almost 3 years ago.

Status:AcceptedStart date:2013-08-29
Priority:NormalSpent time:-
Assignee:-
Category:-
Target version:Expert Group 2013
Initiator:Norway Target year:2014
Case type:Major Owner / responsible:Nordic Casemix Centre
MDC:MDC05 Old forum status:CLOSITEM - Closed item
Target Grouper:COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE

Description

Last updated: 2013-04-29

Title: Endovenous treatment of varicose veins

Forum ID: None

National ID: None

Initiated: 2013-02-01

Initiator: Øystein Mathisen, Sykehuset Østfold Norway

Responsible at National organization: The Norwegians Directorate of Health

Sent to NordDRG Forum: 2013-03-07

Status: ACTITEM - Active item

Expert Network 2013-03-12 Change recommended

Board 2013-03-27 Change accepted


Analysis

The Norwegians Directorate of Health – 2013-02-01

The average calculated cost for an varix operation in Norway is appr. 1700 euro, based on ”old” OR techonology, need of general anesthesia and post-operative observation. We don’t have access to cost data on patient level about the new methods. Some of our hospitals who use these methods indicate that the cost of an endovenous  laser operations might be quite similar to the costs of an invasive operation. The main cost drivers are the disposables, dependent on the method used. For laser the cost is estimated to appr 400 Euro pr. operation. (The investment in new tecnology and capital costs are excluded).

The operation time for laser endoscopy is shorter than for the traditional operations (mean time 55 minutes, minimum time is 23 minutes and maximum time is 93 minutes). For the endovenous operations no OR is needed, which lowers the total costs. One private clinic offers an unilateral laser operation for fixed 2500 Euro, whereas the price for stripping starts from 2000 Euro.                        

Suggestion

The Norwegians Directorate of Health – 2013-02-01

Norwegians patient data from 2011 shows that DRG877O have 37 685 cases. Most of them are others than varicose veins operations, and only 20 cases will potentially be moved. DRG 119O has 6 144 cases in the same year, but it might be that some of them are endovenous coded as invasive operations. The strong growth in endovenous technologies in the private sector indicates that this might be the case.

Regardless to volume, the DRG-logic should be considered changed. We suggest that all the varicose veins operations are grouped in the same DRG, preferably DRG 119O or DRG 119 for inpatients. This will promote the medical relevance and most likely the cost-homogenity as well.

The following list presents relevant procedure codes for endovenous techniques (codes in table 1 are used in combination with additional codes in table 2).

COMMENTS

Martti Virtanen 2013-03-08

I detected an error in the NCSP+ mapping. The Swedish and Finnish codes for Sclerotherapy of varicose veins  are mapped to PHX50 'Sclerotherapy of varicose veins' coded TPH10 in original NCSP. The same codes (Swedish and Norwegian) are mapped for Norwegian version to site specific codes for stripping at PHST10-99 with no original NCSP code. Thus the grouping is different in Norway from the other countries. PHX15 has no 05S15 property and the cases are grouped to conservative cases (in Finland) or as outpatients to specific outpatient groups in Sweden.

In  Finland these cases are mostly done in private clinics not using DRG for reimbursement and therefore there has been no interest in correcting this obvious problem.

The Swedish system possibly covers the cost in the specific outpatient group.

For Norway there reason to remind that TPH10 that exists in Norway probably means the same intervention and should be included in the list above.

Mats Fernström, NPK, Sweden 2013-04-04 & 2013-04-23

•PHST18? Misprint? We think it must be PHST15.

•PHST19? Also a misprint? We think it must be PHST99.

•PHST11 (Swedish PHT11 ‘Injektion av läkemedel i eller perkutan ocklusion av v saphena magnas inmynning i v femoralis’) should be handled like PHST10, PHST12 and PHST15, which means proc. prop. 05S18 and OR=1.

•For all the Swedish codes mapped to PHST10, PHST11, PHST12 and PHST15 the procedure properties containing the letter V (05V03 or 05V07) can be omitted since these properties will have no effect when proc. prop. 05S18 and OR=1 have been added.

•The proposed Swedish texts (full and short) to the DRG E30N are specified in “Technical changes SWE 2014.xlsx”.

Martti Virtanen 2013-04-29

PHST 18 and PHST19 were misprints and have bee corrected below.

The 05V03 and 05V07 properties shall be inactivated for the codes mentioned above.

Decided changes

Expert group 2013-03-12

The mappings in the NCSP+ will be changed as follows:

'Endovenous obliteration of v. saphena magna' PHV10 (SWE/NOR/...) and PHM76 (FIN) will be mapped together with PHT10 'Injection of therapeutic agent into or percutaneous occlusion of long saphenous vein '  to PHST10

'Endovenous obliteration of  v. saphena parva' PHV12 (SWE/NOR/...)  and PHM77 (FIN) as well as PHM76 'Endovenous obliteration of v.saphena anterior' will be mapped together with PHT12 'Injection of therapeutic agent into or percutaneous occlusion of short saphenous vein' to PHST12

'Endovenous obliteration of perforant veins of lower leg' PHV13 (SWE/NOR/...) and 'Endovenous obliteration of perforant veins of upper leg' PHV14 and PHM78 (FIN) will be mapped together with PHT15 (SWE/EST/ENG) and PHT13 and PHM78 'Injection of therapeutic agent into or percutaneous occlusion of communicating veins of lower leg or thigh' to PHST15

'Endovenous obliteration of other vein' PHV99 and PHM99 (FIN) and 'Sclerotherapy of varicose veins' TPH10 will be mapped together with PHT99 'Injection of therapeutic agent into or percutaneous occlusion of other vein' to PHST99

The cases of lower extremity varicose vein endovenous therapeutic interventions will be assigned to DRG 119 (E30N) 'Varicose vein therapy' (Obs. new name) even in the absence of diagnosis for varicose vein (dg prop. 05X21) whereas other varicose vein therapeutic interventions will only be assigned to this DRG if a diagnosis for varicose vein problem (dg. prop 05X21) is indicated. Other varicose vein interventions with specified locations will be assigned to DRG 478-479 (E35E-E35C) 'Other vascular procedures' with/without CC. Varicose vein interventions without specified location (PHST99) will not be assigned to surgical DRG's if there is know indication of general anesthesia or similar conditions.

DRG change

PHST10, PHST12 and PHST15 will be assigned to DRG 119 (E30N)

PHST99 will not be assigned to surgical DRG's without additional information on OR-level

Other PHST group codes will be assigned to DRG 478-479 (E35E-E35C)

Technical change

PHST10, PHST12 and PHST15 and all codes mapped to these codes will have proc. prop. 05S15 and OR=1 (and 05V03 and 05V07 are inactivated)

PHST99 and all codes mapped to it will have proc.prop 05S15 and OR=2

All other PHST codes will have 05S15 and OR=1 (Obs. interventions on spermatic and ovarian veins are thus not affected)

 

Introduction:

NordDRG 2014

MDC-05.png (21.1 KB) Anonymous, 2013-10-29 13:04

Technical changes #64.xlsx (15.3 KB) Ralph Dahlgren, 2015-03-25 09:27

Case #64 Technical changes.xlsx - Updated version (19.6 KB) Martti Virtanen, 2015-04-08 12:52

History

#1 Updated by Anonymous almost 6 years ago

  • Case type set to Major
  • Target year 2014 added
  • Owner / responsible National organisations, Nordic Casemix Centre added
  • Initiator Sweden added

#2 Updated by Anonymous almost 6 years ago

  • Initiator Norway added

#3 Updated by Anonymous almost 6 years ago

  • Status changed from Active to Accepted
  • Target Grouper COMMON added

#4 Updated by Anonymous almost 6 years ago

#5 Updated by Anonymous almost 6 years ago

Comment 23.9.2013 Martti Virtanen

An addition to this case. To have property 05S18 in addition to 05S15 will have any effect on the groupin. Additionally it is not logical to have these two properties. Therefore the property 05S18 is removed from codes PHSB99, PCSN30 and PHSD99 and corresponding national codes.

#6 Updated by Anonymous over 5 years ago

Comment 2013-09-23 Martti Virtanen

The interventions for injection of therapeutic agent or perctutaneous occlusion (PHST-group) including the operations on varicose veins have all properties 14S90 'Significant operation for obstetrical patient'
and 21S09 'Other OR procedure for injuries'. Both are highly questionable with these interventions. As part of this case the properties will be removed from codes with property 05S18. The codes with 05S15 are more problematic and need to be discussed later.

#7 Updated by Anonymous over 5 years ago

  • Target version changed from Expert Group 2013 to Expert Group 2014
  • Owner / responsible deleted (National organisations)
  • Target Grouper DEN, EST, FIN, ICE, LAT, NOR, SWE added

Comment 2013-10-16 Martti Virtanen

Based on a comment from Sweden:
The point of property 14S90 is that a patient with an intervention from this group cannot be assigned to for example normal delivery! I would think we agree on that point. A patient with delivery and stripping is hardly a normal delivery neither from clinical nor from resource use point of view. What might be necessary to discuss is whether this type of patients might be assigned to complicated delivery groups, but that demands a further discussion and probably a rather complicated technical solution.

Currently if a delivery patient has principal diagnosis O220 'Varicose veins of lower extremity in pregnancy' together with PHB10 for example, she will be assigned to a MDC 5 DRG based on the property 05S18. She cannot be assigned to the delivery groups because of 14S90. If the delivery is with Cesarean section, the 14S90 has no effect on the DRG assignment. If the principal diagnosis is delivery, the case will be assigned to DRG corresponding to DRG 477.

However, to my knowledge and based on the change report Liselotte has send, we have not changed property 14S90 of the codes you mentioned.
They have always had 14S90. The property 14S90 has been added to PHV99 and removed from PHT11 and PHT12. These are minor changes that have happened because there has been discrepancy between the different national versions. The latter two cases can be questioned, but I was thinking that they are so small interventions that they could be accepted in normal delivery especially as this is the case in some national versions.

Comment 2013-10-17 Mats Fernström:

But what about 21S09? Vein ligatures and resections are not unusual in trauma cases so that property should not be removed from ligature and resection codes.

#8 Updated by Anonymous over 5 years ago

  • Target version changed from Expert Group 2014 to Expert Group 2013

#9 Updated by Martti Virtanen over 5 years ago

We have now corrected the original problem for cardiovascular cases (MDC 05)
We have corrected small discrepancies between the countries for obstetrical patients with respect to property 14S90.
For trauma patients there is no discrepancy for the property 21S09 between the different versions. All codes with propery 05S18 have also 21S09 except following:
PHSS13 Endoscopic interruption of perforating vein of lower leg
PHSS14 Endoscopic interruption of perforating vein of thigh
PHST11 Injection of therapeutic agent into or percutaneous occlusion of veins of saphenofemoral junction
PHST12 Injection of therapeutic agent into or percutaneous occlusion of short saphenous vein

Also all PHST group codes except the two mentioned above have 21S09. (Some have 05S15 and not 05S18)

The original proposal is obviously closed. I am sorry for mixing 14S90 to the discussion. However if the problem with 21S09 ned active discussion, it should be continued as new case.

This case will be closed.

#10 Updated by Martti Virtanen over 5 years ago

  • Old forum status changed from ACTITEM - Active item to CLOSITEM - Closed item

#11 Updated by Martti Virtanen over 4 years ago

  • Status changed from Accepted to Re-activated

2015-03-03 Martti Virtanen
I noticed in the processs that some of the PHST-group codes do not have 21S09 in the Swedish version but they have it in common version (other versions?).
I read the comment from Mats Fernström on 2013-10-17 so that all these codes should have 21S09 and that this is an error to be corrected?

#12 Updated by Ralph Dahlgren over 4 years ago

Mats Fernström, NPK, Sweden 2015-03-24
None of the PHT codes in Sweden have 21S09. It should be added to get a uniform system. See the enclosed file Technical changes #64.xlsx.

#13 Updated by Martti Virtanen over 4 years ago

  • File Case #64 Technical changes.xlsx added

2015-03-26 Martti Virtanen
As indicated in my comment after Mats F. comment 2013-10-17 we have decided that all PHST-group codes should have 21S09 and ths also 21S10 with the exception of PHST11 and PHST12. These two codes are clearly operations of varicose veins on lower extremities and not typical trama interventions. Obviously by mistake all PHST codes have now lost property 21S09 and in many national versions 21S10 is also missing.
I have now written a technical description for all these codes (#64 Technical changes.xlsx),

#14 Updated by Ralph Dahlgren over 4 years ago

2015-04-07 Comment from NPK Sweden:
Since the original suggestion concerning procpro 21S09 included all the PHT-codes we want all the codes to have procpro 21S09. This to aviod the need for futher discussion which code should or should not have procpro 21S09. We do not accept Marttis suggestion and technical changes concerning 21S09.
The Swedish technical Changes should be introduced for 2016.
As far as 21S10 are concerned this is part of the Finnish Multitrauma and we have no reason to object to which codes should have 21S10. For Finland it is important to really look at the involved codes.

#15 Updated by Martti Virtanen over 4 years ago

2015-04-08 Martti Virtanen
PHST11 'Injection of therapeutic agent into or percutaneous occlusion of veins of saphenofemoral junction', PHST12 'Injection of therapeutic agent into or percutaneous occlusion of short saphenous vein' and PHST15 'Injection of therapeutic agent into or percutaneous occlusion of communicating veins of lower leg or thigh' are obvious varicose vein interventions. In Finnish hospital data trauma cases had never such interventions. On the other hand this means that adding the properties 21S09 and 21S10 has no effect on the DRG assignment.
I have changed the Technical changes accordingly.

#17 Updated by Martti Virtanen over 4 years ago

  • File deleted (Case #64 Technical changes.xlsx)

#18 Updated by Anonymous almost 3 years ago

  • Status changed from Re-activated to Accepted

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