Case #671

Split of DRG Z63O Healthcare administrative procedure without patient contact

Added by Veronika Stemme about 1 month ago. Updated 28 days ago.

Status:ActiveStart date:2020-01-27
Priority:NormalSpent time:-
Assignee:Veronika Stemme
Category:-
Target version:Target version 2021
Initiator:Sweden Target year:2021
Case type:Major Owner / responsible:
MDC:MDC05 Old forum status:
Target Grouper:SWE

Description

The Swedish National Board of Health and Welfare, Veronika Stemme
Problem
Some health care procedures are performed without direct patient contact. This may for instance be writing of comprehensive certificates or analyzing ambulatory ECG recordings. Procedures with the procpro 40v39 Administration of care, and no reported patient contact (DGPROP -00X63 Contact with patient or representative), are grouped to DRG Z63O Healthcare administrative procedure without patient contact. This includes the procedures AF024 "Elektrokardiografi (EKG), 12 avledningar, standard, tolkning (i)", AF029 "Hjärtfrekvensvariabilitetsanalys", AF041 "Långtids-EKG-registrering, bedömning (i)", DF031 "Avläsning av EKG från loop-registrering (i)". To improve the medical description we suggest that the mentioned procedures are instead grouped to a new DRG for Healthcare administrative procedure without patient contact in MDC 05 (Diseases & Disorders of the Circulatory System), E63O Cardiovascular procedure without patient contact.

Analysis
Economical analysis is not needed since this purely a matter of medical description. The DRG:s for Healthcare administrative procedure without patient contact have zero weight.

Suggestion/DRG change
If not combined with a patient contact, the procedures AF024 "Elektrokardiografi (EKG), 12 avledningar, standard, tolkning (i)", AF029 "Hjärtfrekvensvariabilitetsanalys", AF041 "Långtids-EKG-registrering, bedömning (i)", DF031 "Avläsning av EKG från loop-registrering (i) should be grouped to a new DRG ” E63O Cardiovascular procedure without patient contact” instead of DRG Z63O Healthcare administrative procedure without patient contact.

Decided changes
We want this to be implemented in the Swedish version of NordDRG 2021.

Technical changes
Creation of a new DRG E63O Cardiovascular procedure without patient contact.
Creation of a new procpro 05V39 Cardiovascular adminstration of care
The procedures
AF024 "Elektrokardiografi (EKG), 12 avledningar, standard, tolkning (i)",
AF029 "Hjärtfrekvensvariabilitetsanalys",
AF041 "Långtids-EKG-registrering, bedömning (i)",
DF031 "Avläsning av EKG från loop-registrering (i)"
will be given the new procpro 05V39 Cardiovascular adminstration of care.

Please see the file “Technical changes CPK-ID 804”

Technical changes CPK-ID 804.xlsx (23.7 KB) Veronika Stemme, 2020-01-27 16:12

History

#1 Updated by Martti Virtanen about 1 month ago

2020-01-28 Martti Virtanen, Nordic Casemix Centre
As a Swedish proposal only affecting Sweden there is no problem in performing these changes to the system.
However, there are couple questions Swedes might consider.

1) This phenomen is much more general. Most of radiological investigations, quite many laboratory investigations as well as exmaninations in clinical physiology and some times even clinical consultions need an interpretation that can be performed separately by other unit or personnel than the original investigation. Quite often, however, the interpretation is a part of doing the investigation and not registered (nor billed) separately. The model proposed here creates an insentive to perform the interpretations separately when possible, if there is not a separate reimbursement for doing both investigation and interpration.
2)The interpretation (as well as the investigation) is needed in the clinical context and should be attached to the patient contact where it is needed. The activity meant by this new DRG is clearly a 'service' and payment is a 'fee'. Such cost should be part of the reimbursement of the clincal contact at issue. The cost of the contact obviously increases and sometimes it might be necessary to have a DRG for reimbursement of the contact with the extra cost. Then one should also consider what happens when interpration of several different investigations are needed.
3) The people doing these interpretations hardly think they are doing 'administrative' work. This is their real work! To avoid unnecesary conflicts, I would rather call the group 'Interpration of examination' than 'Administrative care'.

#2 Updated by Veronika Stemme 28 days ago

2020-01-31 Veronika Stemme, DRG-team Sweden
Thank you Martti.
1-2. We agree that there are a lot of procedures in healthcare that do not need to be coded. The suggested DRG for ‘Cardiovascular procedures without patient contact’ originates from the wish from the profession to be able to show that they do not work less even if they at some outpatient clinics meet less patients. They argue that the work they do, analysing for instance long-term ECG benefites the patient, but does not always lead to a contact if the findings are normal. The suggested DRG is meant for description not reim-bursement (the DRG-weight = O) and it is intended for local use, not for the national patient register.

3. We agree that advanced ECG analysis is clinical and not administrative work. The name of the new DRG E63O is Kardiovaskulära åtgärder utan patientkontakt (Cardiovascular procedures without patient contact). The procedures that will remain in the DRG Z63O ‘Healthcare administrative procedure without patient contact’ is of more administrative character, like writing of extensive certificate.

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