Case #674

Hypertherm perfusion

Added by Veronika Stemme 28 days ago. Updated 4 days ago.

Status:ActiveStart date:2020-01-31
Priority:MinorSpent time:-
Assignee:Veronika Stemme
Category:-
Target version:NordDRG 2021
Initiator:Sweden Target year:2021
Case type: Owner / responsible:National organisations
MDC:MDC05 Old forum status:
Target Grouper:SWE

Description

Veronika Stemme, The Swedish National Board of Health and Welfare
Problem
This case concerns treatment of malignancy in an extremity with a method performed at Sahlgrenska University hospital. The blood vessels supporting the arm or leg are connected to a heart-lung machine. High doses of chemotherapy is perfused through the affected limb for one hour. We think that these treatments should be grouped to DRG E16N/112A Andra perkutana kardiovaskulära åtgärder (Other percutanous cardiovascular procedures), but this group must then change name to Andra perkutana kardiovaskulära åtgärder och hyperterm perfusion (Other percutanous cardiovascular procedures and hypertherm perfusion). The classification-team at The National Board of Health and Welfare have, after discussion with the profession and the DRG-team, decided that the primary coding of these treatments should be:
ICD-10 code for tumor diagnosis
Perfusion: Upper extremity PXB00 Extrakorporeal cirkulation av övre extremitet extremitet med hjärt-lungmaskin or for lower extremity PXE00 Extrakorporeal cirkulation av nedre extremitet med hjärt-lungmaskin
If removal of lymphatic glands: Axillar PJD52 Iliacal PJD54 Inguinal PJD55
Use of Hyperthermia DV081

Analysis
After considering several options we think that these treatments fit best in DRG E16N/112A. Even if the method is now mostly used for malignant melanoma it is not limited to treatment of skin tumors. E16N is high in the hierarchy and cases will be assigned here even if procedure codes for lymphatic gland removal (PJD52, PJD54, PJD55) are added.
The reported mean cost for the treatments is 127 000 SEK and the mean cost, 2018, for DRG E16N was 140 734 SEK (all cases)/109 852 SEK (cost outlayers removed).

Suggestion
We suggest that the procedures PXB00 Extrakorporeal cirkulation av övre extremitet med hjärt-lungmaskin and PXE00 Extrakorporeal cirkulation av nedre extremitet med hjärt-lungmaskin make the cases with hyperthermia treatment to be grouped to DRG E16N/112A by giving them the new procpro 05S23 Extracorporeal circulation of extremity.

Decided changes
We want these changes implemented in the Swedish version of NordDRG 2021.

DRG change
The procedures PXB00 and PXE00 are added to DRG E16N/112A.

Technical changes
A new row for DRG E16N/112A is introduced, just above the existing row. DRG E16N/112A Andra perkutana kardiovaskulära åtgärder (Other percutanous cardiovascular procedures) change name to Andra perkutana kardiovaskulära åtgärder och hyperterm perfusion. (Other percutanous cardiovascular procedures and hypertherm perfusion).
New proc pro: 05S23 Extracorporeal circulation of extremity
The procedures PXB00 Extrakorporeal cirkulation av övre extremitet med hjärt-lungmaskin and PXE00 Extrakorporeal cirkulation av nedre extremitet med hjärt-lungmaskin get the new procpro 05S23 Extracorporeal circulation of extremity

Please see the file “Technical changes C816 Hypertherm perfusion”

Technical changes C816 Hypertherm perfusion.xlsx (23.5 KB) Veronika Stemme, 2020-01-31 11:25

History

#1 Updated by Kristiina Kahur 4 days ago

Finnish National DRG-Centre/Kristiina Kahur 24-2-2020

Respective codes in Finnish version:
PXB00 -> PXA00 (FIN code), PXSA00 (ncsp+ code) - no use in Finland
PXE00 -> PXA20 (FIN code), PXSA20 (ncsp+ code) - 6 cases, mean cost ca 10 000 EUR.
The change makes clinically sense. However, Finnish cost data cannot provide any support. If implemented, the impact in Finland would be very low.

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