Case #674

Hypertherm perfusion

Added by Veronika Stemme 8 months ago. Updated 6 months ago.

Status:Further 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:FIN, 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

Technical changes_674.xlsx (25.5 KB) Kristiina Kahur, 2020-03-24 13:32

Technical changes_674-2.xlsx (31.2 KB) Martti Virtanen, 2020-04-01 16:16

History

#1 Updated by Kristiina Kahur 7 months 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.

#2 Updated by Martti Virtanen 7 months ago

2020-03-03 Martti Virtanen
This case provokes a few questions that should be discussed together.

1) The codes with name 'Extracorporeal circulation of xxxx using heart-lung assist device' are unnecesary complicated. In fact 'Extracorporeal perfusion of xxxx' would be more to the point. The device does not need to be exactly the same as used for heart-lung assist.

2) Correct coding should include several codes. In addition to the extracorporeal perfusion, one should code the hyperthermia (sometimes hypothermia) and the cytostatic drug used in the perfusion. For example 'Adriamycin in hyperthermic perfusion for a..'. The different codes should be used combined in a rule for assignmet to a specific group. At least in the future, the method may be used in quite different situations and these rules may cause problems in such settings.

The hyperthermic perfusion could be coded in Swedish system with:
Tumor dx
PXB00 Perfusion of..
DV081 Hypertermia
ATC code for the drug.

We need to relink DV081 to a new NCSP+ which is not a problem.

This needs a discussion at the expert group.

#3 Updated by Veronika Stemme 7 months ago

Veronika Stemme, DRG-team Sweden
Answers to Marttis questions so far, looking forward to more discussion during the meeting:
1. The procedure-codes PXB00 and PXE00 are existing codes, we have not changed their texts only added a new procpro to them. If the texts should be changed it needs to be discussed with our collegues who work with the primary codes.

2. The suggested primary coding is the same as we suggest so good that we agree. I did not include the ATC-code when submitting the case since it has no effect on the DRG-grouping, at least in Sweden, but of course it should be included.

#4 Updated by Veronika Stemme 7 months ago

Veronika Stemme, DRG-team Sweden
We have reconsidered the technical changes for this case after Marttis suggestion to include the demand for procedure code for Hyperthermia in the rules.
The existing procedure code for this in Sweden DV081 Värmebehandling (heat treatment) is unspecific, and although our colleagues working with primary coding recommends that this code is included in the primary coding for these cases, we do not think it should be required for the DRG-grouping. Sweden wants the technical changes implemented, for Sweden, as described in our original proposal to this case.

#5 Updated by Kristiina Kahur 6 months ago

Nordic Casemix Centre/Kristiina Kahur 24-3-2020

Given that this change will be implemented in Finnish version too, the technical changes were updated accordingly.

According to technical changes, the short name of DRG E16N (112A) has not changed is SWE version. Would you (Sweden) like to correct it?

Finland should double-check if new name of DRG 112A in Finnish is correct.

#6 Updated by Martti Virtanen 6 months ago

2020-04-01 Martti Virtanen
The proposal was accepted at the Expert group meeting 2020-03-09 for Finland and Sweden.
The name of the NCPS+ code will be changed as soon as it can be done with the new NDMS. The national versions of names are ovbiously a matter of the national organisations. However some contries have already dropped the the 'heart-lung ...' from the text.

The problem with the unspecificity of the intervention remains open, currently it is not causing any problem.

The case is further active until the names of the plus-codes are corrected.

#7 Updated by Martti Virtanen 6 months ago

  • Status changed from Active to Further active

#8 Updated by Veronika Stemme 6 months ago

Veronika Stemme,DRG-team Sweden
The short name is ok for Sweden as it is, without change.

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