Case #679

Adding OR 2 to procedure codes related to injection into joint

Added by Elina Hermiƶ 21 days ago.

Status:ActiveStart date:2020-02-07
Priority:MinorSpent time:-
Assignee:-
Category:-
Target version:NordDRG 2021
Initiator:Finland Target year:2021
Case type: Owner / responsible:
MDC: Old forum status:
Target Grouper:

Description

Problem
This case concerns procedure codes NFXX11 (TNF11, NF2BT, NF2AT in Finnish version) Injection of diagnostic or therapeutic substance into joint and NXXB10 (NK5BT, NK5AT in Finnish version) Joint injection not elsewhere classified. Both codes have OR 0 property in 2020 version.
In Finnish version the codes have not given any PROCPR.
Code NFXX11 has PROCPR Intra articular medication in SWE (08V07) and Icelandic (08O14) versions (name of the property is the same but the code is different).
NXXB10 is used only in Finnish, Norwegian, and Icelandic versions and has no PROCPR in these versions.
Currently most of the outpatient cases with abovementioned procedure codes group to DRG 908O Disease or disorder of the musculosceletal system, short therapy w/o significant procedure which is not clinically meaningful nor economically relevant.

Analysis
For analysis, the data of five Finnish university was used from year 2018. The cases were regrouped and the results analyzed.
This change would affect ca 500 outpatient visits, vast majority (95%) currently grouped into DRG 908O. The new DRG would be 808O.
The mean cost of the cases with abovementioned codes is ca 60% higher than mean cost of DRG 908O, and ca 30% lower than other cases in DRG 808O.

Suggestion
Based on the analysis, we suggest changing OR value of procedure codes NFXX11 (TNF11, NF2BT, NF2AT in Finnish version) and NXXB10 (NK5BT, NK5AT) from 0 to 2.

DRG change
After the suggested changes the outpatient cases with codes NFXX11 (TNF11, NF2BT, NF2AT in Finnish version) and NXXB10 (NK5BT, NK5AT in Finnish version) will group to DRG 808O instead of 908O. Very few cases would change the grouping from 900-series DRG to 800-series DRG depending on main diagnosis.

Cost analysis
Not provided.

Technical changes
Appendix 1.

FIN_8.2-Appendix2.OR 2_injection_into_joint.xlsx (19.6 KB) Elina Hermiƶ, 2020-02-07 08:50

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