Case #682

Chronic uveitis treated with specific biological drug treatment should group to 808H in the Norwegian version

Added by Anja Fagervold 8 months ago. Updated 6 months ago.

Status:AcceptedStart date:2020-02-13
Priority:MinorSpent time:-
Assignee:Anja Fagervold
Category:-
Target version:Target version 2021
Initiator:Norway Target year:2021
Case type:Minor Owner / responsible:National organisations
MDC:MDC08 Old forum status:
Target Grouper:NOR

Description

This problem has been reported from Helse Møre og Romsdal HF. When patients are treated with biological drug treatment for isolated uveitis (e.g. children / adolescents who do not have arthritis or other known autoimmune conditions) they are treated by the eye departments. Nationally, for more than 10 years, Infliximab has been a recognized treatment for these patients if the condition is not controlled through other treatment modalities. Indication for such treatment in children is clarified with a pediatric rheumatologist at the regional hospital.

These cases with ICD-10 code H201 'Kronisk Uveitt/Chronic uveitis' and procedure code 4AB02 'Treatment with L04AB02 Infliximab' + WBGM00 'Intravenous drug treatment' now groups to DRG 902O 'Poliklinisk konsultasjon vedrørende andre øyesykdommer /Outpatient consultation regarding other eye diseases'. Because of the specific biological drug treatment it would be more correct that these cases should be grouped to DRG 808H 'Poliklinisk behandling av revmatologiske lidelser med infusjon av særskilte legemidler/ Outpatient treatment of rheumatological disorders with infusion of special medicines'.

The DRG-logic in the Norwegian version is changed accordingly by adding two new rules and giving ICD-10 code H201 two new properties. This only affects the Norwegian version because of our inclusion of drug treatment codes in the DRG-logic, and further details and analysis is therefore not presented here. Technical specification added.

Technical specification_case 682.xls (105 KB) Anja Fagervold, 2020-02-13 16:36

Technical changes case #682_2.xlsx (10.8 KB) Kristiina Kahur, 2020-04-13 15:10

History

#1 Updated by Martti Virtanen 7 months ago

2020-03-03 Martti Virtanen
The DRG 808(N)H is only used by Norway, so the change will not affect other versions.
The proposal is otherwise OK, but the rule with 08P30 is unnecessary. The second new rule will cover also the cases where the dx H201 is pricnipal dx.

#2 Updated by Martti Virtanen 6 months ago

2020-03-09 Expert group
The expert group accepted the change for Nor version.
The second new rule will not be added since it is not possible to create any patient cases (testcases) for it.

#3 Updated by Kristiina Kahur 6 months ago

Nordic Casemix Centre/Kristiina Kahur, 13-4-2020

TC were updated according to Martti's comments re PDGPROP 02P30. Updated TC are attached to the ticket.
The change concerns Norwegian version only.

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