Case #683

Breast lift/ mastopexy

Added by Kristin Dahlen 15 days ago. Updated 4 days ago.

Status:ActiveStart date:2020-02-13
Priority:MinorSpent time:-
Assignee:Kristin Dahlen
Category:-
Target version:Target version 2021
Initiator:Norway Target year:2021
Case type:Minor Owner / responsible:National organisations
MDC:MDC09 Old forum status:
Target Grouper:COMMON

Description

Problem
A breast lift surgery or mastopexy is performed to obtain a higher position and a fuller curve of breasts that have lost their elasticity and firmness. There are many causes for these kinds of breast changes, including
pregnancy, breastfeeding, weight fluctuations, aging, gravity and heredity.

The procedure HAD40 mastopexy have procedure properties 30S04 Partial mastectomy or other breast procedure and 14S90 Significant operation for obstetrical patient (Norwegian version). Dependent on the indication in MDC 30 the DRG will be one of the following:

260O Subtotal mastektomi ved ondartet svulst, dagkirurgisk behandling
261O Mammaoperasjon ved godartede sykdommer ekskl biopsi/lokal eksisjon, dagkirurgisk behandling
259 Annen mammaoperasjon ved ondartet svulst m/bk
260 Annen mammaoperasjon ved ondartet svulst u/bk
261 Mammaoperasjon ved godartede sykdommer ekskl biopsi/ lokal eksisjon

However, the indication for this procedure might as well be from MDC 09 diseases and disorders of the skin.
One of the correct indications/codes might be L98.7 mye og overflødig hud og underhudsvev. Using this diagnosis code together with HAD40 the DRG result will be 477/ 477O. As this indication is not rare, we would like another grouping result than 477/477O.

Analysis
Per 2 tertiary 2019 it is 187 cases with HAD40 mastopeksi in the Norwegian data. These cases are grouped to different DRG-s based on the main condition and other procedure codes. Most of the cases (36%) do have Z421 Etterbehandling som omfatter plastisk kirurgi på bryst, 10% of the cases do have L987 Mye og overflødig hud og underhudsvev. However, only some of those cases (approx. 3% group to DRG 477/477O.

In the Norwegian version we have at least three different opportunities for a new grouping of the cases now grouped to DRG 477/477O. Both DRG 268/ 268O Plastiske operasjoner på hud og underhud and DRG 531/531O Annen plastikkirurgi etter stor vekttap in MDC 9. DRG 261/261O might also be DRGs to consider.

As the diagnosis code belongs to MDC 9 we might prefer DRG 268/268O.

Suggestion
Procedurecode HAD40 mastopexy shall be given property 09S02 Plastic procedure and be grouped to DRG 268/268O if the main diagnosis is from MDC 9, for example L98.7 Mye og overflødig hud og underhudsvev.

Technical change
PROC PROP 09S02 will be given to procedure code HAD40 Mastopexy.

History

#1 Updated by Kristiina Kahur 4 days ago

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

109 cases with HAD40 (HASD40 ncsp+ code) in 2018 Finnish data (5 university hospitals). No cases with the combination HAD40+L987.
The change makes clinically sense.
Finnish cost data cannot provide the support to this change.

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