Case #685

OR 1 is changed to OR 2 for 44 procedurecodes named "Injection of…."

Added by Anja Fagervold 7 months ago. Updated 6 months ago.

Status:Further activeStart date:2020-02-14
Priority:Error correctionSpent time:-
Assignee:Anja Fagervold
Category:-
Target version:Target version 2021
Initiator:Norway Target year:2021
Case type:Minor Owner / responsible:National organisations
MDC:OR Old forum status:
Target Grouper:NOR

Description

Problem
For different "Injection of…" procedurecodes in Chapter P 'Peripheral vessels and the lymphatic system' (in the Norwegian Procedural codes classification) the OR-property is not consistent. Some have OR 1 and others have OR 2. We find this unlogical and think it is more medically correct that they all have OR 2. We will therefore change OR 1 to OR 2 for 44 procedure codes named "Injection of…" in chapter P (see technical specification).

Analysis
We have tested this change with the DRG-grouper and there are very few cases that change DRG by changing the OR-property for these 44 procedurecodes. With testdata of 2,6 million cases (all Norwegian cases in the DRG-grouping material from tertial 1), 77 cases changes DRG grouping from surgical DRGs to mainly medical DRGs. This minor change is medically argumented and cost analysis is therefore not necessary. Technical specification added.

Technical specification_case 685.xls (116 KB) Anja Fagervold, 2020-02-14 16:29

Ncsp_plus 2020 - injection.xlsx (54 KB) Martti Virtanen, 2020-04-07 14:44

History

#1 Updated by Martti Virtanen 7 months ago

  • Description updated (diff)
  • Priority changed from Minor to Error correction

#2 Updated by Kristiina Kahur 7 months ago

Finnish National DRG-Centre/Kristiina Kahur 6-3-2020

Most of the 44 codes are not used in Finnish version. Impact would be minimal on (re)grouping in Finnish version.
Clinically meaningful change.

#3 Updated by Ralph Dahlgren 7 months ago

2020-03-06 Ralph Dahlgren
Sweden do not agree that this case is an ‘Error Correction’, it is rather a ‘minor’ case.
We notice that the codes that Norway proposes to get OR '2' are codes that only contain ‘injection in…’
The same NCSP+ codes that Norway propose to change from OR ‘1’ to ‘2’ the Swedish codes in their name also contain 'occlusion'.
This means that we are not discussing the same procedures anymore.
Due to this fact we disagree with Norway and Finland and think that it is important with a proper investigation if Sweden are going to change our procedure from OR ‘1’ to ‘2’.
We have tried to make a partial investigation but we have not been able to because of technical problems so any change for Sweden will have to wait and to be discussed at the Expert meeting 2021
Sweden think that maybe since we are talking about different procedures that maybe another mapping in NCSP+ can solve the issue so that Norway and Finland can make the change this year and we can investigate our procedure codes further.

#4 Updated by Kristiina Kahur 6 months ago

  • Status changed from Active to Further active

Nordic Casemix Centre/Kristiina Kahur 6-4-2020

NCC checks the mapping first. The case will be postponed and remain further active until the mapping is fixed.

#5 Updated by Martti Virtanen 6 months ago

2020-03-09 Expert group
The Expert group could not decide whether the there is a problem in the mapping or in the grouping rules. The case was postponed for further analysis.

#6 Updated by Martti Virtanen 6 months ago

  • File Ncsp_plus 2020 - injection.xlsx added

2020-04-07 Martti Virtanen
I created the list of all affected NCSP codes which shows clearly that currently the principle of defining the interventions as OR=2 or OR=1 is quite simple. When done on unspecified vein or lymphocele, the interventions are regarded to be OR=2, whereas all interventions on arteries or defined (usually deeper) veins are defined as OR=1.
The original NCPS lumps together percutaneous injection to and occlusion of a vessel. In the list of the names I found the words injection, occlusion, sclerosing and obliteration. These interventions are obviously performed through percutaneous puncture to a vessel followed by an injection of a therapeutic substance that may flow further or occlude (sclerose or obliterate) the vessel.
In deeper vessels and in arteries the intervention demands more skills and may demand radiological guidance. Therefore some of the interventions have been (based on original US model) regarded as OR interventions (OR=1).
For DRG the essential thing is resource use. However, it seems that the codes are so rarely used, that there no economical statistics about them. In Finland we have 44 cases and in Norway 77 cases annually.
The countries should check the affected interventions based on national codes in the attached list (including also national names). If there are interventions that are performed more often than once a year even economic analysis might be useful.

#7 Updated by Martti Virtanen 6 months ago

  • File deleted (Ncsp_plus 2020 - injection.xlsx)

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