Case #778

Upgrading of processor for cochlea implants

Added by Ralph Dahlgren 4 months ago. Updated about 1 month ago.

Status:AcceptedStart date:2021-06-18
Priority:MinorSpent time:-
Assignee:-
Category:-
Target version:Target version 2022
Initiator:Sweden Target year:2022
MDC:MDC03 Owner / responsible:National organisations
Target Grouper:SWE Old forum status:

Description

2021-06-18 Ralph D
Sorry for being so late for this change in our definition tables.
But Sweden will introduce a new procedure code, DD020 Uppgradering av talprocessor för kokleaimplantat that are similar to a code that Norway already have introduced.
The corresponding code in Norway is DXGT10 Utskifting eller oppgradering av taleprosessor for cochleaimplantat.
This procedure is less resource demanding than the surgery to implant of a cochlea implant but much more or less resource demanding than other procedures in the same MDC.
To solve this problem Sweden needs to introduce a new DRG for this procedure.
The DRG name will be (in Swedish) C03O Uppgradering av talprocessor för kokleaimplantat (Freely translated ~ Upgrading of processor for cochlea implants).
If it is alright with Norway and NCC we can use the grouping property that Norway use, procpr 03S25 Replacement of speech processor for cochlea implants.
But Sweden only wants to give our new procedure code this one grouping property procpr 03S25. Then we want it to have OR 0.

Norway has given their code:
OR 1 ***
PROCPR 14S90 Significant operation for obstetrical patient
PROCPR 99S90 Extensive procedure - list created during the exporting process
These grouping properties we do not want.
We think that it can be done in NDMS, but if impossible please let us know and we will make a new property and then NCC will have to make a new NCSP+ code aswell.

Analysis++
The National Board of Health and Welfare Sweden – 2021-06-17
The cost for a processor is around 60 000 SWE kr (~6 000 Euro), the work involved has a cost around 3390 SWE kr (~340 Euro).
This is in Sweden nothing the doctors are involved in. It is done by an engineer specialized in this. It is done in a regular room for daycare patients. Special computer software is needed and for what we know the installation has to be done ‘from the beginning’ due to the fact that the processors change so much during the time-lapse between changing is done.
In Sweden it is around 5-600 patients that this procedure is done on. The amount will increase since more patients gets Cochlear implants.

Suggestion**
The National Board of Health and Welfare Sweden – 2021-06-17
Sweden will introduce one row for this single procedure code that will lead to DRG C03 Uppgradering av talprocessor för kokleaimplantat (Freely translated ~ Upgrading of processor for cochlea implants). This will need introduction of a new property. The changes are all included in the excelfile called ‘TC_C983 DD020 to Forum.xlsx’.

Decided changes**
The National Board of Health and Welfare Sweden – 2021-06-17
Sweden wants to introduce this change already in 2022.
Very sorry for this very late change.

DRG change
In Sweden there are no single way these cases have been coded before so we realy do not know from which DRGs visits will be moved to this new DRG, maybe from DRG C82O Icke-operativa åtgärder vid kokleaimplantat, besök (Non surgical procedureswith Cochlear implants, visit) .

Technical change++
The new code DD020 Uppgradering av talprocessor för kokleaimplantat (~Upgrading of processor for cochlea implants) will get the property, if accepted, procpr 03S25 Replacement of speech processor for cochlea implants. This new grouping property will be introduced. We will introduce a new DRG DRG C03 Uppgradering av talprocessor för kokleaimplantat (Freely translated ~ Upgrading of processor for cochlea implants.
A new row in DRGlogic will be introduced that will have id 103D0000015, ord 30300000015, drg C03O, text Uppgradering av talprocessor för kokleaimplantat, rtc 0, procpro1 03S25, disch N, dur <1.
We do not demand any ICD-10 code due to the fact it is done by an engineer.
The technical changes are all in the Excelfile ‘TC_C893 to Forum.xlsx’.

TC_C893 DD020 to Forum.xlsx (27.2 KB) Ralph Dahlgren, 2021-06-18 14:56

TC_C893_DD020_Final suggestion 20210817.xlsx (28.4 KB) Ralph Dahlgren, 2021-08-17 09:37

TC_778_NDMS_30082021.xlsx (16.2 KB) Kristiina Kahur, 2021-08-30 15:16

History

#1 Updated by Kristiina Kahur 2 months ago

Nordic Casemix Centre/Kristiina Kahur 11-8-2021

Seems that before implementing this change in SWE tables, the mapping of procedure codes related to insertion of cochlear implant and upgrading of processor for cochlear implant need to be checked once again. The mapping has been discussed earlier in 2017 (see ticket #437). The case was closed, no changes were made. However, some questions remained.

Currently in ncsp+ there are three codes concerning the cochlear implant:
DFSE00 Insertion of cochlear implant
DFXA02 Check-up of cochlear implant
DFXA00 Connecting cochlear implant
There is no specific ncsp+ code for upgrade or replacement of processor for cochlear implant. Should this be created? Norwegian code DXGT10 Utskifting eller oppgradering av taleprosessor for cochleaimplantat is currently linked in NDMS to DFSE00 Insertion of cochlear implant which seems not to be correct.

As for procedure properties, there are two active/used PROCPRs in NDMS:
03S24 Insertion of cochlear implant – used in all national versions
03V09 Assisting procedure for cochlear implant – used only in Swedish version.

In addition, there are two inactive PROCPRs, currently not used in any version:
03O08 Cochlear implant related interventions
03S25 Replacement of speech processor for cochlear implants.
The latter is used in Norwegian def.tables maintained by Norwegian Directorate of Health. I could not find any documentation in Forum about using PROCPR 03S25 in any national versions.

It is technically possible to give different OR values or PROCPRs to the same ncsp+ code in difference national version in NDMS. The question is if the Swedish DD020 Uppgradering av talprocessor för kokleaimplantat and Norwegian DXGT10 Utskifting eller oppgradering av taleprosessor for cochleaimplantat are clinically the same procedures and performed in similar circumstances, hence can the codes be mapped into the same ncsp+ code and given the same properties and OR value.
According to Ralph’s description, DD020 is not extensive OR procedure and hence, OR 0 is ok, whereas in Norwegian version according to given PROCPRs DXGT10 seems to be OR 1 procedure.

The question is - should the mapping be changed and new ncsp+ code created for Swedish code DD020 or should Norway reconsider the OR value and other PROCPRs (14S90 and 99S90) of the procedure code.

Even if harmonizing the properties of SWE DD020 and NOR DXGT10, the current mapping of DXGT10 to ncsp+ code DFSE00 Insertion of cochlear implant needs to be changed and probably a new ncsp+ code for upgrade and replacement of processor for cochlear implant created.

#2 Updated by Ralph Dahlgren 2 months ago

2021-08-11 Ralph D
The Swedish new procedure code 'DD020 Uppgradering av talprocessor för kokleaimplantat' means in Swedish healthcare that a the old processor for cochlea implant is replaced with a new one. In Sweden according to our Swedish ear and nose doctors there are no possibility to upgrade the old processor to work like a new due to the fact that the processor change happens after so many years that new programs cannot be installed in an old one. It was explained to me it is like trying to install new Microsoft office package in an old computer, it will not work due to lack of capacity.
So the Swedish code is not clinically the same as the Norwegian if I understand their code text correctly.
With your clearification Kristiina I think it is easier and make it more clear if Sweden introduce a new grouping property after all. Just to make it more clear and easier to understand in the future, especially since we do not want the same grouping properties.
I can come back with suggestion for this case on Forum if it is ok with you, it will also save some work for you.

#3 Updated by Kristiina Kahur 2 months ago

Nordic Casemix Centre/Kristiina Kahur 11-8-2021

Thanks for clarification, Ralph. It would be great if you could come up with an updated suggestion.
I think 03S25 Replacement of speech processor for cochlear implants would be right property for DD020 but I leave it for you to decide.

#4 Updated by Ralph Dahlgren 2 months ago

2021-08-17 Ralph D
This file contains the final technical changes for the new Swedish code DD020 Uppgradering av talprocessor för kokleaimplantat (Simple english translation - Upgrading of speech processor for Cochlear implant).

The code and solution has been discussed with Mats Fernström who came up with a better solution than the original one done by me.
Since Sweden do not want the Norwegian grouping properties for the similar code that is in use in Norway.
In Sweden this procedure is not an operating room procedure, this means not OR 1. It is done in a regular open daycare visit room, it is a processor that is changed to a new one, no surgery is done.
And changing of a speech processor for cochlear implant will not be preformed at the same time as childbirth in Sweden. This means no grouping property 14S90 Significant operation for obstetrical patient. This also due to the fact that it is in Sweden no surgical procedure, it is a technical procedure done by an engineer.
In Sweden this procedure definitely not apply to get the grouping property PROCPR 99S90 Extensive procedure - list created during the exporting process. In Sweden this is not an extensive procedure.

Given the reasons above Sweden, Mats F, came up with a better solution that more express the Swedish way of handling this code.
The new procedure code DD020 Uppgradering av talprocessor för kokleaimplantat will only have the following grouping properties below:
PROCPR 03V11 Updating or replacement of speech processor for cochlear implants, extens '0'.
OR 0

DD020 Uppgradering av talprocessor för kokleaimplantat is a very significant procedure for the patients that receive a new speech processor, they are so much better now than the old one. But in the perspective of surgical procedures it is not significant in Sweden, hence a new procedure property that more mirror this level of procedure.
Norway are right in creating a new DRG for this because it is still expensive, Sweden will also create a new DRG for it, DRG C03O Uppgradering av talprocessor för kokleaimplantat (freely translated - Upgrading of Speech Processor for Cochlear Implant) in MDC 03.
The rest of the technical changes are in the included Excellfile 'TC_C893_DD020_ Final suggestion 20210817.xlsx'

Sweden thinks it might be better to create at new NCSP+ code for our code DD020 Uppgradering av talprocessor för kokleaimplantat but naturally we leave that up to the NCMC.

Sorry for the late responce.

#5 Updated by Kristiina Kahur about 1 month ago

Nordic Casemix Centre/Kristiina Kahur 25-8-2021

FYI, I found in NDMS that in Swedish version code DD020 has been used earlier for Tonsillotomi. The code was inactivated at 31.12.2007. Now the same code is suggested to use again for different purpose. It might create confusion when you are using and analyzing historical data in which DD020 was used for Tonsillotomi.
If this is not a concern, we delete the old code DD020 Tonsillotomi and add it again with new name Uppgradering av talprocessor för kokleaimplantat/Upgrading of speech processor for Cochlear implant.
We also create new NCSP+ code DFXA04 Upgrading of speech processor for Cochlear implant for mapping purpose.

In case you would like to change the national code for Upgrading of speech processor for Cochlear implant, it would be possible.
Other than that the changes will be made in NDMS 2022 SWE version as suggested in the latest TC.
This all concerns Swedish version only.

#6 Updated by Ralph Dahlgren about 1 month ago

2021-08-26 Ralph Dahlgren
Thank you Kristiina for the information that the procedure code suggested has been used before.
This was nothing I knew about. After I asked about this The Swedish Classification Centre went back and saw what you have noticed aswell.
As you pointed out, to use the same code for somthing different is not good out of a medical and statistical point of view.
So Sweden will thanks to your information change our suggested code.
The change will be to:
DD021 Uppgradering av talprocessor för kokleaimplantat
This means a new more correct code but the same code text as before.
The rest of the changes will be as suggested in the latest TC.
Thank you again for noticing!

#7 Updated by Kristiina Kahur about 1 month ago

Nordic Casemix Centre/Kristiina Kahur 30-8-2021

This change has been introduced into Swedish 2022 version in NDMS. The TC exported from NDMS are attached. Please double-check. Especially the place of the new rule in the logic table.

#8 Updated by Ralph Dahlgren about 1 month ago

2021-09-03 Ralph D
The texts to the Swedish DRG C03O has been changed alittle.
The longer text is: 'Uppgradering av talprocessor för kokleaimplantat, öppenvård'
The short text is: 'Uppgrad processor kokleaimpl O'
The change concerns only Sweden and only the DRG C03O texts.
Sorry for not seing this before and the late corrections.

#9 Updated by Kristiina Kahur about 1 month ago

  • Status changed from Active to Accepted

Nordic Casemix Centre/Kristiina Kahur 3-9-2021

Thank you for clarification. The name of DRG C03O is corrected.
Case is closed.

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