Case #391

Updated by Martti Virtanen almost 5 years ago

National ID: C458
Initiated: 2014-12-10
Initiator: Ralph Dahlgren

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Problem
The clinicians have pointed out a problem that follows. A patient who needs an operation to get a prosthetic shoulder will get grouped to DRG H26E-A/491N 'Larger H26E/A Större reimplantationer eller ledprotesoperationer på övre extremitet, ej komplicerat/mycket komplicerat ( Former DRG 491N Larger re implantations or joint prosthesis surgery on upper limb, not complicated / very complicated' (Större reimplantationer eller ledprotesoperationer på övre extremitet, ej komplicerat/mycket komplicerat), complicated ), but when the necessity occurs that you also have to do surgery of a newly discovered hip injury the patient get grouped to DRG H18E-C/210-211 'Other H18E/C Andra operationer på bäcken, höft och femur utom ledproteser, >17 år, ej komplicerat/komplicerat ( Former DRG 210, 211 Other operations on the pelvis, hip and femur except joint replacements, > 17 years, not complicated/complicated' (Andra operationer på bäcken, höft och femur utom ledproteser, >17 år, ej komplicerat/komplicerat). complicated/complicated ).
This is not a good scenario out of a medical perspective, nor at a resource perspective either.

Analysis
The Swedish National Board of Health and Welfare 2014-12-10
The result is not something that is desired, that the DRG H18E-C/210-211 have system gives an incentive to neglect to put down quite extensive procedure to avoid getting lower reimbursement than H26E-A/491N.

reimbursement..

Suggestion
The Swedish National Board of Health and Welfare 2014-12-10
Change There has to be a change of the order of the rules rows in the Swedish DRGlogic for DRG H26E/A so that it is placed above DRG H18E/C.
There is no need to do an ord change in daycare due to the fact that this type of surgery is not done in daycare.

Decided changes
The Swedish National Board of Health and Welfare 2014-12-10
The
changes should be introduced to the Swedish NordDRG for 2016.

DRG change
Very few cases will be changed from DRG H26E-A/491N H26E/A ( Former DRG 491N ) to DRG H18E-C/210-211 H18E/C ( Former DRG 210, 211 ) .

Technical change
The DRGlogic sheet will have an ord change for DRG H26E/A ( Former DRG 491N ) from ord 408D091000/ 408D091009 to a position after urrent rule 408D05209 (f.ex. ord 4408D052097/ 408D052098, Current rule 408D05209 needs to changed to 408D052090 ).
408D052097/ 408D052098.
For detail description see Excell-File “Decision, Technical changes, NPK C458”

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