Case #387

Updated by Martti Virtanen almost 5 years ago

National ID: NPK C469
Initiated: 2015-01-02
Initiator: Ralph Dahlgren The Swedish National Board of Health and Welfare Responsible at National organization: The Swedish National Board of Health and Welfare
Sent to NordDRG Forum: 2015-02-05
Status: ACTITEM - Active item
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*Problem*
This is a problem that the clinicians points out concerning the procedure code XXDX00 'Determination of body composition with DEXA method' (AV068 'Bestämning av kroppssammansättning med DEXA').
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For example:_
M8000'Postmenopausal osteoporosis with pathological fracture' (Osteoporos efter menopausen med patologisk fraktur) + XXDX00 is assigned in NordDRG SWE to DRG X42O/900V 'Major examination of body composition, short therapy' (Bestämning av kroppssammansättning, besök).

M8000 alone is assigned to DRG H54O/239O 'Doctor visits in malignant tumors of muscle, connective tissue, bone and pathological fractures' (Läkarbesök vid maligna tumörer i muskel, bindväv och skelett samt patologiska frakturer).

When

But when adding
procedure XXDX00/AV068 is added kode AV068 to the case visit the grouping will be assigned to DRG X42O/900V. X42O (Former DRG 900V.

M8000 + ZZ2230 'Professional nurse' (XS919 Sjuksköterska besök) is assigned to DRG Y83O/970V 'Other nursing contact, short therapy' (Övriga sjuksköterskebesök).

We are concerned about the way the NordDRG SWE describes these patients.
In our thinking it is more important to describe the medical problem than the procedure in this case.
The fact is that doctors in Sweden never do the actual procedure XXDX00/AV068 even if they might look and also describe the results.

This is a hierarchy problem but also a medical problem description. The rule for DRG X42O/900V is located before all DRG's for medical visits for orthopaedic problems (f. ex. H54O/239O)

Analysis
The Swedish National Board of Health and Welfare – 2015-01-02
A doctor visit is demands more resources than the bone density measurement since the latter is mostly performed by a nurse on a separate visit. (Nurse contact probably does not increase the cost in the same manner as medica doctor contact).

Suggestion
The Swedish National Board of Health and Welfare – 2015-01-02

Sweden wants this change to NordDRG SWE 2016
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Technical change_
The rule DRG X42O/900V shall be moved below all doctor visits for orthopaedic problems (HxxO group in NordDRG SWE or more exactly below the rule for H99O/821V 'Doctor visits in malignant tumors of muscle, connective tissue, bone and pathological fractures' (Läkarbesök vid maligna tumörer i muskel, bindväv och skelett samt patologiska frakturer).

For technical changes see Excel file Decision C469 Measurement of bone density
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DRG change_
Patients with bone density measurement will be assigned to Medical contacts DRG's, typically DRG H54O/239O instead of DRG X42O/900V.

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