Case #216

Updated by Anonymous about 7 years ago

National ID: 235
Initiated: 2014-01-27
Initiator: Ralph Dahlgren
Responsible at National organization: Ralph Dahlgren/Susann Bengtsson-Berggren
Sent to NordDRG Forum: 2014-01-27


Status: ACTITEM - Active item
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*Problem*

Today there are two types of kidney transplants. "Old" regular kidney transplantation, and transplantation with pre-surgical treatment. Transplants with special pre-surgical treatment makes it possible to, especially at live-donor donation, to transplant without regard to blood type. In some cases also in patients with other types of antibodies, for example against the prospective donor. This can make it possible through special pre-surgical treatment to receive a kidney from a relative that earlier could not be a donor.

This increases the possibility of transplantation. The results are completely equivalent to those obtained by conventional living-donor transplant. This special pre-treatment costs 200-400000 SEK. This due to factors like: extended care, the specific pillars immune-absorption, the absorption treatment, measurement of antibodies, additional medication, etc.'

*Analysis*

Current DRG:

M01O Kidney transplantation, outpatient 302O
M01C Kidney transplant, complicated 302C
M01E Kidney Transplant cc 302N

Current surgical procedure codes:

KAS20 'Homologous kidney transplant, living donor'
combined with
DR001 'Apheresis with simultaneous adsorption, eg LDL, granulocytes'

Data from PAR 2011: 13 of a total of 407 means that the number of DR001 + KAS20 is about 3.3%.
Weight List 2013: Per DRG point 41 501 SEK.
M01C Kidney Transplant K Weight (2013), 9.2832 ~ 385 262 SEK
M01E Kidney Transplant U Weight (2013), 7.2344 ~ 300 235 SEK
KPP 2011:
DRG M01C: Looking at the inner case containing KAS20 + DR001, these have an additional cost of approximately 102 500 SEK in DRG M01C. > 25% higher cost compare to ordinary patients in the same DRG.
M01E: When you look at the inner case containing KAS20 + DR001, these have an additional cost of about 181 100 SEK in DRG M01E. ~ 60% higher cost compare to ordinary patients in the same DRG.

*Suggestion*

*The National Board of Health and Welfare – 2014-01-27*

DR001 have to get a new DGPROP. We suggest DGPROP 11X03 Pre-surgical Apheresis and adsorption.
DRGlogic has to be changed so that there must be a copy of DRGlogic line for M01C but add it DGPROP 11X03 which DR001 has. This will make these special care episodes to group to M01C.

*Decided changes*

*The National Board of Health and Welfare – 2014-01-27*

The changes are to be introduced in SWE NordDRG 2015.

*DRG change*

The cases with the combination KAS20 'Homologous kidney transplant, living donor' and DR001 'Apheresis with simultaneous adsorption, eg LDL, granulocytes' will all be grouped to M01C Kidney transplant, complicated (Former 302C). This means that some cases from DRG M01E Kidney Transplant cc 302N will move to M01C Kidney transplant, complicated 302C.

*Technical change*

DR001 have to get a new DGPROP. We suggest DGPROP 11X03 Pre-surgical Apheresis and adsorption.
DRGlogic has to be changed so that there must be a copy of DRGlogic line for M01C but add it DGPROP 11X03 which DR001 has. This will make these special care episodes to group to M01C.

*Introduction:*

NordDRG [2015] [SWE]

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