Case #134

Updated by Anonymous about 5 years ago

Last updated: 2012-11-01
Initiated: 2012-06-29
By: National DRG Centre in Finland / Petra Kokko, Minna-Liisa Sjöblom

*Problem*
Unexpected grouping of a case and possibility to similar groupings

Following case:
*Diagnoses:*

* E0420 Nontoxic multinodular goitre
* D2240 Benign neoplasm of melanocytic naevi of scalp and neck

*Procedures:*

* BASA40 Unilateral lobectomy of thyroid gland
* QASE80 Excision of other lesion extending through all layers of skin in head or neck

In an inpatient case results in DRG
* 288B Other procedure for obesity

*Analysis*

This grouping is because obesity and thyroid problems are counted as endocrine problems (MDC 10) and thre rule for DRG 288B is before the rule for DRG 290X 'Thyroid procedures'. The intervention QASE00 is for D2240 and not for the thyroid problem. Although it is not an OR-procedure together with BASA40 it is counted. The property 10S04 'OR procedure for obesity' thus fullfills the rule for DRG 288B.
All procedure codes linked to QxSE80 'Excision of other lesion extending through all layers of skin in...' (QxE10) and QxSE82 'Excision of other superficial lesion of skin from head and neck...' (Qxe15) would behave similarly.

*Suggestion*

Procedure codes linked to QxSE80 'Excision of other lesion extending through all layers of skin in...' and QxSE82 'Excision of other superficial lesion of skin from head and neck...' should not have 10S04 property.

*Comments*

*Martti Virtanen 2014-01-28*

This proposal seems to have been lost on the track, it has never been discussed.

The case is basicly for Finland only and therefore earlier partly only in Finish. I have translated the texts and clarified the original proposal.

The problem is valid but the solution needs discussion. QxSE80 and QxSE82 codes are used only in Finland and Iceland. Other use either QxSE02 'Excision of loose normal skin or fold of skin from head and neck'(to which QxE00 is mapped)or QxSE99 'Other excision or repair of skin of head or neck' (to which QxE99 is mapped). QxSE02 codes have 10S04 whereas QxSE99 codes do not have that property. Since in Sweden for example the text for QAE00 is 'Hudexcision i huvud-halsregion' i.e. 'Skin excision in ...' and QAE99 'Annan excision eller rekonstruktion i huvud-halsregion' i.e. 'Other excision or reconstruction in ...' it is unclear how these codes are used.

For Finland and Iceland the proposed change solves the problem. For other countries the coding practice and possibly codes in the QxSE area should be reconsidered.

*Comment Expert Group 2014-03-24*

Discussion is needed about all the mapping of the properties of this group. Change only in Finnish and Icelandic version. Changes in other national versions will be discussed as a new case.

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