Case #350

Updated by Martti Virtanen almost 7 years ago

*Background*
Sweden has will start to use NCSP original structure of codes in groups NHJ0x ‘Closed reduction of fracture of ankle or foot’ and NHJ1x open reduction of ankle or foot’ both with 5th character localizing the intervention as well as in the other NHJ subgroups which has less significance for DRG’s. The old Swedish codes (NHJx9) only included ankle and there was no mention of metatarsal or toe interventions.
The Finnish NCSP version has specific codes for ankle (NHJ08) and metarsal and toe (NHJ40) closed reduction, and a code for open reduction of metatarsal and toe fractures (NHJ50). The Finnish version has no codes for open reduction of ankle without internal fixation (probably realistic)
The Danish, Norwegian and Latvian versions follow the original NSP but have deleted the NHJx9 codes that do not specify the part of the foot/ankle that has been operated on.
The Estonian version has all codes of orginal NCSP (including NHJx9).

*Problems:*
The Swedish code for closed reduction of metatarsal bones (NHJ08) was linked to code for open reduction (NHJ10) which is an obvious error and resulted in false properties.
For some reason only NHSJ00 ‘Closed reduction of fracture of ankle or foot; lateral malleolus’ has had OR=2 property, other closed reductions have OR=0. The old Swedish code (NHJ09) has been linked to NHSJ00 and thus has had OR=2. The Finnish NHJ08 is linked to NHSJ06 and NHJ40 to NHSJ07 and thus they both have OR=0. The other national versions have been linked to the corresponding codes and thus had varying OR properties. In the other group NHSJ codes the properties do not vary and there is no problem.
There is inconsistency in the grouping of NSJx6 (tarsal bones) with respect to properties 08S76 (ankle or foot) and 08S74 (ankle), and 08X15 (ankle) and 08X12 (foot).
Because of the linkage to NHJSx0 the Swedish deleted NHJx9 codes will retain properties 08S74 and 08X15.
The codes not used by the Finnish version are missing the property 21S10 (only used by the Finish multitrauma model and not visible any way in any other version).

*Corrections*
These are obvious problems that should be corrected as soon as possible, if possible already in 2015 version. Significance is however low.
The Swedish NHJ08 is now correctly linked to NHSJ08 and shall have corresponding properties.
All NHJ0x codes shall have OR=2.
All NHSJx0..4 NHSJx0..5 codes shall have properties 08X15 'Problem of the ankle' and 08S74 'Procedure of foot except major joint'. propertties. All NHSJ5..8 NHSJ6..8 codes shall have properties 08X12 'Problem of the foot' and 08S76 'Procedure on ankle or foot'. properties. All NHSJx9 codes shall have 08S76 property but no 08X15 nor 08X12.
All codes in NHSJ group must also have 21S10 property for the Finnish multiple trauma solution. It is now missing from the codes not used by the Finnish version.
Despite quite complex corrections the effects on DRG’s will remain very few. OR=2 may affect outpatient groupings in some versions (outpatient intervention group instead of conservative groups) but not the SWE version.
The test versions of multitrauma groupings will need a small correction that can be performed later.

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