Mats Fernström, the National Board of Health and Welfare, Sweden, 2026-05-12 (SWE ID C1048)

We have reviewed the result of the TC in case #982 - OR value of proc codes KEDE1B ... and found that the original grouping of  

• AF032 Intrakoronart ultraljud och doppler  (FNDE1B Intravascular ultrasonography of coronary arteries),  
• AP052 Intravasalt ultraljud (PXDE1B Endovascular ultrasonography)  
• XGX10 Intrapleural ultraljudsundersökning (GXDE00 Intrapleural ultrasonography)  
• XPX30 Endovaskulärt ultraljud (PXDE1B Endovascular ultrasonography)  

provides a good description of the main problem (principal diagnosis). We also compared the individual healthcare costs with the DRG weights and found that the original grouping was OK also in a cost perspective.  

Thus, we suggest a new way of principal thinking:

• The few ultrasound procedures with OR 1 are alla performed under open surgery or laparoscopy and we see no need to change the OR value for those procedures.
• Ultrasound procedures that are performed transcutaneous could have OR 0 (zero) except when needle biopsy is performed, then OR 2 is more adequate.
• Other ultrasound procedures, for example together with endoscopy, could have OR 2.  

Then the following changes should be done:

• AJ077, Ultraljudsundersökning, bukvägg, (JADE1A, Ultrasound examination of groin and abdominal wall). Change OR from 2 to 0.
• TKE20, Punktionsbiopsi av prostata med MR-ultraljudsfusionsteknik, transrektal, (KEXX00, Prostate needle biopsy). Change OR from 0 to 2.
• TKE23, Punktionsbiopsi av prostata med MR-ultraljudsfusionsteknik, transperineal, (KEXX00, Prostate needle biopsy). Change OR from 0 to 2.

We have tested these changes on our latest cost database (2024) with 16,5 million outpatient visits and 1,14 million hospital stays and there was no change of the grouping at all. Thus, we see no negative effects from the change and the principal thinking seems OK.

TC_C1048 is attached.   

We support Mats’s suggestion with a little moderation (see below in red):

• The few ultrasound procedures with OR 1 are all performed under open surgery or laparoscopy and we see no need to change the OR value for those procedures.
• Ultrasound procedures that are performed transcutaneous could have OR 0 (zero) except when needle or any other biopsy, injection, punction or canalization is performed, then OR 2 is more adequate.
• Other ultrasound procedures, for example together with endoscopy, could have OR 2.

We will go through the features of the ultrasound procedures in our version and in case any changes are needed, come back with a suggestion.

As we agreed at the meeting, I prepared a TC for the changes in the LAT grouper.

These include deleting 3 NCSP duplicates: KDDE10, JHDE00, XFX30. I checked the historical definition tables of 2014, and these codes have been included in our NCSP etc. list since then.

I am also asking for changes to the procrop varval values for three other procedures: XGX96 from 2 to 1 and PYFF93, ZXM00 from 0 to 1.

Previously, I only mentioned one code, but now, after the discussions with my colleagues, there are three. Therefore, I kindly ask you to check our decision from the grouper architecture point of view, to avoid any unintended impact on the grouper work. Our decision to change the procprop varval is based on the name of procedure - all three has the indication “intraoperative” or “perioperative”.

AS agreed, Estonia checked the proposed changes for NCSP code OR values. 

I agree , that OR for these codes  (   est version  : XJH00 and  XKD10 ) should be changed from 2 to 1 .

In addition, I found one duplicate code in EST NCSP version, which should be removed  : 

Please find details  in the file attached. 

2026-09-02 Expert group

This issue was discussed at the meeting with the main focus on the principles of how OR values are determined for ultrasound procedure codes.

In general, the countries agreed on the principles suggested by Sweden/Mats and complemented by Finland/Lotta.  Norway was skeptical about given a OR 1 value to a US procedure code if the procedure is performed during the open surgery because the surgical procedure has (or at least should have) OR 1 value anyway. Estonia seconded this opinion.

In addition to SWE, LAT and EST, also other countries are encouraged to review the OR values of their national US procedure codes based on the suggested principles, and propose changes if relevant and needed.

It would be recommended to start with existing TCs to keep the changes consistent across the countries whenever possible. However, each country is free to make the final decision what kind of changes will be made in their national version.

Following error corrections were made in LAT and EST version and they will appear in 2027PR0 version:

EST:

Code XFX30 Südame epikardiaalne ultraheliuuring was removed (not inactivated)

LAT:

Three codes were removed (not inactivated):

JHDE00 Transanāla ultrasonogrāfija
KDDE10 Transuretrāla ultrasonogrāfija
XFX30 Epikardiāla sirds ultrasonogrāfija

No changes of OR values or any other changes were made in 2027PR tables.

Instead of creating a new ticket for each national update (which was a suggestion at the EG meeting), the task type of this ticket is changed Development initiative → Case. This way we can collect all updates in one ticket and discuss them all together.

We keep this ticket further open end get back to this (incl TCs already submitted by three countries) in EG Spring meeting 2027 to allow countries to (re)consider the need of OR changes of national US procedure codes.