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<div class="journal-details-container"> <h4> Task #1005 has been updated by Mats Fernström. </h4> <div class="details"> <span><strong>Attachment</strong> <a title="Download file" target="_blank" href="https://nordcaseforum.easyredmine.com/attachments/216215/TC_C1048_New.xlsx?t=1778605960">TC_C1048_New.xlsx</a> added</span><br/> </div> <div id="journal-5437-notes" class="note"><p><strong>Mats Fernström, the National Board of Health and Welfare, Sweden, 2026-05-12</strong> (SWE ID C1048)</p><p>We have reviewed the result of the TC in case <a class="issue tracker-2 status-5 priority-21 priority-default multieditable-container closed" title="Case: OR value of proc codes KEDE1B and KEDE1A (on other ultrasound examination codes) (Closed)" onclick="if (!event.metaKey && !event.ctrlKey && event.button === 0) { event.preventDefault(); EasyVue.showModal('issue', 982); return false; }" href="https://nordcaseforum.easyredmine.com/issues/982">#982 - OR value of proc codes KEDE1B ...</a> and found that the original grouping of </p><ul> <li>AF032 Intrakoronart ultraljud och doppler (FNDE1B Intravascular ultrasonography of coronary arteries), </li> <li>AP052 Intravasalt ultraljud (PXDE1B Endovascular ultrasonography) </li> <li>XGX10 Intrapleural ultraljudsundersökning (GXDE00 Intrapleural ultrasonography) </li> <li>XPX30 Endovaskulärt ultraljud (PXDE1B Endovascular ultrasonography) </li> </ul><p>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. </p><p><strong>Thus, we suggest a new way of principal thinking</strong>:</p><ul> <li>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.</li> <li>Ultrasound procedures that are performed transcutaneous could have OR 0 (zero) except when needle biopsy is performed, then OR 2 is more adequate.</li> <li>Other ultrasound procedures, for example together with endoscopy, could have OR 2. </li> </ul><p><u>Then the following changes should be done</u>:</p><ul> <li>AJ077, Ultraljudsundersökning, bukvägg, (JADE1A, Ultrasound examination of groin and abdominal wall). Change OR from 2 to 0.</li> <li>TKE20, Punktionsbiopsi av prostata med MR-ultraljudsfusionsteknik, transrektal, (KEXX00, Prostate needle biopsy). Change OR from 0 to 2.</li> <li>TKE23, Punktionsbiopsi av prostata med MR-ultraljudsfusionsteknik, transperineal, (KEXX00, Prostate needle biopsy). Change OR from 0 to 2.</li> </ul><p>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.</p><p>TC_C1048 is attached. </p></div></div> <hr/> <p>With a reference to <span class="mention" data-mention="#982" data-mention-uid="e904a598"><a class="issue tracker-2 status-5 priority-21 priority-default multieditable-container closed" title="Case: OR value of proc codes KEDE1B and KEDE1A (on other ultrasound examination codes) (Closed)" onclick="if (!event.metaKey && !event.ctrlKey && event.button === 0) { event.preventDefault(); EasyVue.showModal('issue', 982); return false; }" href="https://nordcaseforum.easyredmine.com/issues/982">#982 - OR value of proc codes KEDE1B ...</a></span>, it was decided in EG Spring meeting that we create a new case to allow countries to have a look and check the OR values of all ultrasound codes as they lack consistency - some have OR 1, some OR 2 but most have OR 0. </p><p>Text written by Sweden/Mats is copied here:</p><p>In the Swedish version of NordDRG, the OR property 2 has a rather low impact. Out of 4 576 rules in the table drg_logic there are only 120 rules with the letter P. Most of them (109 rules) are about endoscopy. However, the OR value can be seen as a very rough estimate of resource consumption and then we have thought of a <u>principal</u> thinking: </p><ul> <li data-list-item-id="e80279baa4a1659ffc0bd4c572e64bf39">Ultrasound procedures that require laparotomy, laparoscopy, thoracotomy, or incision of the skin could have OR 1. </li> <li data-list-item-id="e968f91a85699e2c341bb48385e1d506f">Ultrasound procedures that require endoscopy could have OR 2. </li> <li data-list-item-id="ebe7f6a38466150cc61ced6fd6c6f2843">Ultrasound procedures that are performed transcutaneous could have OR 0 (zero) except when needle biopsy is performed, then OR 2 is probably more adequate. </li> </ul><p>With this principle in mind, we tried the following six changes on our patient database for 2024: </p><ul> <li data-list-item-id="e52df273772ab25ec5b00c64bc0f1e7d6"> <strong>AF032</strong> Intrakoronart ultraljud och doppler (<strong>FNDE1B</strong> Intravascular ultrasonography of coronary arteries) <i>from OR 2 to OR 1</i>. </li> <li data-list-item-id="e36f736adf207c13ee2f51d5d620ccc5d"> <strong>AP052</strong> Intravasalt ultraljud (<strong>PXDE1B</strong> Endovascular ultrasonography) <i>from OR 2 to OR 1</i> </li> <li data-list-item-id="e31cd5de323ac3deaa04cb1ff55144d9c"> <strong>TKE20</strong> Punktionsbiopsi av prostata med MR-ultraljudsfusionsteknik, transrektal (<strong>KEXX00</strong> Prostate needle biopsy) <i>from OR 0 to OR 2</i>. </li> <li data-list-item-id="e382473c058522bfa7f93bcafe8055f0e"> <strong>TKE23</strong> Punktionsbiopsi av prostata med MR-ultraljudsfusionsteknik, transperineal (<strong>KEXX00</strong> Prostate needle biopsy) <i>from OR 0 to OR 2</i>. </li> <li data-list-item-id="e22c1af97f6b690c7fbc1713d9a02cdbc"> <strong>XGX10</strong> Intrapleural ultraljudsundersökning (<strong>GXDE00</strong> Intrapleural ultrasonography) <i>from OR 2 to OR 1</i>. </li> <li data-list-item-id="e890b3864650fd8402398d9f6b84ac207"> <strong>XPX30</strong> Endovaskulärt ultraljud (<strong>PXDE1B</strong> Endovascular ultrasonography) <i>from OR 2 to OR 1.</i> </li> </ul><p>The result was that we got a lot of cases in DRG Z60 ‘Annan sällsynt, eller felaktig, kombination av huvuddiagnos och åtgärd’ (DRG 477 ‘Other rare or incorrect combination of principal diagnosis and procedure’) because of the change from OR 2 to OR 1 for FNDE1B, PXDE1B and GXDE00. </p><p>The question then is whether these cases really are incorrectly primary coded or whether the grouping logic needs to be supplemented with new rules that lead to adequate descriptive DRGs. </p><p> </p><p>Using this as a starting point, all countries are kindly invited to share their thoughts on three principles Mats is suggesting when it comes to determining the OR value of ultrasound procedures and check the data if they support this. If not, or if countries suggest different approach, please share via this ticket.</p><p> </p><p>The task type is currently set to ‘Development initiative.’</p>
