#1013 - Use of PROCPR 99S90 Extensive procedure
This case concerns PROCPR 99S90 Extensive procedure - list created during the exporting process and how it is used across all national versions.
Use of PROCPR 99S90 was reviewed both from a clinical perspective and from the perspective of cross‑country differences.
There is no clear definition of “extensive procedure”. However, in casemix or DRG context one could define it as a procedure with high resource intensity that significantly increase expected costs, length of stay, complexity, and clinical risk. Its role is primarily grouping logic, not clinical description.
In the NordDRG system, PROCPR 99S90 is used to identify extensive procedures and, on that basis, to allow grouping to DRG 468/X Rare or incorrect combination of diagnosis and extensive procedure/X. This distinction is necessary to separate cases that are not considered extensive, which are instead grouped to DRG 477/X Rare or incorrect combination of diagnosis and other procedures/X.
In addition, PROCPR 99S90 is used in the rules of following DRGs:
| drg_comb | drg_text_comb | nat_ver |
| 442X | Other OR procedures for injuries, w CC | est/lat/ice/fin/nor |
| 443M | Other major OR procedures after injuries, w MCC | swe |
| 443C | Other major OR procedures in general anaesthesia for injuries, w CC | swe |
| 443N | Other major OR procedures in general anaesthesia for injuries, w/o CC | swe |
| 443X | Other OR procedures for injuries, w/o CC | est/lat/ice/fin/nor |
PROCPR 99S90 with minus (-) sing is not used in any DRG rules (minus sign is used in case to avoid grouping of case with a procedure code having PROCPR 99S90).
After having a look at the use of PROCPR 99S90, here are some observations:
- There are procedure codes which are having OR value 0 or 2, yet having PROCPR 99S90. The codes are as follows:
| code_plus | text_plus | or_val | nat_ver* |
| JCSE35 | Laprascopic operation on oesophageal atresia or congenital tracheo-oesophageal fistula | 0 | nor |
| NHSQ60 | Revision of ampution or exarticulation of ankle or foot | 0 | ice/fin |
| FKSC61 | Repair of mitral valve insufficiency by a transluminally inserted clip | 2 | fin/est |
| NAO10D | Termokoagulasjon i kolumna, CT-veiledet | 2 | nor |
| NAXA00 | Heat coagulation of vertebral lesion | 2 | ice/fin/nor |
| NAXT60 | Manipulation of the spine | 2 | ice/fin |
*As Norwegian version is primarily maintained by Helsedirektoratet, there can be differences between the tables maintained in NDMS and HS.
2. There are cross-country differences among some codes:
| code_plus | text_plus | or_val | nat_ver | Comment |
| LESF03 | Posterior colporrhaphy | 1 | est/lat/ice/fin/nor | Not used in SWE version |
| LESF10 | Colpoperineoplasty | 1 | est/lat/ice/fin/nor | Not used in SWE version |
| FZSA00 | Total cardiopulmonary bypass in normothermia or moderate hypothermia at concurrent surgical procedure | 1 | swe | Used only in SWE version |
| KKSB11 | Percutaneous endoscopic excision of retroperitoneal tumour | 1 | swe | Used only in SWE version |
| LESF40 | Vaginal repair of enterocele | 1 | swe | Used only in SWE version |
| LESF41 | Laparoscopic repair of enterocele | 1 | swe | Used only in SWE version |
| ZTXA40 | Graft of synthetic skin substitute | 1 | swe | Used only in SWE version |
Things to consider:
- remove PROCPR 99S90 from procedure codes with OR 0 or 2, or change the OR value of procedure codes.
- harmonise the use of PROCPR 99S90 across countries, based on the principle that identical procedure codes are interpreted consistently regardless of country, whether as “extensive” or “non‑extensive".
- Revise all procedure codes from PROCPR 99S90 perspective (see attached a table of procedure plus codes with PROCPR 99S90 in 2027PL0 version).
- Given that PROCPR text Extensive procedure - list created during the exporting process was used during the transition of definition tables from FoxPro to NDMS in 2018, I suggest to change the text: Extensive procedure - list created during the exporting process -> Extensive procedure.
This case is meant to be discussed in next EG Spring meeting. Any comments or views on this issue are welcome any time.