<div class="journal-details-container"> <h4> Task #1013 has been updated by Kristiina Kahur. </h4> <div class="details"> <span><strong>Status</strong> changed from <i>Active</i> to <i class="new-value">Further active</i></span><br/> </div> <div id="journal-5535-notes" class="note"><p><strong>2026-09-02 Expert Group</strong></p><p>This issue was discussed in EG meeting. </p><p>It was decided that the text of PROCPR 99S90 will be corrected in NDMS: <i>Extensive procedure - list created during the exporting process</i> → <i>Extensive procedure. </i></p><p>No other changes will be made in the features (in OR values) of any proc code in 2027PR0 version.</p><p>Countries are encouraged to go through the suggestions made by Swedish DRG team as well as the methodological aspects (see above, update of 2026-05-12) and share their views (agree, disagree etc).</p><p>It's up to each country to suggest any changes in their national version by providing respective TCs. However, the aim is to make the same changes across the national versions whenever possible.</p><p>This case will remain further active and will be discussed at the EG 2027 Spring meeting should any updates be received from the countries by then.</p></div></div> <hr/> <p>This case concerns PROCPR 99S90 <i>Extensive procedure - list created during the exporting process</i> and how it is used across all national versions.</p><p>Use of PROCPR 99S90 was reviewed both from a clinical perspective and from the perspective of cross‑country differences.</p><p>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.</p><p>In the NordDRG system, PROCPR 99S90 is used to identify extensive procedures and, on that basis, to allow grouping to DRG 468/X  <i>Rare or incorrect combination of diagnosis and extensive procedure/X.</i> This distinction is necessary to separate cases that are not considered extensive, which are instead grouped to DRG 477/X <i>Rare or incorrect combination of diagnosis and other procedures/X.</i></p><p>In addition, PROCPR 99S90 is used in the rules of following DRGs:</p><figure class="table"><table><tbody> <tr> <td>drg_comb</td> <td>drg_text_comb</td> <td>nat_ver</td> </tr> <tr> <td>442X</td> <td>Other OR procedures for injuries, w CC</td> <td>est/lat/ice/fin/nor</td> </tr> <tr> <td>443M</td> <td>Other major OR procedures after injuries, w MCC</td> <td>swe</td> </tr> <tr> <td>443C</td> <td>Other major OR procedures in general anaesthesia for injuries, w CC</td> <td>swe</td> </tr> <tr> <td>443N</td> <td>Other major OR procedures in general anaesthesia for injuries, w/o CC</td> <td>swe</td> </tr> <tr> <td>443X</td> <td>Other OR procedures for injuries, w/o CC</td> <td>est/lat/ice/fin/nor</td> </tr> </tbody></table></figure><p>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).</p><p> </p><p>After having a look at the use of PROCPR 99S90, here are some observations:</p><ol><li data-list-item-id="e0f0ba99b05b591ec96c18fdc26ef2c29">There are procedure codes which are having OR value 0 or 2, yet having PROCPR 99S90. The codes are as follows:</li></ol><figure class="table"><table><tbody> <tr> <td>code_plus</td> <td>text_plus</td> <td>or_val</td> <td>nat_ver*</td> </tr> <tr> <td>JCSE35</td> <td>Laprascopic operation on oesophageal atresia or congenital tracheo-oesophageal fistula</td> <td>0</td> <td>nor</td> </tr> <tr> <td>NHSQ60</td> <td>Revision of ampution or exarticulation of ankle or foot</td> <td>0</td> <td>ice/fin</td> </tr> <tr> <td>FKSC61</td> <td>Repair of mitral valve insufficiency by a transluminally inserted clip</td> <td>2</td> <td>fin/est</td> </tr> <tr> <td>NAO10D</td> <td>Termokoagulasjon i kolumna, CT-veiledet</td> <td>2</td> <td>nor</td> </tr> <tr> <td>NAXA00</td> <td>Heat coagulation of vertebral lesion</td> <td>2</td> <td>ice/fin/nor</td> </tr> <tr> <td>NAXT60</td> <td>Manipulation of the spine</td> <td>2</td> <td>ice/fin</td> </tr> </tbody></table></figure><p><i>*As Norwegian version is primarily maintained by Helsedirektoratet, there can be differences between the tables maintained in NDMS and HS.</i></p><p>2. There are cross-country differences among some codes:</p><figure class="table"><table><tbody> <tr> <td>code_plus</td> <td>text_plus</td> <td>or_val</td> <td>nat_ver</td> <td>Comment</td> </tr> <tr> <td>LESF03</td> <td>Posterior colporrhaphy</td> <td>1</td> <td>est/lat/ice/fin/nor</td> <td>Not used in SWE version</td> </tr> <tr> <td>LESF10</td> <td>Colpoperineoplasty</td> <td>1</td> <td>est/lat/ice/fin/nor</td> <td>Not used in SWE version</td> </tr> <tr> <td>FZSA00</td> <td>Total cardiopulmonary bypass in normothermia or moderate hypothermia at concurrent surgical procedure</td> <td>1</td> <td>swe</td> <td>Used only in SWE version</td> </tr> <tr> <td>KKSB11</td> <td>Percutaneous endoscopic excision of retroperitoneal tumour</td> <td>1</td> <td>swe</td> <td>Used only in SWE version</td> </tr> <tr> <td>LESF40</td> <td>Vaginal repair of enterocele</td> <td>1</td> <td>swe</td> <td>Used only in SWE version</td> </tr> <tr> <td>LESF41</td> <td>Laparoscopic repair of enterocele</td> <td>1</td> <td>swe</td> <td>Used only in SWE version</td> </tr> <tr> <td>ZTXA40</td> <td>Graft of synthetic skin substitute</td> <td>1</td> <td>swe</td> <td>Used only in SWE version</td> </tr> </tbody></table></figure><p>Things to consider:</p><ol> <li data-list-item-id="e249895875e335ccd6d6e42075091fad5">remove PROCPR 99S90 from procedure codes with OR 0 or 2, or change the OR value of procedure codes.</li> <li data-list-item-id="e0102334ff377e0744c641543db93c4f0">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".</li> <li data-list-item-id="ecc1abfd29bfd55b2cc37036bb36f1d0c">Revise all procedure codes from PROCPR 99S90 perspective (see attached a table of procedure plus codes with PROCPR 99S90 in 2027PL0 version). </li> <li data-list-item-id="e7246b8987ecaef3c2a7e5d4347c4b331">Given that PROCPR text <i>Extensive procedure - list created during the exporting process</i> was used during the transition of definition tables from FoxPro to NDMS in 2018, I suggest to change the text: <i>Extensive procedure - list created during the exporting process</i> -> <i>Extensive procedure</i>.</li> </ol><p>This case is meant to be discussed in next EG Spring meeting. Any comments or views on this issue are welcome any time.</p>