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Mats Fernström#1015 - Craniofacial reconstruction leads to a Z-DRG

Status:
Active
Assignee:
Mats Fernström
Author:
Mats Fernström
Task type:
Case
Priority:
Minor
Start date:
2026-05-26
Spent time:
0.00 h
Created:
2026-05-26 19:02
Initiator:
Sweden
Target Grouper:
SWE
Owner / responsible:
National organisations
MDC:
MDC03
Target year:
2028
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Description

Mats Fernström, the National Board of Health and Welfare, Sweden, 2026-05-26 (SWE ID C1046)

We have noticed that some cases with reconstruction of craniofacial malformation are grouped to DRG Z50 “Tyngre sällsynt, eller felaktig, kombination av huvuddiagnos och åtgärd …” (DRG 468 “Rare or incorrect combination of diagnosis and extensive procedure,…”). This happens when the principal diagnosis ICD code is Q870 ”Medfödda missbildningssyndrom som främst påverkar ansiktets utseende” (Q8700 Congenital malformation syndromes predominantly affecting facial appearance) or the Swedish subgroups combined with the procedure codes AAK20 “Operationer p.g.a. kraniosynostos” (AASK20 “Operations for craniosynostosis”) or AAK30 “Kraniofacial rekonstruktion vid missbildning” (AASK30 “Craniofacial reconstruction in congenital malformations”). The reason for DRG Z50/468 and not DRG Z60/477 is that both AAK20/ AASK20 and AAK30/ AASK30 have procpro 99S90.

The combinations of diagnoses codes and procedure codes mentioned above are correct to use according to the classification team at the National Board of Health and Welfare and then DRG Z50/468 is unsatisfactory. Therefore, we suggest adding procpro 03S01 (Major head or neck procedure) to AAK20/ AASK20 and AAK30/ AASK30. Then the cases will be grouped to DRG C05N/ 049A with the text “Other major operations on head and neck” which is much better than “Rare or incorrect combination of diagnosis and extensive procedure” from a description perspective.

What about the cost perspective? In our latest cost database, we found:

  • 42 cases with AAK20/ AASK20, with an average cost of 221 207 SEK
  • 16 cases with AAK30/ AASK30, with an average cost of 259 268 SEK

The average cost for DRG Z50E/468 is 153 334 SEK while the average cost for DRG C05N/ 049A is 165 806 SEK. Thus, DRG C05N/ 049A is somewhat better than DRG Z50E/468 also from a cost perspective.

In summary, we want to add procpro 03S01 to AAK20/ AASK20 and AAK30/ AASK30 in NordDRG SWE2028, which will lead to a better grouping, both in description and cost perspectives. A TC for this small change is attached.

Attachments (1)