#865 - Regroup prostate biopsy from MDC 23 to MDC 12 - Nordic Casemix Centre - nordcaseforum

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#865 - Regroup prostate biopsy from MDC 23 to MDC 12

Status:

Closed

Assignee:

Mats Ulvund Paulsberg

Author:

Mats Ulvund Paulsberg

Task type:

Case

Priority:

Minor

Start date:

2023-02-21

Spent time:

0.00 h

Created:

2023-02-21 14:42

Closed:

2023-05-08 09:01

Initiator:

Norway

Target Grouper:

Combined

Owner / responsible:

Nordic Casemix Centre

MDC:

MDC12

Target year:

2024

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Description

Problem
A suggestion from the medical professionals at Vestre viken hospital about procedure code KEB06G "Biopsi av prostata, MR-veiledet" and KEB06K "Nålebiopsi av prostata, ultralydveiledet".

New guidelines today advise against transrectal biopsies and rather biopsies using a more percutaneous technique through the perineum. The old biopsy needles cannot be used. The spring/motor is too weak. One must therefore choose more expensive biopsy equipment. Cases with diagnosis codes in MDC 23 will group to DRG 923O where medical professionals at Vestre viken indicates that the reimbursement is too low compared with the cost.

Analysis

The procedure code KEB06G and KEB06K are used as procedure code 23 and 3 482 times during 2021. Where procedure code KEB06G is used, the cases are mainly grouped to DRG 877O "Andre polikliniske kontakter for gjennomføring av middels omfattende prosedyrer". Where procedure code KEB06K is used, 47% of the cases goes to DRG 812P "Mindre prosedyrer på mannlige kjønnsorgan" and 37% are going to DRG 923O "Pol kons vedr faktorer som har betydning for helsetilstanden/kontakt med helsetjenesten".

In DRG 812P where procedure code KEB06K is used are the diagnostic codes C61 "Ondartet svulst I blærehalskjertel", N40 "Benign prostataobstruksjon" and Z125 "Populasjonsbasert screening mhp. Svulst I blæehalskjertel" are mostly used. In 923O with procedure code KEB06K, diagnostic codes R748 "Unormalt serumnivå av andre spesifiserte enzyme" and R749 "Unormalt serumnivå av uspesifisert enzym" are mostly used.

DRG 812P "Mindre prosedyrer på mannlige kjønnsorgan" have cost weight 0,037 which would be about 69 EURO (723 NOK) in ISF reimbursement.

DRG 923O "Pol kons vedr faktorer som har betydning for helsetilstanden/kontakt med helsetjenesten" have cost weight 0,017 which would be about 30 EURO (336 NOK) in ISF reimbursement.

DRG 812P
Total number of cases in 2021: 10 391
Mean cost: 210 EURO (2 308 NOK)

DRG 812P with procedure code KEB06K
Total number of cases in 2021: 1 636
Mean cost: 260 EURO (2 868 NOK)

DRG 923O
Total number of cases in 2021: 154 611
Mean cost: 241 EURO (2 658 NOK)

DRG 923O with procedure code KEB06K
Total number of cases in 2021: 1 891
Mean cost: 275 EURO (3 030 NOK)

Medically the solution with the cases that are grouped to DRG 923O are not optimal, and DRG 812P would be more medical meaningful and homogeneous in terms of costs.

Suggestion

We suggest creating a new procedure property 12O02 "Biopsy of the prostate" and give this to the codes KEB06K, KEB06G, KEX03 and KEX06. We also suggest creating a new rule in drglogic with procpro 12O02 and MDC 23.

We had to do a correction with code KEB06G and take out PROCPRO 11O01 "Puncture of kidney and retroperitoneum" and OR 2. That’s because the code had the wrong property compared to other comparable codes.

We have also been thinking about giving MDC 23 to DRG812P and procedure property 12O01 instead of 12O02, but then we noticed that regrouped a lot of cases from DRG 823R "Mindre prosedyrer vedr faktorer som har betydning for helsetilstanden/ kontakt med helsetjenesten" with Z090 and Z080 as diagnosis code and KXFF00 as procedure code which does not fit in DRG 812P.

DRG change
When testing this change, this will in the Norwegian 1. Tertial 2021 national data regroup 1 016 cases:
From 923O to 812P: 906
From 912O to 812P: 43
From 823R to 812P: 28
From 811P to 812P: 15
From 877O to 812P: 12
From 811R to 812P: 7
From 718O to 812P: 3
From 811P to 811S: 2

Attachments (4)

(1-4/4)

Kristiina Kahur 2023-02-22 15:00

Nordic Casemix Centre/Kristiina Kahur 22-2-2023

To facilitate the analysis in other countries, attached is the mapping of NOR codes KEB06K, KEB06G, KEX03 and KEX06 to NCSP+ codes, respective procedure codes in other national versions and the features of the codes.

One question concerns removal of OR 2 from procedure code KEB06G (KESB00 Biopsy of prostate). There is no ‘IN’ row for OR value. Do you consider adding one? In NDMS, code KEB06G (KESB00 Biopsy of prostate) has OR 1 value. Other features differ in NOR version from other countries features.

DRG 812P (812NP Minor lower urinary tract procedure, short therapy) is used only in NOR and ICE version. Based on DRG logic, DRG 812P is using PROCPR 12O01 Minor male productive system procedures (also used only In ICE and NOR version) which has given to following NCSP+ codes:

KBFB00	Urodynamic investigation of ureter
KDFD00	Uroflowmetry
KDFD03	Urethral pressure profilometry
KDFD06	Physiologic investigation of micturition
KDXX00	Dilatation of urethra
KEXX00	Prostate needle biopsy
KEXX02	Prostate needle biopsy for cytology
KFSA40	Incision of scrotum
KFSD51	Percutaneous endoscopic resection or closure of spermatic vein
KFXX00	Testis needle biopsy
KFXX02	Testis needle biopsy for cytology
KFXX30	Epididymis puncture
KFXX60	Scrotum puncture
KGF000	Penile vascular flow measurements
KGF002	Cavernosometry
KGF010	Electromyography of corpus cavernosum
KGF990	Other examination of erection physiology
KGSB00	Biopsy of penis
KGSD20	Destruction of lesion of skin of penis
KGSH00	Suture of penis
KGXG00	Artificial induction of erection
KXXX99	Other minor procedure in urology

Other countries can concider adding this DRG 812NP into national versions if the the cost and clinical analysis is supporting this.

Attachment Case 865 - codes and features.xlsx added

Malle Avarsoo 2023-02-27 12:46

IN Estonia these cases with mentioned NCSP codes and procprop

Biopsy of prostate	PROCPR	11S05	1	FALSE	Transurethral procedures (no prostatectomy)	est/swe/lat/ice/den/fin/nor
Biopsy of prostate	PROCPR	12S08	1	FALSE	Other male reproductive system OR procedure	est/swe/lat/ice/den/fin/nor

will be grouped in DRG groups ( 11S05 )

310X Transurethral procedures w cc
311X Transurethral procedures w/o cc
311O Transurethral procedures, short therapy
and (12S08) cases into

344X Other male reproductive system o. r. procedures for malignancy
345X Other male reproductive system o. r. procedures except for malignancy
345O Other male reproductive system o. r. procedures, short therapy
These results seem to be clinically correct, if the biopsy of prostate is done in inpatient setting ( and usually it is not the only intervention there ). Relevant information of ambulatory setting procedures is not presented here, as these cases are not grouped in DRG-s.

Adding a new short stay group might be of discussion, although very few cases ( less than 30 ) are found with prostate biopsy only.

Mats Fernström 2023-02-28 14:24

Mats Fernström, the National Board of Health and Welfare, Sweden, 2023-02-28 (SWE ID C979)
In Sweden, we don’t have the Norwegian problem because we have gathered together this type of procedures (see the list below with plus codes within parenthesis) into a separate group, DRG N75O ‘Biopsi av prostata, penis etc, besök’ (Comb. DRG 843V ‘Ultrasound guided intervention of male genital organs, short therapy’) and that irrespectively of the principal diagnosis.
• KGB00 Biopsi av penis (KGSB00 Biopsy of penis)
• TKE05 Aspirationscytologi av prostate (KEXX02 Prostate needle biopsy for cytology)
• TKE10 Punktionsbiopsi prostata transrectal (KEXX00 Prostate needle biopsy)
• TKE13 Punktionsbiopsi prostata perineal (KEXX00 Prostate needle biopsy)
• TKE20 Fusionsbiopsi prostata transrektal (KEXX00 Prostate needle biopsy)
• TKE23 Fusionsbiopsi prostata perineal (KEXX00 Prostate needle biopsy)
• TKF00 Punktionsbiopsi av testis (KFXX00 Testis needle biopsy)
• TKF05 Aspirationscytologi av testis (KFXX02 Testis needle biopsy for cytology)
• TKF30 Perkutan punktion av epididymis (KFXX30 Epididymis puncture)
In our cost database for the year 2021 we have 13 060 cases in DRG N75O with an average cost of 8 219 SEK. In a cost perspective, the group is rather homogeneous with CV = 59 %.

Lotta Sokka 2023-03-08 11:30

2023-03-08 Lotta Sokka

In Finland, the cases of prostate biopsy are mainly grouped to DRGs 923O and 912O. From cost point of view the cases do not fit there.

We have analyzed both options, Norwegian and Swedish, and given that we have in Finland DRG 812O Non-extensive procedure of male reproductive system, short therapy, we would like to introduce a separate DRG for prostate, penis etc biopsy as it is done in SWE version (N75O Biopsi av prostata, penis etc, besök). We will use rules of DRG N75O and place them above the current DRG 923O and 912O.

The Finnish name for the new DRG will be Eturauhasen, kiveksen, peniksen jne. biopsia, lyhyt hoito

Malle Avarsoo 2023-03-15 09:19

Estonia does not need the proposed change, we are happy with the groups we already have.

Kristiina Kahur 2023-03-29 08:36

2023-03-09 Expert Group

This change was accepted for Norway and Iceland according to the TC suggested by Norway and for Finland according to the approach Sweden is using already. No change for Latvia and Estonia.

The changes in FIN version were made in NDMS. A new DRG 843V was added to FIN version. New rule 112D129959 of DRG 843V was placed above the rule 112D129960 of DRG 912O. All TCs made in NDMS FIN version are attached to this ticket.

At the same time text of DRG 843V in Combined version was corrected. New text is Biopsy of male genital organs, short therapy (old one was Ultrasound guided intervention of male genital organs, short therapy).

As for changes in NOR and ICE version, we need to clarify couple of things before we proceed with making changes in NDMS:

According to TC Norway suggest to remove OR 2 value from NOR code KEB06G Biopsi av prostata, MR-veiledet (NCSP+ code KESB00 Biopsy of prostate), but no new OR value is added. Currently, in NDMS code KESB00 has OR 1. Would this be ok for code KEB06G/KESB00?
Two NOR codes are linked to NCSP+ code KESB00: 1) above-mentioned KEB06G and 2) KEB00 Åpen biopsi av prostata. This means that any changes made to code KEB06G will be done also to code KEB00. If this is not acceptable, the mapping needs correction.

This case remains open until we have got the feedback from Norway.

Attachment TC_865_FIN_NDMS_29032023.xlsx added

Mats Ulvund Paulsberg 2023-05-05 14:18

For code KEB06G we want to keep it as suggested in the TC, with no new OR value. For code KEB00 we want to keep OR = 1, and the mappings need correction. In Norway KEB00 is called "Open biopsy of prostate" so we think that this code should have OR = 1.

Kristiina Kahur 2023-05-08 09:01

Nordic Casemix Centre/Kristiina Kahur 8-5-2023

Thank you for feedback.

It was more logical to change the mapping of KEB06G rather than KEB00 in NOR version.

NOR codes KEB06G Biopsi av prostata, MR-veiledetwas and KEX03 Aspirasjonscytologi fra prostata was corrected are mapped now to ncsp+ code KEXX00 Prostate needle biopsy. No changes in mapping of ICE version procedure codes.
TCs made in NDMC/MBC are attached.

Case is closed.

Attachment TC_865_ICE_NOR_IN_NDMS_MBC_08052023.xlsx added
Status changed from Active to Closed

TC_865_ICE_NOR_IN_NDMS_MBC_08052023.xlsx (10 kB) - v1	Kristiina Kahur, 2023-05-08 09:01	Show version history.
TC_865_FIN_NDMS_29032023.xlsx (20 kB) - v1	Kristiina Kahur, 2023-03-29 08:36	Show version history.
Case 865 - codes and features.xlsx (10 kB) - v1	Kristiina Kahur, 2023-02-22 15:00	Show version history.
TC_865.xls (100 kB) - v1	Mats Ulvund Paulsberg, 2023-02-21 14:42	Show version history.

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