Nordic Casemix Center/Kristiina Kahur 11-2-2025

Current proposal concerns LGSA-codes which have PROCPR 13S03 Laparoscopy or incisional tubal interruption. It suggests to remove PROCPR 13S03 by replacing it with PROCPR 13S07 Endoscopic tubal interruption and make respective corrections in DRG names.

DRG 361N (O25N) Gynecological laparoscopy or sterilization in laparatomy is used only in SWE version. Respective DRG code in other versions is 361X (361) Gynecological laparoscopy or sterilization in laparatomy.

There are nine NCSP+ codes meant for female steriliz(s)ation, all start with LGSA (LGA in national versions):

LGSA00    Sterilisation by ligature of Fallopian tubes
LGSA10    Sterilisation by destruction or division of Fallopian tubes
LGSA11    Laparoscopic sterilisation by destruction or division of Fallopian tubes
LGSA20    Sterilisation by constriction of Fallopian tubes
LGSA21    Laparoscopic sterilisation by constriction of Fallopian tubes
LGSA22    Hysteroscopic sterilisation
LGSA96    Other female sterilisation
LGSA97    Other laparoscopic female sterilisation
LGSA98    Other transluminal endoscopic sterilisation

The codes have PROCPR 13S03 Laparoscopy or incisional tubal interruption or 13S07 Endoscopic tubal interruption depending on the technique/type of surgery. 
Endoscopy is a broader term that includes various procedures for examining or treating internal organs through natural openings or small incisions. Laparoscopy is a subset of endoscopy that specifically refers to procedures done in the abdominal or pelvic cavity using small incisions.

LGSA-codes with PROCPR 13S03 Laparoscopy or incisional tubal interruption are:
LGSA00    Sterilisation by ligature of Fallopian tubes
LGSA10    Sterilisation by destruction or division of Fallopian tubes
LGSA20    Sterilisation by constriction of Fallopian tubes
LGSA96    Other female sterilisation

In addition to LGSA-codes there are also other codes with PROCRP 13S03 Laparoscopy or incisional tubal interruption:
JADE01    Laparoscopic ultrasonography
JASH01    Laparoscopy
JASH02    Second look laparoscopy
JASH05    Laparoscopy with biopsy
JASH21    Staging laparoscopy
JASL01    Laparoscopic biopsy of peritoneum
JASL11    Laparoscopy and removal of foreign body
LASA01    Laparoscopic puncture of ovarian cyst
LBSA07    Salpingoscopy
LESA01    Culdoscopy

LGSA-codes with PROCPR 13S07 Endoscopic tubal interruption are:
LGSA11    Laparoscopic sterilisation by destruction or division of Fallopian tubes
LGSA21    Laparoscopic sterilisation by constriction of Fallopian tubes
LGSA22    Hysteroscopic sterilisation
LGSA97    Other laparoscopic female sterilisation
LGSA98    Other transluminal endoscopic sterilisation
No other proc codes have PRCOPR 13S07.

From a clinical and clarity perspective, this change would be logical. However, a national-level cost analysis should be conducted (if possible) to support the proposed change.

FYI, there is no separate DRGs for female sterilisation in AR-DRG (Australia) and MS-DRG (USA) system. However, there is a DRG for male sterilization interventions in AR-DRG.

Estonia supports the proposed change , it makes clinically sense, although we do not seem to have cases coded with NCSP+ from  LGA chapter in DRG-s  361 or 361O.  

If the change will be accpeted by expert group, the DRG names in estonian will be  changed as folowing

 (361)  Gynecological laparoscopy / Günekoloogiline laparoskoopia
 (361O) Gynecological laparoscopy, short therapy / Günekoloogiline laparoskoopia. lühike ravi
(362) Sterilization / Steriliseerimine 
(362O) Sterilization, short therapy / Steriliseerimine, lühike ravi 

In Finland, a large proportion of sterilizations are performed in conjunction with cesarean sections and these cases are grouped to DRGs 371 (371X), 370C or 370M.

In other cases, the most commonly used procedure code for sterilizations is LGA21 (LGSA21) Munanjohtimien tukkiminen puristusrenkaalla tai klipsillä vatsaontelon tähystyksessä, and these cases are mainly grouped to 362O.

We do understand the purpose of the suggested change and clinically it’s also logical. However, for the reasons mentioned above and the fact that (hopefully, in the near future) Finland is aiming for the gender-neutral grouping (which would affect these and many other groups as well), we don’t want this change at this point.

Norway supports the proposed change, which will affect 7 cases (data from 8 first months of 2024). These cases will  from DRG 361O to DRG 362O, due to change of property for LGA00, LGA10 and LGA96 from 13S03 to 13S07. 

This affects very few cases in Iceland but we find this change logical and therefore support it.

Latvia supports changes. 

In 2024 in Latvia 44 cases are grouped into drg 361 (Gynecological laparoscopy or sterilization in laparatomy) with no coded LGAxx sterilisation procedure (LGA00, LGA10, LGA20, LGA96). Mostly oncological dg's. No case grouped into drg 362. Cases with coded LGAxx proc ar grouped into 5 drg's, from which 99% are birth delivery drg's 370, 371, 374. 

The names in Latvian would be: 
361 Ginekoloģiskā laparoskopija | Gynecological laparoscopy
361O Ginekoloģiskā laparoskopija, īslaicīga terapija | Gynecological laparoscopy, short therapy
362 Sterilizācija | Sterilization
362O Sterilizācija, īslaicīga terapija | Sterilization, short therapy
 

The Norwegian DRG names after the change will be:

DRG 361 Gynekologisk laparoskopi

DRG 361O Gynekologisk laparoskopi, dagkirurgisk behandling

DRG 362 Sterilisering av kvinner

DRG 362O Sterilisering av kvinner, dagkirurgisk behandling

2025-03-11 Expert group

These changes were accepted according to originally suggested TCs in all national versions but Finnish.

No changes will be done in COMB version DRG names because of no changes in Finnish version. 

We still are missing updated ICE version DRG names. At the moment, they look like follows:

361 Skoðun innri kynfæra konu um kviðsjá eða ófrjósemisaðgerð í kviðaropnun
361O Skoðun innri kynfæra konu um kviðsjá eða ófrjósemisaðgerð í kviðaropnun, stutt meðferð
362 Ófrjósemisaðgerð um víðsjá eða aðra holsjá
362O Ófrjósemisaðgerð um víðsjá eða aðra holsjá, stutt meðferð

This case will be closed as soon as we get the feedback from Iceland and finalize the changes in NDMS.

New Icelandic names:

361 Skoðun innri kynfæra konu um kviðsjá

361O Skoðun innri kynfæra konu um kviðsjá, stutt meðferð

362 Ófrjósemisaðgerð

362O Ófrjósemisaðgerð, stutt meðferð