Case #1002
Updated by Vegard Kvilesjø 4 months ago
In some cases, female patients are referred for diagnostic laparoscopy, during which sterilization is performed at the same time. For example:
Principal diagnosis:
· N8090 – Endometriosis, unspecified
Secondary diagnosis:
· Z3020 – Sterilization
Procedure codes:
· JASL21 – Laparoscopic excision or destruction of lesion of the peritoneum
· LBSD01 – Laparoscopic partial excision of the Fallopian tube
Grouping (depending on length of stay):
· DRG 362X – Laparoscopic or other endoscopic sterilization
· DRG 362O – Laparoscopic or other endoscopic sterilization, short therapy
In the Norwegian version (and other countries), there is a clear distinction between DRG 361X – Gynecological laparoscopy or sterilization via laparotomy / 361O – Gynecological laparoscopy or sterilization via laparotomy, short therapy and DRG 362X/362O, where DRG 361X/361O applies to laparoscopy and DRG 362X/362O applies to sterilization.
In the example presented above, the main reason for the patient’s contact with the healthcare service is diagnostic laparoscopy. We therefore believe that the stay should group to DRG 361X/361O not DRG 362X/362O.
We also have noted that certain relevant laparoscopy procedures should have the grouping property PROCPR 13S03 – Laparoscopy or incisional tubal interruption, but currently have PROCPR 13S08 – Other female reproductive system OR procedure. We therefore propose changing the grouping property from 13S08 to 13S03 for the following procedures:
· JASL21 – Laparoscopic extirpation or destruction of lesion of the peritoneum
· JASL24 – Laparoscopic excision of local lesion of the pelvic wall
· JASL97 – Other laparoscopic local procedure of the peritoneum
This change would result in the example above grouping to DRG 361X/361O. See the attached TC.
We would also like to discuss whether the names of DRG 361X/361O and DRG 362X/362O in the combined version should be revised to more clearly reflect this distinction. It appears that such a distinction already exists in a number of countries, based on the local DRG-names.
Principal diagnosis:
· N8090 – Endometriosis, unspecified
Secondary diagnosis:
· Z3020 – Sterilization
Procedure codes:
· JASL21 – Laparoscopic excision or destruction of lesion of the peritoneum
· LBSD01 – Laparoscopic partial excision of the Fallopian tube
Grouping (depending on length of stay):
· DRG 362X – Laparoscopic or other endoscopic sterilization
· DRG 362O – Laparoscopic or other endoscopic sterilization, short therapy
In the Norwegian version (and other countries), there is a clear distinction between DRG 361X – Gynecological laparoscopy or sterilization via laparotomy / 361O – Gynecological laparoscopy or sterilization via laparotomy, short therapy and DRG 362X/362O, where DRG 361X/361O applies to laparoscopy and DRG 362X/362O applies to sterilization.
In the example presented above, the main reason for the patient’s contact with the healthcare service is diagnostic laparoscopy. We therefore believe that the stay should group to DRG 361X/361O not DRG 362X/362O.
We also have noted that certain relevant laparoscopy procedures should have the grouping property PROCPR 13S03 – Laparoscopy or incisional tubal interruption, but currently have PROCPR 13S08 – Other female reproductive system OR procedure. We therefore propose changing the grouping property from 13S08 to 13S03 for the following procedures:
· JASL21 – Laparoscopic extirpation or destruction of lesion of the peritoneum
· JASL24 – Laparoscopic excision of local lesion of the pelvic wall
· JASL97 – Other laparoscopic local procedure of the peritoneum
This change would result in the example above grouping to DRG 361X/361O. See the attached TC.
We would also like to discuss whether the names of DRG 361X/361O and DRG 362X/362O in the combined version should be revised to more clearly reflect this distinction. It appears that such a distinction already exists in a number of countries, based on the local DRG-names.