Case #1005
Updated by Lotta Sokka about 1 month ago
With a reference to #982, it was decided in EG Spring meeting that we create a new case to allow countries to have a look and check the OR values of all ultrasound codes as they lack consistency - some have OR 1, some OR 2 but most have OR 0.
Text written by Sweden/Mats is copied here:
In the Swedish version of NordDRG, the OR property 2 has a rather low impact. Out of 4 576 rules in the table drg_logic there are only 120 rules with the letter P. Most of them (109 rules) are about endoscopy. However, the OR value can be seen as a very rough estimate of resource consumption and then we have thought of a principal thinking:
Ultrasound procedures that require laparotomy, laparoscopy, thoracotomy, or incision of the skin could have OR 1. Ultrasound procedures that require endoscopy could have OR 2. Ultrasound procedures that are performed transcutaneous could have OR 0 (zero) except when needle biopsy is performed, then OR 2 is probably more adequate. With this principle in mind, we tried the following six changes on our patient database for 2024:
AF032 Intrakoronart ultraljud och doppler (FNDE1B Intravascular ultrasonography of coronary arteries) from OR 2 to OR 1. AP052 Intravasalt ultraljud (PXDE1B Endovascular ultrasonography) from OR 2 to OR 1 TKE20 Punktionsbiopsi av prostata med MR-ultraljudsfusionsteknik, transrektal (KEXX00 Prostate needle biopsy) from OR 0 to OR 2. TKE23 Punktionsbiopsi av prostata med MR-ultraljudsfusionsteknik, transperineal (KEXX00 Prostate needle biopsy) from OR 0 to OR 2. XGX10 Intrapleural ultraljudsundersökning (GXDE00 Intrapleural ultrasonography) from OR 2 to OR 1. XPX30 Endovaskulärt ultraljud (PXDE1B Endovascular ultrasonography) from OR 2 to OR 1. The result was that we got a lot of cases in DRG Z60 ‘Annan sällsynt, eller felaktig, kombination av huvuddiagnos och åtgärd’ (DRG 477 ‘Other rare or incorrect combination of principal diagnosis and procedure’) because of the change from OR 2 to OR 1 for FNDE1B, PXDE1B and GXDE00.
The question then is whether these cases really are incorrectly primary coded or whether the grouping logic needs to be supplemented with new rules that lead to adequate descriptive DRGs.
Using this as a starting point, all countries are kindly invited to share their thoughts on three principles Mats is suggesting when it comes to determining the OR value of ultrasound procedures and check the data if they support this. If not, or if countries suggest different approach, please share via this ticket.
The task type is currently set to ‘Development initiative.’
Text written by Sweden/Mats is copied here:
In the Swedish version of NordDRG, the OR property 2 has a rather low impact. Out of 4 576 rules in the table drg_logic there are only 120 rules with the letter P. Most of them (109 rules) are about endoscopy. However, the OR value can be seen as a very rough estimate of resource consumption and then we have thought of a principal thinking:
Ultrasound procedures that require laparotomy, laparoscopy, thoracotomy, or incision of the skin could have OR 1. Ultrasound procedures that require endoscopy could have OR 2. Ultrasound procedures that are performed transcutaneous could have OR 0 (zero) except when needle biopsy is performed, then OR 2 is probably more adequate. With this principle in mind, we tried the following six changes on our patient database for 2024:
AF032 Intrakoronart ultraljud och doppler (FNDE1B Intravascular ultrasonography of coronary arteries) from OR 2 to OR 1. AP052 Intravasalt ultraljud (PXDE1B Endovascular ultrasonography) from OR 2 to OR 1 TKE20 Punktionsbiopsi av prostata med MR-ultraljudsfusionsteknik, transrektal (KEXX00 Prostate needle biopsy) from OR 0 to OR 2. TKE23 Punktionsbiopsi av prostata med MR-ultraljudsfusionsteknik, transperineal (KEXX00 Prostate needle biopsy) from OR 0 to OR 2. XGX10 Intrapleural ultraljudsundersökning (GXDE00 Intrapleural ultrasonography) from OR 2 to OR 1. XPX30 Endovaskulärt ultraljud (PXDE1B Endovascular ultrasonography) from OR 2 to OR 1. The result was that we got a lot of cases in DRG Z60 ‘Annan sällsynt, eller felaktig, kombination av huvuddiagnos och åtgärd’ (DRG 477 ‘Other rare or incorrect combination of principal diagnosis and procedure’) because of the change from OR 2 to OR 1 for FNDE1B, PXDE1B and GXDE00.
The question then is whether these cases really are incorrectly primary coded or whether the grouping logic needs to be supplemented with new rules that lead to adequate descriptive DRGs.
Using this as a starting point, all countries are kindly invited to share their thoughts on three principles Mats is suggesting when it comes to determining the OR value of ultrasound procedures and check the data if they support this. If not, or if countries suggest different approach, please share via this ticket.
The task type is currently set to ‘Development initiative.’