Pravidlá kódovania - Podnet na opravu

Organisation: FNsP Skalica a.s.

Created at: 13.03.2024

Processed at: 02.04.2026

Question

When a patient is hospitalized with a combination of gynecologic procedures, the resulting price for the hospitalization is reduced; we are penalized for treating multiple problems in one session, which benefits the patient, us in time, and the health insurance company. The latter saves money for malusing combined procedures, with the resulting price often being less than or equal to one of the cheaper procedures. This method of penalizing the patient for services rendered ultimately forces providers to split the combined procedure into two for economic reasons, resulting in higher costs for the insurance company, increased burden on the patient, and increased time burden on the department.
These are combinations of procedures - laparoscopy with conization, hanging surgery with vaginal plastics, combination of hysteroscopy and laparoscopy

Answer

The CKS DRG team has recalculated the relative weights repeatedly since 2022. This is a calculation of the values of relative weights, lower and upper limits of treatment time and other parameters from the Catalogue of case lump sums, which is performed annually on the basis of data from Slovak inpatient health care providers who regularly submit the annual CKS DRG benefit each year. Thus, the valuation of the combination of different procedures has been recalculated repeatedly since the feedback was submitted and reflects the average cost to providers for those procedures.

The review and correct pricing of combined procedures within the JHS in the SK-DRG is currently being addressed by the CKS DRG team, if a combination of specific procedure codes is not correctly assigned to the reimbursement DRG groups, feedback should be sent to the JHS identifying the specific procedure codes that are being done in combination during the classification case.