Organisation: Dôvera ZP, a.s.

Created at: 19.03.2026

Question

Reporting of location is a mandatory data element of DR 274* No 33. There is currently no generally accepted way of determining the flag (P,L,B,Z) for this item. In principle, two approaches are possible: 'linguistic' and 'clinical'. The "linguistic" approach sticks to the expressis verbis naming of the health performance. For example, procedure 8U160 Intraoperative neurophysiological monitoring within 4 hours, or procedure 8P1022 Controlled artificial ventilation of the lungs, 8n236.2 Individual therapeutic physical education II are 'locally vague' (thus would require a 'Z' symptom statement). a "clinical" approach may result in a "B" symptom statement. Another example from practice - one (the same) CP: 8n236.2 Individual therapeutic physical education II (statement B), 8n2861 Cold therapy I (statement P) 8n233 Verticalization with gait training (statement Z), 5t12br Open repositioning of a simple fracture in the articular region of the distal fibula, osteosynthesis with an angulated splint (statement P). Although all of the above procedures are "locally indeterminate" by name, they have reported different signs of localizations, which is due to the "clinical" approach. After the implementation of the control of the correctness of the localisation of the procedures by the health insurance company (the correctness of the mandatory reporting item has to be mandatorily checked), a considerable degree of inconsistency was found between the ways of defining the localisation of the procedure on the part of the PI and the PUHH. This inconsistency was apparently largely due to the use of the above-mentioned 'linguistic/clinical' approaches.

Answer

Due to recurrent disputes in the determination of laterality of diagnoses and medical procedures, the CKS DRG proceeded to determine the initial draft of the need for coding laterality of entire codes of diagnoses and medical procedures. That proposal is currently being commented on by the Medical Analysis Working Group and will be published by the CKS DRG once the final settings have been determined, and you will be notified of its publication via the CKS DRG Update. It is agreed that the determination of the laterality coding obligation from 2027 onwards will be part of the ZZV and MKCH codes, where their settings will be subject to regular updates based on feedback from users of the classification system.