Standpoints

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.

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.

According to DR 274*, reporting of localizations is mandatory for all diagnoses. Currently, there is no universally accepted anxiety on how to define localization with respect to the existence of paired organs and paired body parts. In both situations, an "anatomical" and "clinical" approach is possible in determining localization. For paired organs, the 'anatomical' approach means adherence to a strictly anatomical nomenclature (e.g. 'one' lung, 'one' mandible, 'one' maxilla). the "clinical" approach already involves more of a clinician's perspective when defining the diagnosis (e.g.: lung tumor on the right, mandibular ramus fracture on the left, etc.). With "paired body parts" a similar problem arises (e.g. "one" Atherosclerosis of other and unspecified limb arteries, "one" Hemiparesis). However, from a "clinical" point of view, it is "requested" and useful to add localization (e.g. AS ... right, Hemiparesis left, etc.). When deploying a health insurance company check (a mandatory reporting item DR must also be mandatory to check) on the correctness of the localization of diagnoses in the reports from the PHC, a high rate of disagreement in the definition of localization was defined. This disagreement was largely due to the different approaches (anatomical vs clinical) to this issue just described.

Elimination of the main and secondary diagnosis location entries in the data interfaces for inpatient healthcare reporting.

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.