Review of Extra charged material in procedures No. 51711 after the implementation of the obligatory and optional Extra charged material on January 1, 2001

Overview

Review workers of the Review Office for Surgical Fields of the General Health Insurance Company (GHIC) of the Czech Republic for Prague follow systematically the development of endoscopic operations in Prague and relatedly analyze reporting and refunding of this type of health care by the General Health Insurance Company.

The paper presents the review of reported laparoscopic operations in surgical specialties and the development of operations from 1999 to 2001 and related changes in reporting and refunding the procedure No. 51711 including reported DRG markers and Extra charged material are compared. At the same time, the procedure of physicians reviewers related to the analysis of all available data from the Information Centre of the GHIC and their comparison with the data from medical documentation in the health facility is described.

Factual negotiations during controls and comparing the reported procedure No. 51711 and Extra charged material to records from medical documentation is considered the contribution with the possibility of checking mistakes because reporting and refunding of reported procedures is not correct in 70% health facilities which contracted the procedure No. 51711.

Key words:
code No. 51711 – laparoscopic and thoracoscopic procedure – DRG markers – Extra charged material subgroup No. 82 – Code book of GHIC – analysis from IC GHIC – review – mistakes in reporting