Main diagnosis
In the German DRG system , the main diagnosis for hospital treatment is defined as:
- "The diagnosis which, upon analysis, was found to be primarily responsible for inducing the patient's inpatient hospital stay ."
"After analysis" means that the course of the hospital treatment and the findings are taken into account. However, since the main diagnosis must have prompted inpatient treatment, no diagnosis can be considered the main diagnosis that only developed in the course of treatment - for example as a complication - unless the complication required more effort than the admission diagnosis .
example
A patient is admitted to the hospital because of a fall while feeling dizzy. The admission diagnosis is dizziness. In the course of the examination and treatment it turns out that the cause of the dizzy spell was a derailed blood sugar level . Therefore, the main diagnosis of diabetes mellitus ( diabetes ). This does not change if, in the course of treatment, the patient falls out of bed because of confusion, breaks his leg and has to be operated on. Even if the broken leg and the operation should ultimately be the more complex and costly treatment, the hospital stay was not caused by this, but by the dizziness caused by diabetes mellitus. Diabetes mellitus remains the main diagnosis, the broken leg is a secondary diagnosis .
meaning
The concept of the main diagnosis primarily has no medical meaning, but was defined for reasons of billing for hospital treatments. With the introduction of the flat rate per case and special remuneration in 1996 , it was necessary to define a main diagnosis and a main service for the definition of the flat rate per case. However, the main definition of the diagnosis was based on the effort involved in treating the diagnosis.
With the use of DRGs for billing, a whole set of rules was developed with the German Coding Guidelines for the encryption of diagnoses and services (procedures). Since main and secondary diagnoses as well as procedures have a significant influence on the DRG determination and this in turn determines the price for hospital treatment, uniform encryption across the hospitals is required. The coding guidelines and the definition of the main diagnosis contained therein are intended to serve this purpose.
Due to its importance for billing, there have always been and continues to be disputes between hospitals and the health insurance companies or the medical service of the health insurance companies ( MDK ) about the correct assignment of the main diagnosis , which are increasingly being carried out via the social courts.
Individual evidence
- ↑ German coding guidelines ( DKR ( Memento of the original from May 13, 2005 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this note. )
