Coding example
Here you will find common examples of clinical service delivery and billing for implantation and explantation of the catheter. In the inpatient sector, billing in Germany is based on the uniform billing system for inpatient services - the DRG system.Starting in 2020, hospitals' nursing staff costs were excluded from DRG per-case flat rates. In addition to the DRG charge, the hospital receives a nursing charge based on the principle of self-cost recovery. The total charge is therefore the sum of the DRG charge and the nursing charge.
Coding example
Here you will find common examples of clinical service delivery and billing for implantation and explantation of the catheter. In the inpatient sector, billing in Germany is based on the uniform billing system for inpatient services – the DRG system.
Starting in 2020, hospitals’ nursing staff costs were excluded from the DRG per-case flat rates. In addition to the DRG charge, the hospital receives a nursing charge based on the principle of self-cost recovery.
The total charge is therefore the sum of the DRG charge and the nursing charge.
The examples were based on the 2023 federal prime rate (€4,000.71).
Which parameters are important?
- the main diagnosis
- the procedures performed in the hospital (operations, complex examinations)
How to code these parameters as calculation basis:
- Diagnosis: ICD (International Classification of Diagnosis)
- Procedures: OPS (Operations and Procedures Code)
The special grouper software, which is mandatory in Germany, calculates the respective DRG from the ICD and OPS.
Both ICD and OPS databases and the grouper software are available free of charge on the Internet (for example, www.drg.uni-muenster.de).
What does the health insurance company pay the hospital for a DRG?
- each DRG has a relative weight (synonym cost weight)
- Each federal state has a prime rate (Länderbasisfallwert) – the average is represented by the federal prime rate
- Relative weight × prime rate = payment amount (€)*.
* The hospital receives this amount if it discharges the patient between the lower limit length of stay and the upper limit length of stay.
We will now present some billing examples for the stationary sector.
The country’s base rate from 2020 was used in the examples. No further diagnoses or complications (PCCL) were used, in order to show the minimum payout amount for the hospitals.
Billing examples - Catheter implantation
| Main diagnosis | Pleural effusion – ICD = J90 |
| Procedure | Therapeutic drainage of pleural cavity with small lumen permanent indwelling system – OPS = 8-144.1 |
| Calculation | Grouper-DRG = E73B Relative weight × federal prime rate 2023 = payment amount 0.59 × €4,000.71 = €2,360.42 DRG charge plus €850.55 nursing charge Total charge: 3.210,97 € |
| Lower limit length of stay 2 days Average length of stay 5.5 days Upper limit length of stay 12 days |
| Main diagnosis | Ascites – ICD = R18 |
| Procedure | Other abdominal surgery: Implantation of a catheter indwelling system in the abdominal cavity, tunneled subcutaneously: For ascites drainage – OPS = 5-549.21 |
| Calculation | Grouper-DRG = Z01C Relative weight × federal prime rate 2023 = payment amount 0.488 × €4,000.71 = €1,952.35 DRG charge plus €921.60 nursing charge Total charge: € 2,873.95 |
| Lower limit length of stay 2 days Average length of stay 3.8 days Upper limit length of stay 8 days |
| Main diagnosis | Alcoholic cirrhosis of the liver – ICD = K70.3 |
| Procedure | Other abdominal surgery: Implantation of a catheter indwelling system in the abdominal cavity, tunneled subcutaneously: For ascites drainage – OPS = 5-549.21 |
| Calculation | Grouper-DRG = H06C Relative weight × federal prime rate 2023= payment amount 0.928 × €4,000.71 = €3,712.66 DRG charge plus €866.65 nursing charge Total remuneration: € 4,579.31 |
| Lower limit length of stay 2 days Average length of stay 6.4 days Upper limit length of stay 15 days |
Billing examples - Catheter explantation
| Main diagnosis | Pleural effusion – ICD = J90 |
| Procedure | Other thoracic surgery: surgical removal of an indwelling system for drainage of the pleural cavity – OPS = 5-349.7 |
| Calculation | Grouper-DRG = E73B Relative weight × federal prime rate 2023= payment amount 0.59 × €4,000.71 = €2,360.42 DRG charge plus €850.55 nursing charge Total charge: 3.210,97 € |
| Lower limit length of stay 2 days Average length of stay 5.5 days Upper limit length of stay 12 days |
| Main diagnosis | Ascites – ICD = R18 |
| Procedure | Other abdominal surgery: Removal of catheter indwelling system from the abdominal cavity, tunneled subcutaneously: For ascites drainage – OPS = 5-549.41 |
| Calculation | Grouper-DRG = Z01B Relative weight × federal prime rate 2023= payment amount 0.488 × €4,000.71 = €1,952.35 DRG charge plus €921.60 nursing charge Total charge: € 2,873.95 |
| Lower limit length of stay 2 days Average length of stay 3.8 days Upper limit length of stay 8 days |
| Main diagnosis | Alcoholic cirrhosis of the liver – ICD = K70.3 |
| Procedure | Other abdominal surgery: Removal of catheter indwelling system from the abdominal cavity, tunneled subcutaneously: For ascites drainage – OPS = 5-549.41 |
| Calculation | Grouper-DRG = H06C Relative weight × federal prime rate 2023= payment amount 0.928 × €4,000.71 = €3,712.66 DRG charge plus €866.65 nursing charge Total remuneration: € 4,579.31 |
| Lower limit length of stay 2 days Average length of stay 6.4 days Upper limit length of stay 15 days |
Bottom line
After catheter placement/explantation, patients can usually leave the hospital after 2 – 3 days. Thus, they are close to the lower limit length of stay.
