[What is anaesthesiology worth in the German DRGs?--First experience with German DRGs]

Abstract

This overview reports on first experience with German DRGs version 1.0 from 2003, with special regard to relevant procedures and diagnoses of anaesthesiology. Basically, the G-DRGs are a translation of the AR-DRGs 4.1. Only the 2004 version represents a first "real" German DRG system. Particularly anaesthesiological measures for procedures which are normally performed without narcosis can lead to essentially relevant remuneration. In intensive care medicine, the hours of artificial ventilation must be recorded exactly. In the 2004 version of the G-DRGs, intensive medical performances are mainly differentiated regarding the time of ventilation, which leads to better payment than under version 1.0. In intensive care medicine, additional remuneration is only intended for dialyses and other organ-supporting procedures. Pain therapy is insufficiently documented in the G-DRGs. Although new codes of pain treatment are included in the G-DRGs, they do not lead to relevant remuneration. Diagnoses and procedures coded by the anaesthetist should be registered in the clinic information system without delay. Only non-anaesthesia-associated diagnoses, i.e. additional diagnoses resulting from the preanaesthetic check-up of the patient in the preanaesthetic department, should be checked by non-anaesthesiological physicians. The correct documentation and transfer of ASA classifications is necessary for additional charges in external quality management and to avoid financial sanctions. In our experience, regarding operated patients, anaesthetists can contribute a lot to enquiries by health insurance companies, e.g. whether the payment code for an in- or an out-patient should be used. Departments of anaesthesia should appoint an anaesthetist as DRG representative to supervise anaesthesiological coding and DRG-relevant procedures.