[Depiction of cardiovascular surgery in the current modified German DRG system 2021].

Abstract

Introduction: The year 2020 will always stand in the shadow of the pandemic triggered by the coronavirus 2019 (COVID-19). The first three quarter years of 2020 were characterized by an unprecedented reduction of elective inpatient services and a prioritization of intensive care capacity for the treatment of COVID-19 patients. This also resulted in clear consequences for the services provided in cardiac surgery. In addition, during the course of the year the personnel in hospitals were confronted with a plethora of amendments in the legal framework conditions. Nevertheless, the modified German diagnosis-related groups (G-DRG) system 2021 was calculated by the Institute for the Remuneration System in Hospitals (InEK). This article describes and assesses the most important amendments of the modified G‑DRG system 2021 for cardiac, thoracic and vascular surgery.

Methods: Analysis of the relevant diagnoses, procedures and G‑DRG structures in the system versions for 2020 and 2021 based on the information published by the InEK and the German Federal Institute for Drugs and Medical Devices (BfArM).

Results: Expansions of the relevant classification systems for diagnoses (ICD-10-GM 2021) and procedures (OPS 2021) lead to an increase in specific coding of essential interventions and operations in cardiovascular surgery. Within the framework of the adaptation of the G‑DRG structures, the condensation of the previous fixed rates for heart transplantation to G‑DRG A05Z and devaluation of coronary bypass operations and reconstructive vascular interventions are particularly important.

Conclusion: For cardiovascular surgery there are manifold amendments with sometimes substantial repercussions for the case proceeds. Additionally, for many German hospitals the effects of the corona pandemic are not yet finally foreseeable. A further increasingly more urgent influencing factor particularly affecting vascular medicine is the increasing pressure to promote outpatient treatment. In this respect, the catalogue for outpatient operations in hospitals (AOP), which is expected in 2022 and will presumably be much expanded, will once again clearly increase the enforcement of outpatient performance of services that were previously performed as inpatient treatment.