425/2011 Coll.
DECREE
Dated December 15, 2011
Establishing point values, the amount of payment for health care covered by public health insurance
and regulatory restrictions on the volume
provided health care covered by public health insurance in 2012
Ministry of Health determined in accordance with § 17 para. 6 of the Act no. 48/1997
Coll., On public health insurance and amending and supplementing some
related laws, as amended by Act no. 117/2006 Coll. Law no.
245/2006 Coll., Act no. 261/2007 Coll. and Act no. 298/2011 Coll .:
§ 1
This decree provides for 2012 point values, the level of reimbursement of health care provided to insured
according to § 2 para. 1 of Law no. 48/1997 Coll., On
public health insurance and amending and supplementing certain || | related acts, as amended (the "Act")
and health care provided to policyholders from other Member States
European Union, European economic area and Switzerland
by the directly applicable European Union ^ 1)
policyholders and other states with which the Czech Republic has concluded international
social security agreements related to the field of health care
^ 2) (hereinafter referred to as "foreign insured"), paid from the public | || health insurance and regulatory restrictions on the volume of health care for
payment methods specified in § 3-17, provided
A) contractual institutional healthcare facilities, including
specialized medical institutions, hospitals, long term sick
healthcare facilities reporting day of treatment no. 00005 by
decree is issued a list of medical procedures with point | || values ^ 3) (hereinafter "the list of duties") and medical devices
hospice type pursuant to § 22a of the Act
B) contractual practitioners and general practitioners for children and adolescents,
C) in contractual outpatient healthcare facilities providing
specialized outpatient medical care, including outpatient
health care facilities providing health care and hemodialysis
orthoptic health care
D) in contractual outpatient healthcare facilities providing
health care in specializations 603 and 604 according to the list of operations,
E) contracting dentists
F) in contractual outpatient healthcare facilities providing
health care in specializations 222, 801, 802, 804, 805, 807, 809, 812
up to 819, 822 and 823 according to the list of operations (hereinafter "enumerated expertise ")
G) in contractual outpatient healthcare facilities providing
health care in specializations 911, 914, 916, 921 and 925 list
performances
H) in contractual outpatient healthcare facilities providing health care
expertise 902 list performances
I) contractual health care facilities of emergency medical services,
contractual healthcare facilities providing medical transport
service and medical first aid service,
J) contractual health care facilities spa treatment and convalescent homes,
K) as part of emergency medical care in a non-contracting
medical devices.
§ 2
(1) The reference period is defined for purposes of Annexes Nos. 1, 4 and 8 to this Decree
2010 and for Annexes Nos. 3, 5, 6 and 7 hereto
respective half-year 2010
(2) The reporting period is defined for purposes of Annexes Nos. 1, 4 and 8 to this Decree
2012 and for Annexes Nos. 3, 5, 6 and 7 hereto
respective half-year 2012.
(3) A unique insured person for the purposes of this decree means one
insured by the respective insurance
treated by medical facilities in the specialty under review or reference period
least once, that does not matter if it is a treatment in
under their own care or the care requested. If this
insured health facilities in the specialty
treated in the relevant reporting period or the period of reference several times to include a number of unique
insured by the respective insurance
treated in the specialty only once. In the event of a merger of health insurance
a number of unique insured shall be the sum insured
unique health insurance companies that have merged. If the insured is in
Reference period, the policyholder more than one health insurance company,
in the number of unique treated insured is counted only once.
(4) In calculating the total number of reported medical facilities and health insurance recognized
points for his performance as the reference period
according to Annexes no. 3, 5 to 8 hereto these points means points annualized
list of performance amended effective January 1, 2012.
§ 3
For health care provided to foreign policyholders paid by
list of operations, the value of point in § 8, 12 and 14 and in Annexes.
1-8 hereto.
§ 4
(1) For healthcare provided by healthcare facilities
institutional care, with the exception of health care provided in specialized medical
institutions, long-term care patients in healthcare facilities reporting day of treatment
no. 00005 list performance
and medical facilities hospice type a point value, the amount of reimbursement
health care and regulatory restrictions laid down in Annexes Nos. 1, 9-11
to this Decree.
(2) For health care provided in specialized medical institutions,
long-term care patients in healthcare facilities reporting day of treatment
no. 00005 list performances and
medical facilities hospice type paid a flat rate
for one day hospitalization or list output value point above
payments for health care and regulatory restrictions laid down in Annex no. 1 to this decree
.
§ 5
For health care provided by GPs and GPs
for children and adolescents paid combined capacity- performance payment,
combined capacity- performance payment of capitation by calling or
list performances, a point value, the amount of reimbursements
health care and regulatory restrictions laid down in Annex no. 2 hereto.
§ 6
For specialized outpatient healthcare provided in outpatient healthcare facilities
paid according to the performance list
point value, the amount of payment for health care and regulatory restrictions laid down in Annex
no. 3 hereto.
§ 7
For outpatient healthcare provided in outpatient healthcare facilities in
specializations 603 and 604 according to the list of achievements
paid by the list of operations with the point value, the amount of payment for health care
and regulatory restrictions laid down in Annex no. 4 hereto.
§ 8
(1) For health care provided by dentists paid by
list of operations with the point value determined in the amount of CZK 0.95.
(2) The amount of payment for health care provided in Czech crowns, dental
doctors are not paid in accordance with paragraph 1 and the applicable regulatory restrictions on the
provided in Annex no. 12 hereto.
(3) Health Insurance is entitled to limit the amount of reimbursement of medical
device so that the total cost of health insurance
spent on the health care provided by dentists in 2012
not exceed the aggregate amount of these fixed costs in health
insurance plan health insurance. If they exceeded the total amount
payment for health care provided by dentists, set in
health insurance plan health insurance for the healthcare,
was caused by providing more necessary and urgent health care
compared to 2010 , health insurance, this larger volume
take into account the payment.
§ 9
For health care provided by outpatient health care facilities in the listed specializations
paid by a list of performance value
point and the level of reimbursement of health care provided in Annex no. 5 to this Decree
.
§ 10
For healthcare provided outpatient medical facilities in specialties
911, 914, 916, 921 and 925 according to the list of paid performances
list performances, the point value and the level of reimbursement of health care
down in Annex . 6 hereto.
§ 11
For health care provided by outpatient health care facilities in expertise
902 list performances paid by a list of performance
point value and the level of reimbursement of health care provided in Annex no. 7 to this Decree
.
§ 12
For health care provided in the framework of the emergency medical services paid by
list of performances is determined point value of 1.10 CZK.
§ 13
For those provided medical transport services are funded by the list
performances with point value and the level of reimbursement of health care provided in Annex no.
8 hereto.
§ 14
For health care provided in the framework of an emergency medical service
paid according to the list down performance point value in the amount of CZK 0.95.
§ 15
(1) For complete spa treatment provided by medical establishments
spa treatment down payment for one day stay in the amount that was agreed
31 December 2010, at least in the amount of CZK 850.
(2) spa care provided by healthcare facilities
spa treatment down payment for one day stay in the amount
which was agreed on 31 December 2010, at least in the amount of CZK 280.
(3) For health care provided in sanatoria down payment for
one day stay in the amount that was agreed on 31 December 2010
least in the amount of CZK 540.
§ 16
According to § 3-15 shall be applied if the health insurance and medical devices
under conditions specified in § 17 para. 6
Act agree otherwise.
§ 17
For urgent health care in non-contractual healthcare facilities
paid according to the list down performance point value of 85%
point values set out in § 8, 12 and 14 and Annexes Nos. 1 to 8 to this | || Decree. The point value is rounded to 2 decimal places.
§ 18
This decree comes into force on 1 January 2012.
Minister
:
Doc. MD. Heger, CSc.
Appendix 1
Point value, the amount of reimbursement of health care and regulatory restrictions under § 4
A)
Residential care under § 4 para. 1
First Reimbursement of medical equipment in 2012 includes individual ingredients
the contractually agreed payment, payment in the form of a case fee, earmarked
payment of a remuneration fee in the form of a case and outpatient component
payment. The reference period is included
all health care provided in 2010, health care facilities reported 31
May 2011 and health insurance recognized by 30 September 2011.
reporting period is included in all health care provided in
in 2012, the medical establishment recognized until 31 March 2013 and health insurance
recognized until 30 May 2013.
Second Individually contractually agreed remuneration component
2.1 The amount and method of payment for health care included in the Classification
inpatients ^ 4) (hereinafter referred to as the "Classification") into groups related to the diagnosis
:
A), 08021, 08022, 08023, 08041, 08042, 08043, 08181, 08182, 08183,
B) 05011, 05012, 05013, 05070, 05161, 05162, 05163, 05111, 05112, 05113
,
C) 02041, 02042, 02043,
D) 01051, 01052, 01053,
E) 05191, 05192, 05193,
F) 06061, 06062, 06063,
G), 07041, 07042, 07043,
H) 08191, 08192, 08193,
I) 13091, 13092, 13093,
Listed in Annex no. 9 (hereinafter "the listed groups") health insurance
the contractually agreed with medical facilities. If
health insurance with health facilities agree individually
the contractually agreed payment component may include payment of other health care
than stated in the first sentence; in which case this payment,
well as reimbursement for health care is classified under Klasifikace4)
into listed groups not included in the payment referred to in point 3.
2.2 The amount of reimbursement of medicines and foods for special medical purposes
(hereinafter referred to as "medicine"), marked with the symbol "S" according to § 39 paragraph
. 1 Decree no. 376/2011 Coll., Which implements certain provisions
law on public health insurance (hereinafter
"Decree") on one unique insured who has been
such medicine under review period is fixed at 98%
average payment per unique insured for the reference period
related to individual diagnoses. Total payment related to individual
diagnosis is calculated as a multiple of payment per unique set
insured under the first sentence and the number of unique insured persons who have been granted
such medicine within a given diagnosis during the reporting period
. The highest possible total payment for the evaluation period is calculated by multiplying the
payment provided for under the first sentence and 110% of the number of unique
Insured, which was within the diagnosis given above
medicine in the reference period.
Third Payment in the form of a case fee
3.1 Payment in the form of a case fee (PUdrg2012)
includes payment for health care is classified under classification into groups related to diagnosis
listed in Annex no. 10 hereto and is determined as follows:
PUdrg2012 = CMred * ZS2012
Where:
CMred CMalfa2012 reduced the amount of which is determined by
the following conditions:
a) if the ratio CMalfa2012 / CMalfa2010 is greater than 1.05 and
simultaneously PPalfadrg is greater than 1.03, then
CMred CMalfa2010 = 1.05 *
Where:
CMalfa2012 number of hospitalizations
recognized medical facilities and
health insurance company recognized under review
period, which are classified according to the Classification
into groups related to the diagnosis, multiplied
indices of these groups listed
Annex no. 10 hereto
CMalfa2010 number of hospitalizations and completed
health insurance company recognized in the reference
period, which are classified according to the Classification
into groups related to the diagnosis, multiplied
indices of these groups listed
Annex no. 10 hereto
PPalfadrg ratio of the number of medical facilities
declared a health insurance company recognized
hospitalizations, completed in 2012,
classified into groups related to the diagnosis
according to the classification listed
Annex no. 10 hereto,
and health facilities reported
and health insurance number of accepted
hospitalizations, completed in 2010,
classified into groups related to the diagnosis
according to the classification listed
Annex no. 10 hereto
b) if the ratio CMalfa2012 / CMalfa2010 is smaller or equal than
1.05, and the ratio CMalfa2012 / CMalfa2010 not greater than
(PPalfadrg + 0.02), then
CMred = CMalfa2012
c) if the conditions set out in point a) or
b) if the ratio CMalfa2012 / CMalfa2010 exceeds
(PPalfadrg + 0.02), then
CMred decreases by as many percentage points
which makes the difference between CMalfa2012 /
CMlafa2010 and (PPalfadrg + 0.02) for
the following conditions:
1) if CMalfa2012 / CMalfa2010 smaller or
equal than 1.05, then
CMred = CMalfa2012
2) if CMalfa2012 / CMalfa2010 greater than
1.05, then
CMred CMalfa2010 = 1.05 *
ZS2012 base rate for payment of fee in the form of a case,
which is calculated as follows:
ZS2012 = [IZS2010 * (1 - Kp) + (Kp * ZSref)] + Kn
Where:
IZS2010 reference individual base rate
which is calculated as follows:
IZS2010 Uall2010 = /
CMall2010
Where:
Uall2010 total amount of payment for
medical facilities declared and
Health care insurance recognized
provided during hospitalization
in the reference period, including settlement
regulatory restrictions and realized
increase in payments, with the exception of a supplement for
outpatient reimbursement component
CMall2010 number of hospitalizations
completed in the reference period
They are included in the Classification
groups related to the diagnosis, multiplied
indices of these groups listed
in Annexes Nos. 9, 10 and 11 to this
Decree
Kp approach rate which is determined in
EUR 0.25
ZSref reference (national) base rate, which
down in the amount of CZK 29 500
Kn rate increase in the basic rate ZS2012,
which is fixed at 1.07
Fourth The payment allocated to the payment of fee in the form of a case
Allocated 4.1 Payment of remuneration in the form of a case
fee includes payment for health care is classified under classification into groups
related to the diagnosis listed in Annex no. 11 hereto.
For health care reimbursement allocated from the settlement of a case in the form of a flat rate,
Paid by the list of operations, medical facilities and reported
health insurance recognized in the reviewed period, the value of
point at EUR 1.07 * ICBref to the limit (LIM PUbetadrg2012)
calculated as follows: || |
LIM PUbetadrg2012 = [(Vbetadrg2010 ICBref *) + ZUMbetadrg2010 ZULPbetadrg2010 + + + LPbetadrg2010 KPbetadrg2010)] * 1.07
Where:
Vbetadrg2010 total number of health facilities reported
and health insurance recognized points for performances
performed during hospitalization, for the reference period
which, under the classification assigned to groups
Annex No. 11 to this Decree. The points
the first sentence shall be converted at the list of operations in
amended effective 1 January 2012
ICBref calculated individual price point medical
device, which is determined as the quotient Uref / Bref
Where:
Uref total payment of medical facility belonging
for all health care provided
in the reference period for the settlement of all
regulatory measures, with the exception of regulation on
prescribed medicines and medical
resources, reduced reimbursement for separately billed
Medicines and separately charged material
granted in the reference period, reported
and health insurance recognized in connection
care of patients, a lump sum which is
Medicines paid according to § 17 para. 7 of the Act,
and the payment of other health care covered
in Czech crowns (KPref)
Bref total number of health facilities reported
and health insurance recognized points
recalculated according to the list of interventions are effective
1 January 2012 for health care provided
in the reference period
ZUMbetadrg2010 total amount of payment for medical
facilities reported a health insurance company recognized
separately charged material provided in the reference
period in connection with the performances made during
hospitalizations in the reference period are
by classification assigned to the groups listed
Annex no. 11 hereto.
ZULPbetadrg2010 total amount of payment for medical
device through a health insurance company recognized
separately charged Medicines provided
in the reference period in connection with performance
made during hospitalizations in reference
periods that are included in the Classification
groups listed in Annex no. 11 hereto.
LPbetadrg2010 lump sum which is paid medicinal
preparations according to § 17 para. 7 of the Act, to, treating
declared days and health insurance recognized as
reference period stretched for hospitalizations
in the reference period, which by
Classification included in the groups listed in Annex
No.11 hereto.
KPbetadrg2010 total amount of payment for other health care
paid in Czech crowns declared and medical
insurance company recognized for the reference period
provided medical facilities during
hospitalizations in the reference period are
by classification assigned to the groups listed
Annex no. 11 hereto.
4.2 for reimbursement of health care aside from the settlement in the form of a case
fee, paid by the list of operations, medical facilities reported
and health insurance recognized over the period under review, the calculated limit
(LIM PUbetadrg2012), down value point of EUR (ICBref * 1.07) *
0.5 and reimbursement for separately charged material, particularly charged
medicinal products, a lump sum which is paid medicinal products pursuant to § 17 paragraph
. 7 of the Act and other health care paid in Czech crowns,
is calculated as follows:
(ZUMbetadrg2012 ZULPbetadrg2012 + + + LPbetadrg2012 KPbetadrg2012) * 0.5
Where:
ZUMbetadrg2012 total amount of payment for medical
facilities reported a health insurance company recognized
separately charged material provided under review
period in connection with the performances made during
hospitalizations during the reporting period that are
by classification assigned to the groups listed
Annex no. 11 hereto.
ZULPbetadrg2012 total amount of payment for medical
device through a health insurance company recognized
separately charged Medicines provided
the period under review in connection with performance
made during hospitalization under review
periods that are included in the Classification
groups listed in Annex no. 11 hereto.
LPbetadrg2012 lump sum which is paid medicinal
preparations according to § 17 para. 7 of the Act, to, treating
declared days and health insurance recognized as
reviewed period stretched for hospitalizations
in the reporting period, which according to the Classification
included in the groups listed in the Annex. 11
hereto.
KPbetadrg2012 total amount of payment for other health care
paid in Czech crowns declared and medical
insurance company recognized in the reviewed period
provided medical facilities during
hospitalizations during the reporting period that are
by classification assigned to the groups listed
Annex no. 11 hereto.
the total amount of payment (MAX PUbetadrg2012) which is calculated
as follows:
MAX LIM PUbetadrg2012 PUbetadrg2012 = 1.03 *
Fifth For health care paid for by the list of operations, including health care provided to foreign
insured, determining the point value of CZK 0.90
amount.
6th Outpatient component of the settlement includes payment
specialized outpatient medical care, health care in specializations 603 and 604, according to the list
performances, health care physicians for adults and
practitioners for children and adolescents, health care provided | || dentists, health care in the listed specializations,
medical transport, emergency medical service and health care provided by
specializations 902, 911, 914, 921 and 925 (hereinafter referred to as "ambulatory care") with || | exception of the performances, which is recognized income and release testing.
06.01 For specialized outpatient health care, paid for by
list of operations, the value of the item and the amount of reimbursement of health care down
in Annex no. 3 hereto
06.02 For health care provided in 603 specialties and 604, according
list of achievements, paid for by the list of operations, the value of the item and the amount
reimbursement of health care provided in Annex no. 4 hereto.
06.03 For health care provided by general practitioners and
practitioners for children and adolescents, paid a combined capitation payment
power, combined capacity- performance payment of capitation or by calling
list performances, and the value of a point above
reimbursement of health care provided in Annex no. 2 hereto.
06.04 Health care provided by dentists are paid according to § 8 of the decree
.
06.05 For health care provided in the listed specializations,
paid by the list of operations, the value of the item and the amount of coverage for health care
down in Annex no. 5 hereto.
06.06 For the performance of the health service, funded by the list of operations, the
point value and the level of reimbursement of health care provided in Annex no. 8 of this Decree
.
07.06 Health care provided in the framework of an emergency medical service is paid
according to § 14 of this Decree.
08.06 For healthcare provided expertise 902 list
performance, paid for by the list of operations, the value of the item and the amount of reimbursement
healthcare provided in Annex no. 7 to this Decree.
09.06 For health care provided in specialized fields 911, 914, 921 and 925
, according to the list of achievements, paid for by the list of operations, the value
point and the level of reimbursement of health care provided in Annex no. 6 to this Decree
.
6.10 If the sum of the payments calculated in accordance with paragraphs 6.1 to 6.9
will be less than 98% reimbursement for outpatient care provided in the reference period
(Uamb2010), medical facilities and health insurance company reported
recognized points for outpatient care provided in
the reporting period will be at least 100% of the number of points for outpatient care
granted in the reference period, and if the medical facility in the period under review
treated at least 100% of unique insured
compared with the reference period, then the final payment for outpatient
Care provided during the review period (UVamb2012) provides equal
UVamb2012 Uamb2010 x = 0.98
6.11. If a healthcare facility declared and recognized by health insurance
points for outpatient care provided under review
period will be less than 100% of the number of points for outpatient care
granted in the reference period and at the same time if the medical device || | period under review treats less than 100% of unique insured
compared with the reference period, then UVamb2012
reduced by the same number of percentage points by which not reached 100% of the value specified in item
6.10 To reduce mentioned in the first sentence applies higher values of
, which has not reached 100% of the value specified in paragraph 06.10
6.12. For contracted power 09,563, according to the list of operations, down
point value of CZK 0.91 and CZK 88,101 for contracted power, according
list of operations, establishing a point value of CZK 1.
7th If in a medical facility to changes in the scope and structure
reimbursed care provided in comparison with the reference period and
health insurance company will approve these changes, take them into account in the contract, including
to quantify the impact of reimbursement.
8th In the event that the medical facility will provide the reference or
period under review, health care, and 50 less relevant
insured health insurance, the health care is reimbursed according to the list of operations
a point value in the amount of CZK 0.90.
9th Health insurance may provide medical equipment
monthly pre-payment of one-twelfth of the amount of reimbursement provided
According to the ordinance on data for the reference period. When determining the amount
interim health insurance coverage taking into account changes in the scope and structure
care provided, including changes in the number of hospitalizations, number
points and the number of unique insured. Preliminary settlement for rated
period will be financially settled within the overall financial
settlement, including regulatory restrictions, and no later than 180 days after the date
end of the evaluation period.
B)
Residential care under § 4 para. 2
First Flat rate per day of hospitalization
A) flat rate per day of hospitalization down for each category
patient and the type of treatment the day alone and includes the value
respective day of treatment, including the overhead associated with Curing day
category and patient list performances, a lump sum which is paid
medicinal products pursuant to § 17 para. 7 of the Act, and health procedures
which is recognized income and layoff list
examination performance.
B) The amount of the flat rate per day of hospitalization in the period under review
shall amount to 103% of the flat rate per day of hospitalization
belonging to the medical facility in the reference period.
C) If the medical facility to changes in the scope and structure
reimbursed care provided in comparison with the reference period and
health insurance company will approve these changes, take them into account in the design
contract, including quantification of impacts payments.
Second Reimbursement of outpatient care, special outpatient care and special institutional care
A) For outpatient care covered by the list of operations with the point value
down in the amount of CZK 0.95.
B) For special outpatient care provided in accordance with § 22 letter. c)
bill paid by the list of operations, establishing a point value in the amount of CZK
0.90 to 100% by volume computed as follows:
POPho
PBro x ---------
grapple
Where:
PBro total number of health facilities reported a
health insurance recognized as reference points
period
POPho number of unique insured treated medical
facilities in the period under review
Grapple number of unique insured treated medical
facilities in the specialty during the reference period
Health care provided to health care facilities over 100%
the calculated volume is paid to the point value of 0,40 CZK.
Financial settlement shall be made no later than 120 days after the date
the end of the reporting period.
C) For the special institutional care provided in health facilities
hospice type pursuant to § 22a of the Act, paid for by the list of performances is determined
point value in the amount of CZK 0.90.
C)
Regulatory constraints
First Regulatory restrictions on the payment in the form of a case fee
01.01 If the health insurance company finds differences in the Classification ^ 4)
particular healthcare facility within the meaning of purpose coding performs
targeted or random investigation to confirm or refute the suspected
targeted behavior or coding.
02.01 Targeted investigation means the search for specific
hospitalization cases which when analyzed using the information system
showed significant variations. Such cases require a health insurance
complete clinical documentation and auditing doctors perform clinical
audit. If the results of a clinical audit finding that the medical device when reporting
ignored the methodological rules and reporting
coding and hospital because the case was classified
illegally into DRG groups with a higher value relative weights, health insurance
adequately reduce the payment of this amount:
In mathematical terms:
(CMpůvodní - CMrevidovaný) ZS2012 x 3 x
Where:
CMpůvodní number of hospitalizations completed
in the reporting period, which according
Klasifikace4) assigned to groups related to
diagnosis, multiplied by the indices of these groups
are given in Annexes Nos. 9, 10 and 11 to this
Decree recognized medical facility before
carrying out targeted or random investigations
Health insurance
CMrevidovaný number of hospitalizations completed
in the reporting period, which according
Klasifikace4) grouped related
diagnosis, multiplied by the indices of these groups
which are given in Annexes Nos. 9, 10 and 11 to
this decree, health facilities reported
and health insurance recognized pursuant
targeted or random investigations
03.01 Random survey means a random selection
specified number of hospitalization cases in the appropriate DRG base, at which time a
clinical audit, ie. Compared reported with health care
recorded in the clinical documentation. When irregularities are detected, apply
health insurance this award as a regulatory measure for the entire DRG
base period under review and reduce the payment.
In mathematical terms:
a) review of a statistically significant fewer number of cases
appropriate DRG base:
((CMpůvodní - CMrevidovaný) / (CMpůvodní)) times the sum of the CM base x 0.2 x ZS2012
b) revision of a statistically significant number of cases DRG
respective base:
((CMpůvodní - CMrevidovaný) / (CMpůvodní)) times the sum of the CM base x 0.8 ZS2012x
Where:
CM base sum DRG relative weights of the base
DRG base aggregated group of the groups related to
diagnosis according Klasifikace4). They are given first
4 characters from pětičíselného code DRG groups.
A statistically significant number of relevant DRG base
more than 5%, a minimum of 30 cases
within the appropriate base in the appropriate DRG
medical equipment
Statistically less significant number of relevant DRG
base
less than 5%, at least 10 cases
within the appropriate base in the appropriate DRG
medical equipment
Second Regulatory constraints on prescribed medicines and medical devices
A) If the total payment for medicines and medical devices
prescribed medical facilities insured
competent health insurance company in the period under review, with the exception of medicinal products or medical devices approved
physician reviewer, exceeds 98% || | reimbursement for medicines and medical devices prescribed in
reference period, with the exception of medicinal products or medical
funds approved inspection physician, health insurance will reduce overall healthcare facility
payment of an amount corresponding to a maximum of 40% of
exceeded. Reduction under the first sentence
health insurance does not apply if the medical facility demonstrates that an increased total
payment for prescription medicines and medical devices
was caused by changing the amount or method of payment or as a result of changes in the structure
treated insured competent health insurance company.
B) In the event that medical facilities provided in the period under review
health care and 50 fewer insured by the respective insurance, health insurance
apply the regulation referred to in point 1
Appendix 2
Point value, the amount of reimbursement of health care and regulatory restrictions under § 5
A)
Combined capacity- performance payment
First The amount of the capitation payment is calculated according to the total number of registered medical device
converted insured
respective health insurance, multiplied by the standard rate fixed at one
medical facilities registered insured respective health insurance
calendar month. Number of adjusted insured
appropriate health insurance is calculated by multiplying the number of registered medical device
insured by the respective insurance
in each age group according to item 7, index multiplied by
point 7 above the base rate, or the total amount payment may be increased
if the conditions stipulated in the contract between the health
insurance and medical facilities. The base rate under the first sentence
shall amount
A) 50 CZK for physicians and general practitioners for children and adolescents,
who provide medical care to the extent of at least 30
office hours spread over 5 days per week, with at least one day a week
they have extended opening hours to 18 hours and allow the insured
ordered at least two days a week at a fixed hour
B) 49 CZK for physicians who provide medical care to the extent of at least 25
office hours spread over 5 days a week, taking at least 1
weekday office hours are extended at least 18
hours. If local conditions require, health insurance
a medical facility agree to extend the opening hours
differently
C) 47 CZK for other practitioners,
D) 49 CZK for other practitioners for children and adolescents.
Second Performances by the list of operations included in capitation payments expertise
001 list of performance:
---------- ---------------------------------------- ------------------------------------
No. Performance Name
---------- ---------------------------------------- ------------------------------------
01023 TARGETED a GP
01024 CONTROL seen by a GP
01025 CONSULTATION practitioner FAMILY MEMBERS OF PATIENT
01030 Administrative tasks practitioner
09215 INJECTION IM, SC, ID
09,216 injections into the soft tissue or intradermal buds WITHIN reflexology treatments
09217 INTRAVENOUS INJECTION an infant or child up to 10 years
09219 INTRAVENOUS INJECTION an adult or child OVER 10 YEARS
09220 cannulation of peripheral veins INCLUDING THE INFUSION
09233 FILLED precinct anesthesia
09237 outweigh TREATMENT AND WOUNDS FROM 1 TO 10 CM2 CM2
09507 SUPPORTIVE PSYCHOTHERAPY by physicians NEPSYCHIATREM
09511 minimal contact between doctors and patients
09,513 telephone consultations attending physician PATIENT
09523 MEDICAL EDUCATION INTERVIEW with the patient or family
09525 INTERVIEW WITH FAMILY PHYSICIAN
44239 TREATMENT AND THE DOCTOR outweigh leg ulcer (1 BEREC)
71511 REMOVING foreign body from the ear
71,611 EXCLUSION foreign body from the nose - SIMPLE
---------- ---------------------------------------- ------------------------------------
Third Performances by the list of operations included in capitation payments expertise
002, according to the list of achievements:
---------- ---------------------------------------- ------------------------------------ -------------- ----------
no. This performance
---------- ---------------------------------------- ------------------------------------ -------------- ----------
01025 CONSULTATION practitioner FAMILY MEMBERS OF PATIENT
01030 Administrative tasks practitioner
02023 targeted examination by general practitioners for children and youth - child up to 6 years
02024 Control examination by general practitioners for children and youth - children under 6 years
02,033 targeted examination by general practitioners for children and youth - CHILD OVER 6 YEARS
02034 Control examination by general practitioners for children and youth - CHILD OVER 6 YEARS
06111 COMPLEX - Examination of the patient's condition SISTER own social environment
06119 COMPLEX - samples of biological material
06121 COMPLEX - local treatment
06123 COMPLEX - Education, reeducation, NURSING REHABILITATION
06125 COMPLEX - enemas, douches, catheterization, irrigation, treatment of indwelling catheters
06127 COMPLEX - administration of inhalation and healing therapies PO, SC, IM, IV, UV, EVENT.DALŠÍ APPLICATIONS
06129 for training and mentoring inject insulin
09215 INJECTION IM, SC, ID
09,216 injections into the soft tissue or intradermal buds WITHIN reflexology treatments
09217 INTRAVENOUS INJECTION an infant or child up to 10 years
09219 INTRAVENOUS INJECTION an adult or child OVER 10 YEARS
09220 cannulation of peripheral veins INCLUDING THE INFUSION
09,221 infusion in infants or children under 10 years
09233 FILLED precinct anesthesia
09235 removal of small skin lesions
09237 outweigh TREATMENT AND WOUNDS FROM 1 TO 10 CM2 CM2
09253 PREPUCIA RELEASE, INCLUDING non-surgical repositioning Paraphimosis
09507 SUPPORTIVE PSYCHOTHERAPY by physicians NEPSYCHIATREM
09511 minimal contact between doctors and patients
09,513 telephone consultations attending physician PATIENT
09523 MEDICAL EDUCATION INTERVIEW with the patient or family
09525 INTERVIEW WITH FAMILY PHYSICIAN
71511 REMOVING foreign body from the ear
71,611 EXCLUSION foreign body from the nose - SIMPLE
---------- ---------------------------------------- ------------------------------------ -------------- ----------
Fourth For medical services not included in capitation payments and health
performances unregistered insured under the health insurance company,
medical facility declared and recognized by health insurance, paid by
list of achievements, down point value in the amount of CZK 1.08.
Fifth For the performance of traffic visiting service, funded by the list of performances
down a point value in the amount of CZK 0.90.
6th The index is the ratio of costs to insured persons in that age group
towards the cost of the insured in the age group 15-19 years.
7th Age groups and indexes:
----------------------------------
Age Group Index
----------------------------------
0-4 years 3.91
5-9
1.70 years, 10-14 years
1.35 15 - 19 1.00
20-24 years
0.90 25-29 years 0.95
30-34
1.00 years, 35-39 years
1.05 40-44 years 1.05
45-49 years
1.10 50-54 years 1.35
55-59
1.45 years, 60-64 years
1.50 65-69 years 1.70
70-74 years
2.00 75-79 years 2.40
80-84
2.90 years, 85 years and over 3.40
----------------------------------
B)
Combined capacity- performance payment of capitation by calling
First The amount of the capitation payment by calling the capitation down by
Part A) point 1. Calling capitation is granted in cases where practical
doctor or a general practitioner for children and adolescents has, with regard to
geographic conditions, has a smaller number of converted registered
insured by the respective insurance than 70% of the national average
number of those insured (the national average number
always determined for the calendar year, according to data of the Central register
insured, managed by General health
insurance Czech Republic) and the provision of such care is necessary to fulfill the obligations
health insurance according to § 46 para. 1 of the Act.
Second Match capitation can provide up to 90% capitation payments
calculated nationwide average number of FTE registered
insured competent health insurance company. On Match participates
health insurance company with which the medical device
concluded a contract for the provision and payment of health care share corresponding
percent of their insured the restatement registered
insured by health facilities.
Third For payment performance by a list of performance points 4-6 A)
apply mutatis mutandis.
C)
Health care covered by the list of operations
For health care paid for by a list of performance values are determined
point in the amount of CZK 0.95; Transport for performances in guest service provides
point value in the amount of CZK 0.90.
D)
Regulatory constraints
First Regulation on prescribed medicines and medical devices and to pull
care in listed specializations (in solicited care
Do not involve medical procedures and screening mammography screening
colorectal cancer by a health care facility which has a
health insurer to provide such medical procedures concluded a contract
) and 902 expertise:
01.01 If the average reimbursement for medicines and medical devices
prescribed medical facilities, relative to one
converted insured exceeds 120% of the national average payment per
prescribed medicines and medical devices, a health insurance company is entitled to exercise
regulatory deduction to 25% of
exceeded. To the average payment per insured converted to
will also include additional payments for medicines, for which the prescribing doctor
ruled out the possibility of replacing according to § 32 par. 2 of the Act, and that
health insurance paid. Health insurance company take into account cases where
medical facility demonstrates that an increase in average payment for
health facilities prescribed medicines and medical devices
related to one full-time equivalent
insured was caused by the change in the amount or method of payment, or
due to changes in the structure of treated insured.
02.01 If the average payment for solicited care in the listed specializations and expertise
902, according to the list of operations, related to one full-time equivalent
insured exceeds 120% of the national average
requested reimbursement for care in listed specializations and expertise
902, list performances, the health insurance company is entitled to exercise control
deduction to 25% of this excess.
Second Regulatory restrictions of paragraph 1.1 and 1.2 do not apply if
medical devices justify the health care provided on the basis of which
exceeding the average reimbursement under Section 1.1, or
02.01
Third Regulatory restrictions of paragraph 1.1 and 1.2 also apply if
medical facility in 2011 or 2012 registered 50 and less relevant
insured health insurance or medical care provided
50 and less unregistered insured by the respective insurance || | or in the case of health care provided to foreign policyholders.
Fourth Regulatory restrictions under Section 1.1 shall not apply if the total payment
for all medicinal products and medical devices
prescribed by GPs and GPs for children and adolescents in 2012,
tracked separately for each specialization, do not exceed the estimated amount
payments to the appropriate healthcare for 2012, based on
health insurance plan appropriate health insurance.
Fifth Regulatory restrictions under section 1.2 shall not apply if the total payment
for solicited care in the listed specializations and expertise
902 in 2012 will not exceed the estimated amount of reimbursement for this type of health care
2012, based on the health insurance plan
competent health insurance company.
6th The health insurance company is entitled to exercise control deduction by
points 1.1 and 1.2 up to a maximum amount corresponding to 15% of the volume of reimbursement
provided by the health insurance fund medical equipment for
capitation payment and medical services reduced by the amount of reimbursement for extra
charged material and separately charged Medicines in 2012.
7th If the medical facility provides health care to more
specializations, regulatory restrictions under Section 1.1 and 1.2 of the health insurance
calculated, or apply for any particular expertise,
if the health insurance company with the medical facility agree otherwise
.
Appendix 3
Point value, the amount of reimbursement and regulatory restrictions in accordance with § 6
A)
Point value and the level of reimbursement
First The amount of payment is determined by a list of performance payment for medical services rendered
a point value equal
A) CZK 1.08 for medical devices in the contractual specializations 305
306, 308 and 309 according to the list of operations, performance reporting expertise 910 -
psychotherapy list of performance together with curative day care centers daily
list of performances and for healthcare facilities contracting expertise
901 - clinical psychology list performances
B) CZK 0.95 to healthcare facilities providing hemodialysis treatment, with the exception of the contracted performance
18550, according to the list of operations, for which
Provides point value in the amount of CZK 0.80.
C) CZK 1 for healthcare facilities contracting expertise 927 - orthoptist
list performance for healthcare institutions contracting expertise 903
- Clinical Speech Therapy list of performances and for healthcare facilities contracting expertise
905 - visual therapist list performances
D) 0.68 to CZK 43,311 performances, 43313, 43315, 43613, 43617, 43627, 43629, 43633
list of performance contracting expertise 403 - Radiation Oncology
list performances
E) 0.68 to CZK 75,347 and 75,348 performances by a list of performance contracting expertise
705 - ophthalmology list performances
F) CZK 1.03 for screening performances 15101 and 15105 according to the list of performance contracting expertise
105 - gastroenterology list of performances and CZK 1
for newborn screening
G) 1.02 CZK for specialized outpatient health care
not listed above, to the volume calculated for each proficiency by
list of operations as follows:
POPho
PBro x -------
grapple
Where:
PBro total number of health facilities reported
and health insurance recognized Points
reference period
POPho number of unique insured treated
medical facilities in the specialty
the period under review
Grapple number of unique insured treated
medical facilities in the specialty
in the reference period
Health care provided health care facility over the calculated volume
in the specialty, expressed in number of points for the performance of a medical device
declared a health insurance company recognized for the reference period shall be paid
list of performances with a point value equal to CZK 0.30.
Second For medical devices that existed during the reference period, or
which did not provide care in the specialty, may
health insurance for the purpose of calculating the volume, average number of points per
one unique insured treated in the specialty for
reference period comparable medical facilities.
Third In the medical facility, where compared to the reference period will
due to changes in scope of contracted health care provided in some
expertise (ie. Changing spectrum of contracted power)
increase in the average number of points per unique insured, the volume number | || point by point 1. g) increase the number of points that corresponds
medical facility declared and recognized by health insurance
newly contracted health interventions.
Fourth Reduced value of a point in the specialty in accordance with point 1. g) shall not apply
:
A) in the case of medical devices, which reference or
period under review within one expertise were treated with 50 and fewer unique
insured, when the contracted capacity of care
least 30 office hours per week. In the case of contracted capacity
care provided less than 30 office hours per week limit to 50
unique treated insured calculates the coefficient n / 30 where n
is equal to the capacity contracted for the specialist care.
B) in the case of health care provided to foreign policyholders.
In the cases referred to in subparagraph a) all services paid with the value of CZK 1.02
point.
Fifth Health insurance may provide medical equipment
preliminary monthly payment equal to one-sixth the amount of reimbursement for
corresponding reference period, or in the amount of health care facilities reported
a recognized health care for that month.
Chosen form of pre-payment of health insurance keeps it after the trial period, if
medical facility during the reporting period, requests a reduction in the amount
interim payments. Preliminary settlement period under review
will be financially settled within the overall financial settlement, including regulatory
restrictions, and no later than 120 days after the end of the reporting period.
B)
Regulatory constraints
First If the medical device reaches the average payment per
unique insured separately charged for medicines, except
charged separately medicines marked with "S" according to § 39 paragraph
. 1 decree, and separately charged material in the reporting period increased,
Than 100% of the average payment per unique insured for separately billed
medicines, except separately charged
medicinal products marked with "S" according to § 39 par. 1 of the Decree, and billed separately
material in the reference period, the health insurance company may
medical devices at the end of 2012 to reduce the payment of 40%
amount by which the total payment for provided separately charged
medicinal products and separately charged material in the reporting period exceeded
a payment in the reference period, and this means contained in the contract
medical facilities and health insurance companies.
Second If the medical device reaches the average payment per insured
unique for prescribed medicines and medical devices
period under review, higher than 100% of the average payment per
one unique insured for prescription medicines and medical devices
in the reference period, the health insurance company may
medical facility after the end of the reporting period, to reduce the payment by
40% of the amount by which the total payment for prescription medicines and medical devices
in the reporting period exceeded such reimbursement in
reference period, and this means contained in the contract
medical facilities and health insurance companies. To the average payment per insured
unique also included additional payments for medicines, for which the prescribing doctor
ruled out the possibility of replacing according to § 32 par. 2
Act.
Third If the medical device reaches the average payment per insured
unique for solicited care in the specializations listed in
reporting period exceeds 100% of the average payment per unique
insured in the reference period, the health insurance company may
medical devices after the end of the reporting period, to reduce the payment by
40% of the amount by which the total payment for solicited care in the listed
specializations in the reporting period exceeded such reimbursement in
reference period, and this means the treaty medical
facilities and health insurance companies. They do not include the requested care
medical services mammography screening, cancer screening
cervical and colorectal cancer screening conducted
medical device that has a health insurance company to
providing these medical procedures concluded a contract.
For the purposes of determining the amount of the average payments and the amount of any reduction under the first sentence
performances are solicited care in the reporting period and the reference appreciated by
list of operations are effective 1 January 2012 point value valid in
the period under review.
Fourth Regulatory restrictions in paragraphs 1-3 shall not apply if the medical device
reasons provided health care, giving rise to
exceeded the average reimbursement under points 1, 2, or third
Fifth Regulatory restrictions of paragraph 1 shall not apply if the total payment for all separately charged
medicines and separately charged material
outpatient healthcare facilities providing specialized outpatient medical care
in the reporting period does not exceed the relevant
for health insurance 100% reimbursement for this type of health care
reference period.
6th Regulatory restrictions of paragraph 2 shall not apply if the total payment for
all medicinal products and medical devices
prescribed in outpatient healthcare facilities providing specialized outpatient medical care
period under review
outweighs the estimated amount of reimbursement for this type healthcare for 2012, based on
health insurance plan appropriate health insurance.
7th In the medical facility, where compared to the reference period there was a change of the contracted
range of health care provided (change of performances
carriers authorized to prescribe medicinal products and medical devices
and require care in specializations listed
), health insurance in agreement with the medical device
average value of payments in the reference period for these purposes
proportionately adjusted.
8th For medical devices, which in the reference period or in its
part did not exist or had a contract with the health
Insurance, health insurance can be used for the purpose of applying
regulatory restrictions in points 1-3 benchmarks comparable
medical facilities.
9th If the medical facility were treated or assessed in reference
period in the specialty 50 or fewer unique policyholders, while
contracted capacity of care provided at least 30 office hours per week
, health insurance this profession are excluded from the calculation of regulation by
1 to 3. In the case of contracted capacity provided by care
less than 30 office hours per week limit to 50
unique treated insured calculates the coefficient n / 30 where n is equal to the capacity contracted
care for the specialist.
10th Regulatory restrictions of paragraph 3 shall not apply if the total payment
for solicited care in the listed specializations in the period under review
not exceed the estimated amount of reimbursement for this type of health care
year 2012 based on the health insurance plan appropriate health | || insurers.
11th The health insurance company is entitled to exercise control points deduction by
1-3 maximum amount corresponding to 15% of the volume of reimbursement
provided by the health insurance fund medical equipment for
medical services less the amount of reimbursement for separately charged material and
Medicines charged separately for the period.
12th If the medical facility prescribes medical device
over 15,000 CZK approved inspection physician health insurance, it will not
amount is included in the calculation of regulatory limitations under paragraph 2
13th If the medical facility provides health care to more
specializations, regulatory restrictions of paragraph 1-3 the health insurance
calculated or applied separately for each specialization, if
health insurance with health facilities agree otherwise.
Appendix 4
Point value, the amount of reimbursement and regulatory restrictions under § 7
A)
Point value and the level of reimbursement
First The amount of payment is determined by a list of performance payment for medical services rendered
a point value in the amount of CZK 1.06.
Second The total amount of reimbursement of medical equipment
A) providing the expertise in health care, 603 or 604
not exceed the amount which is calculated as follows:
POPzpo x puro
Where:
POPzpo number of unique insured treated in the
expertise in health facilities assessed
period.
Puro average payment for medical services, including specially
Billed material and separately charged medicinal
products per unique insured
treated in the specialty medical facilities
in the reference period.
B) providing the health care expertise simultaneously in 603 and 604
expertise does not exceed an amount equal to the sum of the amounts for each
expertise, where the amount of the individual expertise
calculated as follows:
POPzpo x puro
Where:
POPzpopočet unique insured treated in the
expertise in health facilities assessed
period
Puro is calculated as follows:
Puro PPBROo = x + RDHB PUZUMROo PUZULPROo +
Where:
PPBROo average number of health facilities reported a
health insurance company recognized points per
unique insured treated in the specialty
medical facility in the reference period
RDHB actually reached the point value for health care
provided medical facilities in the expertise of 603
and 604 list of outputs in health insurance
in the reference period, which is determined as a proportion
total reimbursement of such medical devices
health insurance for health care provided
expertise in healthcare facilities 603 and 604 by
list of operations minus the amount of reimbursement for extra
charged material and separately charged Medicines
the reference period and the total number of points
health care provided health care facility
expertise in the 603 and 604 reported for the reference
term health insurance fund recognized
PUZUMROo average payment for separately charged material
one unique insured in the specialty of
medical facility in the reference period
PUZULPROo average payment for separately billed medicinal
preparations for one unique insured in the
expertise in a medical facility in the reference
period
Third The total amount of reimbursements under paragraph 2 shall be subject to the conditions
stipulated in the contract between health insurers and medical device
increased in the same manner as in the reference period, if
health insurance with health facilities agree otherwise.
Fourth For medical devices that existed during the reference period, or
which did not provide care in the specialty, is entitled to health insurance
for the purpose of calculating the total amount of payment used
average payment per unique insured for the reference period
comparable medical facilities.
Fifth In the medical facility, where compared to the reference period will
due to changes in scope of contracted health care provided in some
expertise (ie. Changing spectrum of contracted power)
increase in the average payment per unique insured, the total amount of payment | || medical device according to claim 2 will increase the value of the medical device
declared a health insurance company recognized a newly
contracted medical procedures, including material separately invoiced and billed separately
medicines. Newly contracted performances for these purposes will appreciate
list performance using point values CZK 1
if health insurance is a medical device
agree otherwise.
6th A health insurance bill into account the cases where the
increase in costs will occur in connection with the increase of pregnant women were insured.
7th Health insurance also take into account cases where the medical device
demonstrates that increased the average cost of separately charged
material and separately charged medicines per unique
insured in the specialty were caused by the change in the amount or method of their
payment, or due to changes in the structure of the treated
insured.
8th If the medical facility were treated or assessed in reference
period in the specialty 50 or fewer unique policyholders, while
contracted capacity of care provided at least 30 office hours per week
, health insurance this profession are excluded from the calculation of regulation by
point 2. a) and b). In the case of contracted capacity provided
care less than 30 office hours per week limit is 50
unique treated insured calculates the coefficient n / 30 where n equals
capacity contracted for the specialist care.
9th Health insurance may provide medical equipment
monthly pre-payment of one-twelfth of the amount of reimbursement for
corresponding reference period, or in the amount of medical equipment
declared and recognized health care for that month.
B)
Regulatory constraints
First Regulation for prescribed medicines and medical devices and
for solicited care in the listed professions.
1.1 If the medical device reaches the average payment per insured
unique for prescribed medicines and medical devices
period under review, higher than 100% of the average payment per
one unique insured for prescription medicines and | || medical devices in the reference period, the health insurer is entitled
healthcare facilities to reduce the payment of 40% of the amount by which the total
payment for prescription medicines and medical devices
in the reporting period exceeded such payment in the reference period and it
methods contained in the contract of medical facilities and health insurance
. To the average payment per unique insured with
will also include additional payments for medicines, for which the prescribing doctor
ruled out the possibility of replacing according to § 32 par. 2 of the Act.
1.2 If the medical device reaches a higher average payment per
one unique insured for solicited care in the listed
specializations in the reporting period, 100% of the average payment per insured
unique in the reference period, health insurance is
entitled to reimbursement of medical devices to reduce by 40% the amount by which the total
requested reimbursement for care in specializations listed in
Reporting period exceeded such payment in the reference period,
methods contained in the contract of medical facilities and health insurance
. Do not include the requested care medical services
mammography screening, cervical cancer screening and
colorectal cancer by a health care facility that has
insurance company to provide those medical procedures contract.
For the purpose of calculating the average amount of reimbursement and any deductions by
first sentence performances solicited care in the reporting period and the reference
appreciated by the list of operations are effective 1 January 2012
point value in force the period under review.
Second Regulatory restrictions in points. 1.1 and 1.2 do not apply if
medical devices justify the health care provided on the basis of which
exceeding the average reimbursement under Section 1.1, or
02.01
Third When compared to the reference period was changed contracted
extent provided health care, health insurance agreement with the medical establishment
average value of payments in the reference period for these purposes
proportionately adjusted.
Fourth In the event that the medical establishment in the reference period or in its
part did not exist or had a contract with the health insurance
, the health insurance company is entitled to use for the purposes of applying
regulatory restrictions in sections 1.1 and 1.2 below the reference value | || comparable medical facilities.
Fifth If the medical facility were treated or assessed in reference
period in the specialty 50 or fewer unique policyholders, while
contracted capacity of care provided at least 30 office hours per week
, health insurance this profession are excluded from the calculation of regulation by
items 1.1 and 1.2. In the case of contracted capacity provided by care
less than 30 office hours per week limit to 50
unique treated insured calculates the coefficient n / 30 where n is equal to the capacity contracted
care for the specialist.
6th The insurance company does not apply the regulation referred to in 1.2, if the total payment
for solicited care in the listed specializations in the period under review
outweighs this kind of healthcare is the estimated amount of reimbursement for
2012 based on the health insurance plan health insurance.
7th The health insurance company is entitled to exercise control deduction by
points 1.1 and 1.2 up to a maximum amount corresponding to 25% of the payment
provided health insurance medical equipment for health
performance, minus the amount of payment for the material and separately charged separately || | charged Medicines for the period.
8th If the medical facility prescribes medical device over 15
000 CZK approved inspection physician health insurance, it will not
amount is included in the calculation of regulatory restrictions under Section 1.1.
9th If the medical facility provides health care to more
specializations, regulatory restrictions under Section 1.1 and 1.2 of the health insurance
calculated, or apply for any particular expertise,
if medical facilities and health insurance company agree otherwise.
Appendix 5
Point value and the level of reimbursement pursuant to § 9
First For the contracted performance of mammography screening, according to the list
performances down the point value of CZK 1; contracted for performances
cervical screening, according to the list of operations, down
point value in the amount of CZK 1.03.
Second For healthcare provided expertise 809 list
performance to volume computed according to section 5 provides point value in the amount of CZK 1.05
, with the exception of the contracted output from 89,711 to 89,725 and
output from 89,611 to 89,619 by list of operations, for which the volume up
calculated in accordance with Section 5 provides point value of 0.67 CZK.
Third For health care provided in specializations 222, 801, 802, 804
805, 812-815, 818, 819 and 822 to the volume calculated under Section 5
point value determined in the amount of CZK 0.67.
Fourth For health care provided in specialized fields 807, 816, 817 and 823
to the amount calculated in accordance with paragraph 5 point value determined in the amount of CZK 0.67
. In the case of medical devices proves that in the reporting period
certified ISO 15189 CSN or NASKL II
point value under the first sentence to the amount calculated in accordance with Section 5 states in the amount of CZK 0.52
.
Fifth Health care provided during the review period in the listed
specializations are to be paid with the value of a point by point 2-4 to the calculated volume
100% medical facility declared and recognized by health insurance
points over the reference period; over the volume of health care
specialties listed in paragraph 2 and 3 shall be met with a point value of CZK 0.40 and
specialties mentioned in point 4 point value CZK 0.20. This volume is calculated as follows
:
POPho
PBro x ------
grapple
Where:
PBro total number of health facilities reported a
health insurance recognized as reference points
period
POPho total number of unique insured treated
medical facilities in the period under review
Grapple total number of unique insured treated
medical facilities in the reference period
6th For medical devices that exist in the reporting period, or
which did not provide care in the specialty, or which can not be
volume of total remuneration for reasons that medical devices
arose during the reference period, or if medical
facility provides the care and 50 fewer unique policyholders may
health insurance for the purpose of calculating the amount under point 5
use the average payment per unique insured for the reference period
comparable medical facilities.
7th The provisions of paragraph 5 shall not apply in the case of health care provided
foreign policyholders.
8th If in a medical facility to changes in the scope and structure
reimbursed care provided in comparison with the reference period and
health insurance company will approve these changes, take them into account in the design
contract, including payments to quantify the impact.
9th Health insurance may provide medical equipment
preliminary monthly payment equal to one-sixth the amount of reimbursement for
corresponding reference period. The financial settlement will occur no later than 120 days after the date
end of the evaluation period.
Annex 6
Point value and the level of reimbursement pursuant to § 10
First For outpatient healthcare facilities providing health care expertise
925 list performances down the point value of 1
CZK.
Second For outpatient healthcare facilities providing health care expertise
911, 914, 916 and 921 according to the list of performance values are determined
point in the amount of CZK 0.90.
Third For the performance of traffic visiting service, funded by the list of performances
down a point value in the amount of CZK 0.90. At these performances are not covered
provisions in paragraphs 4 and 5.
Fourth Health care provided health care facility to 105% of the calculated volume
or modified by section 6, shall be borne by
list of performances with a point value according to points 1 and 2.
This volume is calculated as follows:
POPho
PBro x -------
grapple
Where:
PBro total number of health facilities reported a
health insurance recognized as reference points
period
POPho total number of unique insured treated
medical facilities in the period under review
Grapple total number of unique insured treated
medical facilities in the reference period
Fifth Health care provided to health care facilities over 105% in volume
calculated in accordance with paragraph 4, or modified by paragraph 6, in 925
expertise pays a point value of CZK 0.70 and CZK in specialties
911, 914, 916 and 921 with a point value of 0.63 CZK.
6th If in a medical facility to changes in the scope and structure
reimbursed care provided in comparison with the reference period and
health insurance company will approve these changes, take them into account in the design
contract, including payments to quantify the impact.
7th The provisions of paragraphs 4 and 5 shall not apply if the medical device
were treated with 50 or fewer unique insured in the reference period.
8th The health insurance company can arrange a medical facility
monthly pre-payment in the amount of health care facilities through a health insurance
recognized health care for the current month, while
this form of health insurance keeps it after the trial period.
Preliminary payment for this period health insurance financially deal
Later than 120 days after the end of the reporting period.
Annex 7
Point value and the level of reimbursement pursuant to § 11
First The point value is determined in the amount of CZK 0.80.
Second For the performance of traffic visiting service, funded by the list of operations,
the point value determined in the amount of CZK 0.90. At these performances are not covered by the provisions of Section 3
Third Health care provided health care facility above calculated
volume, or adjusted according to section 4 shall be paid according to the list of performances with
point value in the amount of CZK 0.40. This volume is calculated as follows:
POPho
PBro x -----
grapple
Where:
PBro total number of health facilities reported a
health insurance recognized as reference points
period
POPho total number of unique insured treated
medical facilities in the period under review
Grapple total number of unique insured treated
medical facilities in the reference period
Fourth If in a medical facility to changes in the scope and structure
reimbursed care provided in comparison with the reference period and
health insurance company will approve these changes, take them into account in the design
contract, including payments to quantify the impact.
Fifth The provisions of paragraph 3 shall not apply if the medical facility were treated
50 or fewer unique insured in the reference period.
6th The health insurance company can arrange a medical facility
monthly pre-payment either in the amount of health care facilities reported
and health insurance recognized health care for a given month or
equal to one-sixth of 100% of the payments in the reference period, while
chosen form of health insurance keeps it after the trial period.
Preliminary payment for this period health insurance financially settle
later than 120 days after the end of the reporting period.
Appendix 8
Point value and the level of reimbursement pursuant to § 13
First The point value is determined
A) in the amount of CZK 0.95 to healthcare facilities providing transport
health service in continuous operation
B) in the amount of CZK 0.85 for medical facilities that do not provide transport
health service in continuous operation.
Second Health care provided health care facility to 100%
the calculated volume is paid according to the list of performance with value
points out in paragraph 1. This volume is calculated as follows:
POPho
PBro x --------------
grapple
Where:
PBro total number of health facilities reported a
health insurance recognized as reference points
period
POPho total number of insured persons who were transferred, which was
the period under review provided medical transport
service. Převezeným the insured means the insured
on which was recorded the performance of transport on the basis
command to health delivery.
Grapple total number of insured persons who were transferred, which was
in the reference period provided medical transport
service; in the case of a merger of health insurance companies
the number of insured persons who were transferred shall be the sum
was transported insured health insurance companies
merged
Third Above 100% volume computed under point 2
health insurance company is entitled to adjust the value of the point referred to in paragraph 1, for
medical devices mentioned in point 1. a) 0.55 CZK and
for medical devices mentioned in point 1. b) 0.45 CZK.
Fourth The provisions of paragraph 3 shall not apply to medical devices which
reference or evaluation period provided medical transport service
less than 50 převezeným insured competent health insurance company.
Fifth If in a medical facility to changes in the scope and structure
reimbursed care provided in comparison with the reference period and
health insurance company will approve these changes, take them into account in the design
contract, including payments to quantify the impact.
6th Health insurance may provide medical equipment for 1st and
second half of 2012 pre-payment of 100% of the payment in the appropriate
half of 2010.
Appendix 9
Groups related to the diagnosis according to the classification; 4) with the indices of these groups
--------- ----------------------------------------------------------------------------------------------------------- ----------------
IR-DRG-4) Name of Index 2012
--------- ----------------------------------------------------------------------------------------------------------- ----------------
01051 RELEASE carpal tunnel WITHOUT CC 0.1655
01052 RELEASE Carpal Tunnel S CC 0.1931
01053 RELEASE Carpal Tunnel With MCC 0 1931
02041 performance on Cocco WITH OR WITHOUT vitrectomy WITHOUT CC 0.3356
02042 performance on Cocco WITH OR WITHOUT vitrectomy with CC 0.3610
02043 performance on Cocco WITH OR WITHOUT vitrectomy with MCC 0.3610
05,011 cardiac defibrillator implants and TO SUPPORT THE HEART WITHOUT CC 31.2554
05,012 cardiac defibrillator implants AND SUPPORT FOR THE HEART WITH CC 31.9302
05,013 cardiac defibrillator implants AND SUPPORT FOR THE HEART WITH MCC 32, 9778
05,070 IMPLANTATION SUSTAINED the pacemaker in acute myocardial infarction, heart failure or shock, 5.7648
05111 IMPLANTATION WITHOUT CONSTANT Pacemakers acute myocardial infarction, heart failure or shock, WITHOUT CC 4.1290
05112 IMPLANTATION SUSTAINED without acute Pacemakers myocardial infarction, heart failure and shock with CC 4.1969
05,113 IMPLANTATION WITHOUT CONSTANT Pacemakers acute myocardial infarction, heart failure and shock with MCC 5.5368
05,161 Pacemakers EXCHANGE WITHOUT CC 3.2280
05162 EXCHANGE Pacemakers With CC 3.2280
05,163 Pacemakers EXCHANGE WITH MCC 3.2280
05,191 ligatures STRIPPING AND VASCULAR WITHOUT CC 0.5102
05,192 ligatures and STRIPPING vessels with CC 0.5452
05,193 ligatures STRIPPING AND VASCULAR With MCC 0.5741
06061 IN TANNING laparoscopic surgery, thigh, umbilical or epigastric Kyle WITHOUT CC 1.0579
06062 IN TANNING laparoscopic surgery, thigh, umbilical or epigastric Kyle CC 1.1577
06063 Laparoscopic PERFORMANCES IN TANNING, thigh, umbilical or epigastric Kyle MCC 1.3609
07041 Laparoscopic cholecystectomy WITHOUT CC 1.1271
07042 Laparoscopic cholecystectomy S CC 1.2974
07,043 laparoscopic cholecystectomy with MCC 1.7831 || | 08021 BILATERAL AND MULTI-high output in the joints of the lower KONČETINBEZ CC 3.1672
08022 BILATERAL AND MULTI-high output in the joints of the lower KONČETINS CC 3.8072
08023 BILATERAL AND MULTI-high output in the joints of the lower KONČETINS MCC 6.4456 | || 08041 GREAT PERFORMANCES lower extremity replantation AND THEIR JOINT WITHOUT CC 2.9401
08042 GREAT PERFORMANCES lower extremity replantation AND THEIR JOINT WITH CC 2.9954
08043 GREAT PERFORMANCES lower extremity replantation AND THEIR JOINT WITH MCC 3.9954
08,181 high output in the knee joint WITHOUT CC 3.5400
08,182 high output in the knee joint with CC 3.7009
08,183 high output in the knee joint with MCC 4.1049
08191 arthroscopy WITHOUT CC 0 , 4890
08,192 arthroscopy S CC 0.5313
08193 arthroscopy with MCC 0.5571
13091 dilation, curettage and conisation WITHOUT CC 0.2657
13092 dilation, curettage and conisation S CC 0.3048
13093 dilation, curettage A cone biopsy with MCC 0.3403
--------- ----------------------------------------------------------------------------------------------------------- ----------------
Annex 10
Groups related to diagnosis by Klasifikace4) with indices of these groups
used to calculate CMalfa2012 and CMalfa2010
----------- ------------------------------------------------------------------------------------------------------- --------------------
IR-DRG-4) Name of Index 2012 -----------
------------------------------------------------------------------------------------------------------- --------------------
00041 LONG mechanical ventilation for> 240 hours (11 to 21 days) without CC 12.4333
00042 LONG mechanical ventilation for> 240 HOURS (11-21 days) with CC 12.9457
00043 LONG mechanical ventilation for> 240 hours (11 to 21 days) with MCC 16.3563
00051 LONG mechanical ventilation for> 96 h (5-10 days) without CC 6.2664
00052 LONG mechanical ventilation for> 96 h (5-10 days) with CC 6.7740
00053 LONG mechanical ventilation for> 96 h (5-10 days) with MCC 8.6333
00060 LONG mechanical ventilation> 1800 hours (over 75 days) 78.6404
00080 LONG mechanical ventilation for> 1008 hour (43-75 days) with ECO POWER ROUGH 64.5424
00090 LONG mechanical ventilation for> 1008 hour (43-75 DAYS)
41.7574 00100 LONG mechanical ventilation for> 504 hours (22-42 days) with ECO POWER ROUGH 40.0096
00110 LONG mechanical ventilation for> 504 hours (22-42 DAYS) 27.6450
00121 LONG Mechanical ventilation> 240 hours (11 to 21 days) with ECO ROUGH performance without CC 18.5425
00122 LONG mechanical ventilation for> 240 hours (11 to 21 days) with ECO POWER WITH ROUGH CC 20.0672
00123 LONG Mechanical ventilation> 240 hours (11 to 21 days) with ECO POWER WITH ROUGH MCC 23.6230
00131 LONG mechanical ventilation for> 96 h (5-10 days) with EKONOMICKYNÁROČNÝM performance without CC 9.4710
00132 LONG MECHANICAL FAN> 96 hours (5-10 days) with EKONOMICKYNÁROČNÝM PERFORMANCE WITH CC 10.2808
00133 LONG mechanical ventilation for> 96 h (5-10 days) with EKONOMICKYNÁROČNÝM of performance with MCC 13.5331
01011 craniotomy WITHOUT CC 3 , 3635
01012 craniotomy S CC 4.2416
01013 craniotomy with MCC 6.4048
01021 spinal performance without CC 2.4582
01022 spinal exercising with CC 3.3653
01023 spinal PERFORMANCE With MCC 6.4614
01031 performance on extracranial arteries WITHOUT CC 2.0432
01032 performance on extracranial arteries with CC 2.5773
01033 performance on extracranial arteries with MCC 3.2833 01,041
performance on cranial and peripheral nerves WITHOUT CC 0.4131
01042 performance on cranial and peripheral nerves S CC 0.4780
01043 performance on cranial and peripheral nerves with MCC 0.7155
01061 OTHER PERFORMANCE IN diseases and disorders NERVOUS systems without CC 1.1741
01,062 other performances during illness and nervous system disorders S CC 1.7936
01,063 other performances during illness and nervous system disorders with MCC 3.1294
01301 TROUBLES AND SPINAL CORD INJURY WITHOUT CC 0.6082
01302 TROUBLES AND SPINAL CORD INJURY WITH CC 0.7768
01303 TROUBLES AND SPINAL CORD INJURY WITH MCC 1.4572
01311 malignant diseases, some infections and degenerative disorders of the nervous system without CC 0.5945 || | 01312 malignant diseases, some infections and degenerative nervous system disorder with CC 0.7223
01313 malignant diseases, some infections and degenerative nervous system disorder with MCC 1.1329
01,321 multiple sclerosis and cerebellar ataxia WITHOUT CC 0.4091
01322 multiple sclerosis and cerebellar ataxia CC 0.4458
01323 multiple sclerosis and cerebellar ataxia MCC 0.9835
01331 nontraumatic intracranial hemorrhage WITHOUT CC 1.0395
01332 nontraumatic intracranial hemorrhage S CC 1 , 3540
01,333 nontraumatic intracranial hemorrhage with MCC 2.3921
01341 of stroke Myocardial WITHOUT CC 0.7394
01342 of stroke with myocardial infarction and CC 0.8977
01,343 of stroke S Myocardial With MCC 1.5303
01351 nonspecific stroke and precerebral OCCLUSION WITHOUT MYOCARDIAL WITHOUT CC 0.5915
01352 nonspecific stroke and precerebral OCCLUSION WITHOUT heart attack with CC 0.7029
01353 nonspecific cerebrovascular accident A precerebral OCCLUSION WITHOUT heart attack with MCC 1.1390
01361 TIA WITHOUT CC 0.4194
01362 TIA S CC 0.4767
01,363 transient ischemic attack with MCC 0.6246 01,371
DISORDERS cranial and peripheral nerves WITHOUT CC 0.4798
01372 DISORDERS cranial and peripheral nerves S CC 0.5438
01,373 DISORDERS cranial and peripheral nerves with MCC 1.0409
01,381 bacterial and tuberculous infection NERVOUS SYSTEM WITHOUT CC 1.3279
01382 bacterial and tuberculous infection nervous system CC 1.8002
01,383 bacterial and tuberculous infection nervous system MCC 3.0761
01,391 nonbacterial INFECTIONS OF THE NERVOUS SYSTEM, OTHER THAN viral meningitis WITHOUT CC 0.8903
01,392 nonbacterial infections, NERVOUS SYSTEM, EXCEPT viral meningitis S CC 1.2776
01,393 nonbacterial infections, nervous system and viral meningitis EXCEPT WITH MCC 2.5203
01401 viral meningitis WITHOUT CC 1.0897
01402 viral meningitis S CC 1.1996
01403 viral meningitis with MCC 1.9426
01,411 non-traumatic disorders of consciousness and coma WITHOUT CC 0.4439
01,412 non-traumatic disorders of consciousness and coma with CC 0.6706
01,413 non-traumatic disorders of consciousness and coma with MCC 1.3956
01421 epileptic seizures WITHOUT CC 0.4465
01422 S epileptic seizures CC 0.5452
01423 S epileptic seizures MCC 0.9674
01,431 migraine and other HEADACHES WITHOUT CC 0.3889
01,432 migraine and other headaches with CC 0.5115
01,433 migraine and other headaches with MCC 0.7633
01441 cranial and intracranial INJURY WITHOUT CC 0.7038
01442 cranial and intracranial INJURY S CC 1.1114
01443 cranial and intracranial INJURY WITH MCC 2.3874
01451 concussion WITHOUT CC 0.2200
01452 concussion S CC 0.2506
01453 concussion MCC, 0.4390
01,461 OTHER nervous system disorders WITHOUT CC 0.3765
01462 OTHER Nervous System Disorders With CC 0.5087
01463 OTHER DISORDERS NERVOUS SYSTEM WITH MCC 0.8054
02011 enucleation and performance on the eyecups WITHOUT CC 0.9020
02,012 enucleation and the performance of orbit with CC 1.1793
02,013 enucleation and the performance of orbit with MCC 1.4158 | || 02021 extraocular enforcement, other than ORBIT WITHOUT CC 0.3580
02022 extraocular enforcement, other than of orbit with CC 0.4682
02023 extraocular enforcement, other than of orbit with MCC 0.5400
02,031 intraocular PERFORMANCE, EXCEPT THEM WITHOUT CC 0.7382
02032 intraocular enforcement, other than a lens with CC 0.9164
02,033 intraocular enforcement, other than a lens with MCC 0.9164
02301 ACUTE AND SERIOUS INFECTIONS eye without CC 0.4164
02302 ACUTE AND SERIOUS INFECTIONS WITH EYE CC 0.4592
02303 ACUTE AND SERIOUS EYE INFECTION WITH MCC 1.0647
02311 Neurological and vascular disorders of the eye WITHOUT CC 0.4175
02312 Neurological and vascular disorders of the eye's CC 0.4433
02313 Neurological and vascular disorders of the eye's MCC 0.7062
02321 OTHER DISORDERS eye without CC 0.2617
02322 OTHER INCIDENTS WITH EYE CC 0.3153
02,323 OTHER EYE DISORDERS WITH MCC 0.4041
03011 high output in the larynx and trachea WITHOUT CC 2.9187
03012 high output in the larynx and trachea S CC 3.7098
03013 high output in the larynx and trachea with MCC 5.2102 || | 03021 OTHER GREAT PERFORMANCES head and neck WITHOUT CC 1.6354
03022 OTHER GREAT PERFORMANCES AT THE HEAD AND NECK WITH CC 3.0449
03,023 OTHER GREAT PERFORMANCES AT THE HEAD AND NECK WITH MCC 4.5078
03031 Performance on facial bones, EXCEPT LARGE CAPACITY head and neck WITHOUT CC 1.2750 03,032
performance on facial bones, except large output per head and neck CC 1.3504
03033 performance on facial bones, EXCEPT LARGE CAPACITY THE HEAD AND NECK WITH MCC 2.3205
03041 performance on the mouth without CC 0.6850
03042 PERFORMANCE mouth with CC 0.9758 03,043
performance on the mouth with MCC 1.0239
03051 PERFORMANCE ON A mastoid cavities WITHOUT CC 0.9428
03052 PERFORMANCE IN A mastoid cavities S CC 1.0356
03053 PERFORMANCE IN A mastoid cavities with MCC 1.1375 03,061
performance on the salivary glands WITHOUT CC 0.8532
03062 performance on the salivary glands S CC 0.9504
03063 salivary gland performance on MCC, 1.1096
03071 AXLE cleft lip and palate WITHOUT CC 1.2484
03072 AXLE cleft lip and palate S CC 1.2484
03,073 REMEDY cleft lip and palate With MCC 1.2484 03,081
performance on the tonsils and adenoids WITHOUT CC 0.4129 03,082
performance on the tonsils and adenoids S CC 0.5310 03,083
performance on the tonsils and adenoids with MCC 0.5799
03,091 OTHER PERFORMANCE IN disorders and diseases of ears, nose, mouth and throat without CC 0.4117
03092 OTHER PERFORMANCE IN disorders and diseases of ears, nose, mouth and throat with CC 0.5328
03093 OTHER PERFORMANCE WHEN disorders and diseases of ears, nose, mouth and throat with MCC 0.8540
03301 Malignant diseases of the ear, nose, mouth and throat without CC 0.5266
03,302 Malignant diseases of the ear, nose, mouth and throat S CC 0 , 5369
03303 Malignant diseases of the ear, nose, mouth and throat with MCC 0.7291
03,311 balance disorders WITHOUT CC 0.3984
03312 balance disorders S CC 0.4497
03,313 balance disorders with MCC
0.5906 03,321 0.2644 epistaxis WITHOUT CC
03322 epistaxis S CC
0.3033 03,323 0.3678 MCC, epistaxis
03,331 epiglottitis, otitis media, upper respiratory tract infection, laryngotracheitis WITHOUT CC 0.2968
03332 epiglottitis, otitis media, upper respiratory tract infection, laryngotracheitis S CC 0.3869
03,333 epiglottitis, otitis media, upper respiratory tract infection, laryngotracheitis with MCC 0.5453
03341 DISEASES AND TEETH mOUTH WITHOUT CC 0.4844 03,342
diseases of the teeth or mouth CC 0.5590 03,343
diseases of the teeth or mouth MCC 0.7861
03351 Other disorders of the ears, nose, mouth and throat WITHOUT CC 0.3240
03,352 Other disorders of the ears, nose, mouth and throat with CC 0.3922
03,353 Other disorders of the ears, nose, mouth and throat with MCC 0.4509
04011 GREAT thoracosurgeries WITHOUT CC 3.1129 || | 04012 GREAT thoracosurgeries S CC 3.7317
04013 GREAT thoracosurgeries With MCC 5.2131
04021 SMALLER thoracosurgeries WITHOUT CC 2.5833
04022 SMALLER thoracosurgeries S CC 2.5833
04023 SMALLER thoracosurgeries With MCC 3.5263
04031 OTHER PERFORMANCE IN disorders and diseases of the respiratory system WITHOUT CC 1.1106
04,032 OTHER PERFORMANCE IN disorders and diseases of the respiratory system S CC 1.4817
04,033 OTHER PERFORMANCE DISORDERS A respiratory diseases with MCC 3.1355
04,301 cystic fibrosis WITHOUT CC 1.7392
04,302 cystic fibrosis S CC 1.7392
04,303 cystic fibrosis MCC, 2.4898
04,310 respiratory failure 1, 8379
04,321 pulmonary embolism WITHOUT CC 0.8624 04,322
pulmonary embolism S CC 0.9606 04,323
pulmonary embolism with MCC 1.1092
04331 SEVERE TRAUMA WITHOUT CHEST CC 0.3750 04,332
SEVERE TRAUMA WITH CHEST CC 0.5822
04333 SEVERE TRAUMA CHEST WITH MCC 1.1834
04,341 Malignant diseases of the respiratory system without CC 0.6493
04,342 Malignant respiratory diseases S CC 0.7336 04,343
Malignant respiratory diseases with MCC 0.9149
04351 infection and inflammation of the respiratory system WITHOUT CC 0.8245
04352 infection and inflammation of the respiratory system S CC 0.9536
04353 infection and inflammation of the respiratory system with MCC 1, 4623
04,361-FREE pneumonia and whooping cough WITHOUT CC 0.6336
04,362-FREE pneumonia and whooping cough S CC 0.8153
04,363-FREE pneumonia and whooping cough MCC, 1.2048 04,371
chronic obstructive pulmonary disease without CC 0.5061 04,372
chronic obstructive pulmonary disease S CC 0.6172
04373 Chronic obstructive pulmonary disease with MCC 0.8347
04,381 asthma and bronchiolitis have NO CC 0.4030 asthma and 04,382
bronchiolitis CC 0.5200
04,383 asthma and bronchiolitis MCC 0.7078
04,391 interstitial lung disease WITHOUT CC 0.6486
04,392 interstitial pulmonary disease with CC 0.7289
04,393 interstitial pulmonary disease with MCC 1.0508
04401 effusion, pneumothorax and pleuran WITHOUT CC 0.8332
04,402 pleuran pneumothorax and effusion with CC 0.8893
04403 pleuran pneumothorax and effusion with MCC 1.2888
04,411 signs, symptoms and diagnoses of respiratory WITHOUT CC 0.4140
04412 SIGNS, SYMPTOMS AND DIAGNOSIS OF OTHER rESPIRATORY SYSTEM WITH CC 0.5689
04413 SIGNS, SYMPTOMS AND DIAGNOSIS OF OTHER rESPIRATORY SYSTEM WITH MCC 0.7837
05000 DEATH TO 5 DAYS TO RECEIVE AT HOME diagnoses circulatory system 0.4511 05,021
performance on a heart valve cardiac catheterization WITHOUT CC 13.4427 || | 05022 performance on a heart valve cardiac catheterization S CC 14.2702 05,023
performance on a heart valve cardiac catheterization MCC, 05031 18.7505
OPERATIONS AND PROCEDURES FOR Congenital heart defects without CC 10.1871
05032 OPERATIONS AND PROCEDURES FOR Congenital heart defects CC 10.8189
05 033 OPERATIONS AND PROCEDURES FOR Congenital heart defects MCC 20.0593 05,041
performance on a heart valve cardiac catheterization WITHOUT WITHOUT CC 10.8503 05,042
performance on cardiac valve without cardiac catheterization S CC 11.7978 05,043
performance on a heart valve WITHOUT cardiac catheterization with MCC 16.6765
05051 SE coronary bypass cardiac catheterization WITHOUT CC 9.3611
05,052 coronary bypass cardiac catheterization S CC 9.8107
05,053 coronary bypass cardiac catheterization with MCC 13.2823
05,061 coronary bypass cardiac catheterization WITHOUT WITHOUT CC 8.1477
05062 WITHOUT coronary bypass cardiac catheterization S CC 8.5120 05,063
WITHOUT coronary bypass cardiac catheterization with MCC 10.4874
05081 OTHER cardiothoracic performance without CC 5.6667
cardiothoracic 05,082 OTHER PERFORMANCE WITH CC 6.6091
cardiothoracic 05,083 OTHER PERFORMANCE WITH MCC 16.7915
05091 MAJOR ABDOMINAL VASCULAR performance without CC 4.4977
05092 MAJOR ABDOMINAL VASCULAR exercising with CC 6.4571
05093 MAJOR ABDOMINAL VASCULAR exercising with MCC 8.2821
05101 OTHER PERCUTANEOUS cardiovascular procedures after acute myocardial infarction without CC 3 , 6996
05,102 OTHER PERCUTANEOUS cardiovascular procedures after acute myocardial infarction CC 3.8394
05103 OTHER PERCUTANEOUS cardiovascular procedures after acute myocardial infarction MCC 5.2074
05121 BIG CHEST VASCULAR performance without CC 8.0771 | || 05122 GREAT PERFORMANCES WITH CHEST VASCULAR CC 9.5665
05123 GREAT PERFORMANCES WITH CHEST VASCULAR MCC 12.9493
05131 OTHER PERCUTANEOUS cardiovascular procedures without acute myocardial infarction without CC 3.0743
05132 OTHER PERCUTANEOUS cardiovascular procedures without acute myocardial infarction CC 3.2475
05133 OTHER PERCUTANEOUS cardiovascular procedures without acute myocardial infarction MCC 3.4204
05,141 other vascular performance without CC 1.9097
05,142 other vascular PERFORMANCE WITH CC 2.2589
05143 other vascular exercising with MCC 3.5512
05,151 amputations due to a failure of the circulatory system, EXCEPT upper limbs and toes WITHOUT CC 1.8032
05,152 amputations due to a failure of the circulatory system, except upper limb and digit U FEET WITH CC 2.1795
05,153 amputations due to a failure of the circulatory system, EXCEPT upper limbs and toes with MCC 3.1750
05,171 amputation A toe FOR circulatory disorders WITHOUT CC 1.2117 || | 05172 amputation A toe FOR circulatory disorders S CC 1.3029
05,173 amputation A toe FOR circulatory disorders with MCC 1.8852
05181 CONTROL pacemakers and defibrillators, EXCEPT FOR REPLACEMENT OF EQUIPMENT WITHOUT CC 0.9674
05182 CONTROL pacemakers and defibrillators, EXCEPT FOR REPLACEMENT OF EQUIPMENT WITH CC 1.2148
05183 CONTROL pacemakers and defibrillators, EXCEPT FOR REPLACEMENT OF EQUIPMENT WITH MCC 1.9359
05201 OTHER PERFORMANCE IN diseases and disorders of the circulatory system WITHOUT CC 0.9486
05202 OTHER PERFORMANCE IN diseases and disorders of the circulatory system S CC 1.6369
05203 OTHER PERFORMANCE IN diseases and disorders of the circulatory system with MCC 3, 3085
05,221 percutaneous coronary angioplasty,> = 3 film-coated stents in acute myocardial infarction without CC 9.8565
05,222 percutaneous coronary angioplasty,> = 3 film-coated stents in acute myocardial infarction with CC 10.5829 05223 PERCUTANEOUS
coronary angioplasty,> = 3 film-coated stents in acute myocardial infarction with MCC 10.5829
05231 percutaneous coronary angioplasty <= 2 film-coated stents in acute myocardial infarction without CC 5.2097
05232 percutaneous coronary angioplasty <= 2 COATED stents in acute myocardial infarction with CC 5.8352
05,233 percutaneous coronary angioplasty <= 2 film-coated stents in acute myocardial infarction with MCC 6.0637
05241 percutaneous coronary angioplasty,> = 3 uncoated stents in acute myocardial infarction WITHOUT CC 7.2150
05,242 percutaneous coronary angioplasty,> = 3 uncoated stents in acute myocardial infarction with CC 7.6529
05,243 percutaneous coronary angioplasty,> = 3 uncoated stents in acute myocardial infarction with MCC 9.9539 | || 05,261 percutaneous coronary angioplasty,> = 3 COATED STENTS without acute myocardial infarction without CC 8.9033
05,262 percutaneous coronary angioplasty,> = 3 COATED STENTS without acute myocardial infarction CC 9.8071
05263 percutaneous coronary angioplasty > = 3 COATED STENTS without acute myocardial infarction MCC 11.9823
05,271 percutaneous coronary angioplasty <= 2 COATED STENTS without acute myocardial infarction without CC 4.6655
05,272 percutaneous coronary angioplasty <= 2 COATED STENTS without acute myocardial infarction CC 5.0327
05,273 percutaneous coronary angioplasty <= 2 COATED STENTS without acute myocardial infarction MCC 6.0290
05,281 percutaneous coronary angioplasty,> = 3 uncoated STENTS without acute myocardial infarction without CC 6.4633
05,282 percutaneous coronary angioplasty,> = 3 uncoated STENTS without acute myocardial infarction CC 6.7762
05,283 percutaneous coronary angioplasty,> = 3 uncoated STENTS without acute myocardial infarction MCC 8.0162
05291 SELECTIVE PERCUTANEOUS catheter ablation without acute myocardial infarction without CC 7.5377
05,292 SELECTIVE PERCUTANEOUS catheter ablation without acute myocardial infarction CC 7.9889
05293 SELECTIVE PERCUTANEOUS catheter ablation without acute myocardial infarction MCC 8.0393 || | 05301 cardiac catheterization for acute myocardial infarction without CC 0.9252
05302 cardiac catheterization for acute myocardial infarction with CC 1.1722
05,303 cardiac catheterization for acute myocardial infarction with MCC 1.8741
cardiac catheterization IN 05311 coronary heart disease without CC 0.5308
05,312 cardiac catheterization in ischemic heart disease with CC 0.7522
05,313 cardiac catheterization in ischemic heart disease with MCC 0.9014
05321 cardiac catheterization in other disorders of the circulatory system WITHOUT CC 0.6907
05,322 cardiac catheterization in other disorders of the circulatory system S CC 0.9862
05323 cardiac catheterization in other disorders of the circulatory system with MCC 1.4109
05331 acute myocardial infarction without CC 0.5322 || | 05,332 acute myocardial infarction CC 0.8145
05,333 acute myocardial infarction MCC 1.4087
05341 Acute and subacute endocarditis WITHOUT CC 1.2123
05342 Acute and subacute endocarditis S CC 2.0224 || | 05,343 acute and subacute endocarditis with MCC 3.3147
05351 HEART FAILURE WITHOUT CC 0.6523
05352 HEART FAILURE WITH CC 0.7505
05353 HEART FAILURE WITH MCC 1.1227
05361 deep vein thrombosis not CC 0.4582
05362 deep vein thrombosis S CC 0.5266
05363 deep venous thrombosis with MCC 0.6457
05,371 of unexplained cardiac arrest WITHOUT CC 1.3627
05372 unexplained cardiac arrest with CC 1.6676
05,373 of unexplained cardiac arrest with MCC 3.1660
05,381 PERIPHERAL VASCULAR DISORDERS AND OTHER WITHOUT CC 0.4949
05382 Peripheral and other vascular disorders The S CC 0.6034
05,383 PERIPHERAL VASCULAR AND OTHER INCIDENTS WITH MCC 0.7291
05,391 artherosclerosis without CC 0 , 4145
05,392 atherosclerosis CC
0.5651 05,393 0.8565 atherosclerosis MCC
05401 hypertensive CC
0.3481 05,402 0.4275 hypertension with CC
05403 hypertension with MCC 0 , 5823 05,411
congenital heart and valvular disorder without CC 0.4268
05412 Congenital heart and valvular disorder with CC 0.6433 05,413
congenital heart and valvular disorder with MCC 1.2176
05,421 cardiac arrhythmia A conduction disturbances WITHOUT CC 0.4130
05,422 cardiac arrhythmias and conduction disturbances S CC 0.5888
05,423 cardiac arrhythmias and conduction disturbances with MCC 0.8039
05431 angina and chest pain WITHOUT CC 0, 3560
05432 angina and chest pain S CC 0.4593
05433 angina and chest pain with MCC 0.5707
05,441 syncope and collapse of NO CC 0.3598
05,442 syncope and collapse of With CC 0.4715
05443 syncope and collapse of MCC, 0.6548
05451 CARDIOMYOPATHY WITHOUT CC 0.4730
05452 cardiomyopathies with the CC
0.7187 05,453 1.2239 cardiomyopathies with the MCC
05461 FAILURE, AND REACTION Vascular complications of heart OR DEVICES OR PERFORMANCE WITHOUT CC 0.5968
05,462 FAILURE, AND REACTION Vascular complications of heart OR DEVICES OR PERFORMANCE WITH CC 0.8470
05463 FAILURE, AND REACTION Vascular complications of heart OR DEVICES OR PERFORMANCE WITH MCC 0.8470
05471 OTHER circulatory disorders WITHOUT CC 0.4116
05472 OTHER circulatory disorders S CC 0.5656
05473 Other disorders of the circulatory system with MCC 0.7805 05,481
stenting to the peripheral vasculature WITHOUT CC 3.0983
05482 stenting to the peripheral vasculature S CC 3.4008
05,483 stenting to the peripheral vasculature with MCC 4.4106
06011 GREAT PERFORMANCES ON tHICK The small intestine WITHOUT CC 3.2740
06012 Big performance for thick and thin intestine with CC 3.9194
06013 Big performance for thick and thin intestine with MCC 5.8634
06021 high output in the stomach, esophagus A duodenum WITHOUT CC 2.9183
06022 high output in the stomach, esophagus and duodenum S CC 4.3616
06023 high output in the stomach, esophagus and duodenum with MCC 4.4533
06031 less power for thick and thin intestine without CC 1,5617
06032 less power for thick and thin intestine with CC 2.1795
06033 less power for thick and thin intestine with MCC 3.7071
06041 peritoneal adhesions RELEASE NO CC 0.9554
06,042 peritoneal adhesions RELEASE WITH CC 1.1203 06,043
RELEASE adhesions of the peritoneum with MCC 1.4718
06051 performance on appendix WITHOUT CC 0.8574
06052 performance on appendix S CC 1.0564 || | 06053 appendix S performance on MCC 1.4343
06071 LOWER performance on the stomach, esophagus and duodenum WITHOUT CC 1.7107
06,072 less power ON stomach, esophagus and duodenum S CC 2.0925
06073 less power NA stomach, esophagus and duodenum with MCC 2.6807
06081 laparotomy performance at TANNING, thigh, umbilical or epigastric Kyle WITHOUT CC 0.5808
06082 laparotomy performance at TANNING, thigh, umbilical or epigastric Kyle CC 0, 8060
06083 laparotomy performance at TANNING, thigh, umbilical or epigastric Kyle MCC 1.0848 06,091
anal STOMIC performance without CC 0.5257 06,092
anal STOMIC PERFORMANCE WITH CC 0.6475
06093 anal STOMIC of performance with MCC 0.9445
06101 OTHER PERFORMANCE IN disorders and diseases of the digestive system without CC 0.9291
06,102 OTHER PERFORMANCE IN disorders and diseases of the digestive system S CC 1.5043
06103 OTHER PERFORMANCE IN disorders and diseases of the digestive system with MCC 2.6533
06111 performance on appendix AT HOME complicating diagnosis without CC 1.2669
06112 performance on appendix AT HOME complicating diagnoses CC 1.9430 | || 06,113 performance on appendix AT HOME complicating diagnosis with MCC 1.9430
06301 Malignant diseases of the digestive system without CC 0.4698
06,302 Malignant Disorders of the digestive system S CC 0.6105
06,303 Malignant Disorders of the digestive system S MCC 0.8449
06,311 Peptic ulcers and gastritis WITHOUT CC 0.3949
06,312 Peptic ulcers and gastritis S CC 0.6376
06,313 Peptic ulcers and gastritis with MCC 1.0695
06,321 esophagus without DISORDERS CC 0.3646
06,322 DISORDERS esophageal CC 0.5748
06,323 DISORDERS esophageal MCC 0.9514
06331 diverticulitis, diverticulosis, inflammatory bowel disease WITHOUT CC 0.4831
06332 diverticulitis, diverticulosis Inflammatory bowel disease S CC 0.5695
06333 diverticulitis, diverticulosis, inflammatory bowel disease with MCC 1.0721
06341 VASCULAR impairment of the gastrointestinal system without CC 0.6465
06342 VASCULAR impairment of the gastrointestinal system S CC 1.0302
06343 VASCULAR impairment of the gastrointestinal system with MCC 1.4423
06,351 OBSTRUCTION gastrointestinal system without CC 0.3997
06,352 OBSTRUCTION gastrointestinal system S CC 0.5824
06353 OBSTRUCTION gastrointestinal system with MCC 0.9869 | 06361 || Severe infections of the gastrointestinal system without CC 0.8477
06,362 serious infections of the gastrointestinal system S CC 1.0214
06,363 serious infections of the gastrointestinal system with MCC 1.8128
06371 OTHER gastroenteritis and abdominal pain WITHOUT CC 0 , 2656
06372 OTHER gastroenteritis and abdominal pain with CC 0.3752
06,373 OTHER gastroenteritis and abdominal pain with MCC 0.4926
06,381 OTHER disorders of the digestive system without CC 0.2986
06,382 OTHER disorders of the digestive THE S CC 0.4393
06383 Other disorders of the digestive system with MCC 0.6896
07011 operations of the pancreas, liver and coupler CC 3.6183
07012 operations of the pancreas, liver and clutch with CC 4, 7070
07013 operations of the pancreas, liver and clutch with MCC 8.5695
07021 GREAT PERFORMANCES biliary WITHOUT CC 2.5924
07022 GREAT PERFORMANCES biliary S CC 3.4094
07023 GREAT Performance on biliary tract MCC 5.1100
07031 cholecystectomy, Laparoscopic EXCLUDING WITHOUT CC 1.3902
07032 cholecystectomy, Laparoscopic EXCEPT WITH CC 1.9484
07033 cholecystectomy, Laparoscopic EXCEPT WITH MCC 3.5187 || | 07051 OTHER PERFORMANCE IN disorders and diseases hepatobiliary system and pancreas WITHOUT CC 1.5328
07,052 OTHER PERFORMANCE IN disorders and diseases hepatobiliary system and pancreas S CC 2.1029
07,053 OTHER PERFORMANCE IN disorders and diseases hepatobiliary system and pancreas With MCC 3.7810
07301 cirrhosis and alcoholic hepatitis WITHOUT CC 0.5731
07302 cirrhosis and alcoholic hepatitis S CC 0.6949
07303 cirrhosis and alcoholic hepatitis With MCC 1.0112
07,311 MALIGNANCIES hepatobiliary system and pancreas WITHOUT CC 0.5457
07,312 MALIGNANCIES hepatobiliary system and pancreas S CC 0.6912
07,313 MALIGNANCIES hepatobiliary system and pancreas with MCC 0.8102
07,321 DISORDERS pancreatic malignancy EXCEPT FOR FREE CC 0.6920
07,322 DISORDERS pancreatic malignancy EXCEPT WITH CC 0.9334
07,323 DISORDERS pancreatic malignancy EXCEPT WITH MCC 2.0646 07,331
liver disorders, in addition to malignant cirrhosis and alcoholic hepatitis WITHOUT CC 0 , 4965 07,332
liver disorders, in addition to malignant cirrhosis and alcoholic hepatitis S CC 0.6516
07333 liver disorders, in addition to malignant cirrhosis and alcoholic hepatitis With MCC 0.9990
07,341 Other disorders of the biliary tract WITHOUT CC 0.4865
07,342 Other disorders of the biliary tract with CC 0.6678
07,343 OTHER DISORDERS biliary tract with MCC 1.0180
08011 spinal fusions and scoliosis deformities IN NO CC 10.9531 08012
spinal fusion AT deformities and scoliosis S CC 13.5254 08013
spinal fusion AT deformities and scoliosis with MCC 13 , 5254
08031 spinal fusions, NE deformities WITHOUT CC 4.3285
08032 spinal fusion, not for the deformity CC 4.5850
08033 spinal fusion, not for the deformity MCC 6.6406
08051 reconstructive surgery for cranial and facial bones WITHOUT CC 5.0547
08,052 reconstructive surgery for cranial and facial bones with CC 5.0547
08053 reconstructive surgery for cranial and facial bones with MCC 5.9965
08,061 replantation UPPER GREAT PERFORMANCES limbs and their joints without CC 2.9566
08062 GREAT PERFORMANCES upper extremity replantation AND THEIR JOINT WITH CC 3.4289
08063 GREAT PERFORMANCES upper extremity replantation AND THEIR JOINT WITH MCC 4.9591
08,071 amputations DISORDERS musculoskeletal and connective tissue NO CC 1.7207
08072 amputation AT musculo-skeletal disorders and connective tissue S CC 2.1167
08,073 amputations AT musculo-skeletal disorders and connective tissue with MCC 4.2738
performance on 08081 hip and femur, EXCEPT replantation of large joints WITHOUT CC 2.0261 08,082
performance on the hip and femur, EXCEPT replantation of large joints S CC 2.3570
08083 performance on the hip and femur, EXCEPT replantation of large joints S MCC 3.4530
08101 performance on the back of the neck, EXCLUDING MERGER spine without CC 1.3357
08102 performance on the back of the neck, EXCLUDING MERGER WITH SPINAL CC 1.8128
08103 performance on the back of the neck, EXCEPT FOR SPINAL FUSION WITH MCC 2.3462 08,111
performance on knees, legs and hocks, EXCEPT FOR FOOT WITHOUT CC 1.0611 08,112
performance on knees, legs and hocks, EXCEPT WITH FOOT CC 1.2157 08,113
Performance on knees, legs and hocks, EXCEPT WITH FOOT MCC 1.9429
08121 removal of internal fixation devices without CC 0.3900 08,122
removal of internal fixation device S CC 0.4458
08123 removal of internal fixation device S MCC 0.6020 LOCAL
08131 resection of the musculoskeletal system WITHOUT THE CC 0.6595 LOCAL
08132 resection of the musculoskeletal system ON WITH CC 1.0518 LOCAL
08,133 resection of the musculoskeletal system ON WITH MCC 2.1974 08,141
Performance on feet WITHOUT CC 0.5703
08142 performance on the foot with CC 0.6184
08,143 feet with performance on MCC 0.9787
08151 PERFORMANCE upper extremities WITHOUT CC 0.8056
08,152 PERFORMANCE upper extremities S CC 1.1247
08153 Upper extremities performance on MCC, 1.5758
08161 performance on soft tissue without CC 0.5125 08,162
performance on soft tissue with CC 0.7360
08,163 performance on soft tissues with MCC 1.6449
08171 OTHER PERFORMANCE IN disorders and diseases of the musculoskeletal system and connective tissue without CC 0.5509
08,172 OTHER PERFORMANCE IN disorders and diseases of the musculoskeletal system and connective tissue with CC 0.9553
08,173 OTHER PERFORMANCE IN disorders and diseases of the musculoskeletal system and connective tissue with MCC 2.0359
08301 Thigh bone fractures WITHOUT CC 0.5413
08302 Thigh bone fractures S CC 0.6260
08,303 bone fractures THIGH WITH MCC 1.2612
08311 pelvic fractures, dislocations HIP WITHOUT CC 0.5051
08312 pelvic fractures, dislocations of the hip CC 0.5956
08313 pelvic fractures, dislocations of the hip MCC 1, 2579
08,321 fractures, dislocations, EXCEPT femurs and pelvis WITHOUT CC 0.3246
08322 fractures, dislocations, EXCEPT femurs and pelvis S CC 0.4378
08,323 fractures, dislocations, EXCEPT femurs and pelvis with MCC 0.6500
08,331 MALIGNANCIES musculoskeletal and connective tissue disorders, pathological fractures, WITHOUT CC 0,5739
08332 MALIGNANCIES musculoskeletal and connective tissue disorders, pathological fractures CC 0.8445
08,333 MALIGNANCIES musculoskeletal and connective tissue disorders, pathological fractures, MCC, 1.1413
08341 osteomyelitis WITHOUT CC 0.6534
08,342 osteomyelitis S CC 0.8250
08,343 osteomyelitis With MCC 1.6282
08351 septic arthritis without CC 0.8802
08352 septic arthritis CC 0.9937
08353 septic arthritis MCC, 1.9164
08361 connective tissue disorders WITHOUT CC 0.5881
08362 connective tissue disorders S CC 0.7207
08363 connective tissue disorders MCC, 1.3420
08,371 of conservative treatment of back problems WITHOUT CC 0.4241
08,372 of conservative treatment of back problems with CC 0 , 4965 08,373
conservative treatment of back problems with MCC 0.7236
08381 Other diseases of bones and joints WITHOUT CC 0.4240
08,382 other diseases of bones and joints S CC 0.5143
08,383 OTHER DISEASES BONE AND JOINT WITH MCC 0.9399
08,391 FAILURE, reactions and complications of orthopedic DEVICES OR PERFORMANCE WITHOUT CC 0.5155
08,392 FAILURE, reactions and complications of orthopedic DEVICES OR PERFORMANCE SCC 0.6480
08393 FAILURE, REACTION and complications of orthopedic DEVICES OR PERFORMANCE SMCC 1.4792
08401 MUSCULOSKELETAL signs, symptoms, sprains and less significant inflammatory diseases WITHOUT CC 0.3504
08402 MUSCULOSKELETAL signs, symptoms, sprains and less significant inflammatory diseases S CC 0.4687
08403 mUSCULOSKELETAL signs, symptoms, sprains and less significant inflammatory diseases with MCC 0.8512
08,411 Other disorders of the musculoskeletal system and connective tissue without CC 0.3203
08412 Other disorders of the musculoskeletal system and connective tissue S CC 0 , 4879
08,413 Other disorders of the musculoskeletal system and connective tissue with MCC 1.0219
09011 Skin grafts AND / OR WITHOUT debridement CC 0.6432 09,012
skin grafts AND / OR debridement S CC 0.9547 || | 09013 Skin grafts AND / OR debridement with MCC 2.2606
09021 PERFORMANCE breasts WITHOUT CC 0.8987
09022 PERFORMANCE breasts with CC 1.1172
09,023 PERFORMANCE breasts with MCC 1.2539 | || 09031 OTHER PERFORMANCE IN disorders and diseases of the skin, subcutaneous tissue and breast WITHOUT CC 0.4773
09032 OTHER PERFORMANCE IN disorders and diseases of the skin, subcutaneous tissue and breast CC 0.7743
09,033 OTHER DISORDERS AND PERFORMANCE diseases of the skin, subcutaneous tissue and breast MCC 1.2723
09301 SERIOUS DISORDERS SKIN WITHOUT CC 0.7443
09302 SERIOUS INCIDENTS WITH SKIN CC 0.7443
09303 SERIOUS INCIDENTS WITH SKIN MCC 0.9261 || | 09 311 Malignant breast disease WITHOUT CC 0.4403
09312 Malignant breast disease S CC 0.5682
09,313 Malignant breast disease with MCC
0.6987 09,321 0.5097 phlegmone WITHOUT CC
09322 S phlegmone CC
0.6851 09,323 0.9204 phlegmone MCC, 09,331
injury to the skin, subcutaneous tissue and breast WITHOUT CC 0.2325 09,332
injury to the skin, subcutaneous tissue and breast CC 0.3068 09,333
injury to the skin, subcutaneous tissue and breast MCC 0.5512
09,341 OTHER Skin and Cancer without CC 0.3904
09,342 other type of skin and breast S CC 0.5641
09343 other type of skin and breast MCC 0.7644
10011 performance on the adrenal gland and the pituitary gland WITHOUT CC 2.4895
10012 performance on the adrenal gland and the pituitary gland S CC 2.6920
10013 performance on the adrenal gland and the pituitary gland MCC, 4.6155 | 10021 || skin grafts and debridement WOUNDS to endocrine, nutritional and metabolic disorders WITHOUT CC 1.5342
10022 Skin grafts and debridement WOUNDS to endocrine, nutritional and metabolic disorders S CC 1.9745
10023 skin grafts and debridement WOUNDS to endocrine, nutritional and metabolic disorders with MCC 2.8642
10031 PERFORMANCE WITHOUT obesity CC 2.5427
10032 PERFORMANCE FOR oBESITY WITH CC 3.0195
10033 PERFORMANCE FOR oBESITY WITH MCC 11.4603
10,041 lower extremity amputations in endocrine, nutritional and metabolic disorders WITHOUT CC 1.6262
10042 amputations in endocrine, nutritional and metabolic disorders S CC 2.0063
10,043 lower extremity amputations in endocrine, nutritional and metabolic disorders with MCC 3.5973
10051 performance on the thyroid and parathyroid glands, THYROGLOSSÁLNÍ performance without CC 1.1038
10052 performance on the thyroid and parathyroid glands, THYROGLOSSÁLNÍ exercising with CC 1.2607
10053 performance on the thyroid and parathyroid glands, THYROGLOSSÁLNÍ exercising with MCC 1.5583
10061 other performances in endocrine, nutrition and METABOLIC PORUCHÁCHBEZ CC 1.4625
10062 other performances in endocrine, nutritional and metabolic PORUCHÁCHS CC 1.9251
10063 other performances in endocrine, nutritional and metabolic PORUCHÁCHS MCC 4.1708
10301 dIABETES, NUTRITION AND OTHER METABOLIC FAULTS WITHOUT CC 0.4371
10302 dIABETES, NUTRITION AND OTHER metabolic disturbances with CC 0.5291
10303 dIABETES, NUTRITION AND OTHER metabolic disturbances with MCC 0.8410
10311 volume and electrolyte disturbances WITHOUT CC 0, 3865
10312 volume and electrolyte disturbances S CC 0.4283
10313 volume and electrolyte disturbances with MCC 0,5766
10321 inborn errors of metabolism WITHOUT CC 0.4206
10322 inborn errors of metabolism S CC 0, 5547
10323 inborn errors of metabolism with MCC 0.8823
10331 other endocrine disorders WITHOUT CC 0,5736
10332 other endocrine disorders with CC 0,5736
10333 other endocrine disorders with MCC 0.7831 | 11021 || high output in the bladder without CC 4.9977
11022 GREAT PERFORMANCES bladder S CC 5.4633
11023 GREAT PERFORMANCES bladder MCC, 8.1819
11031 high output in the kidneys and urinary tract WITHOUT CC 1.9112
11032 high output in the kidneys and urinary tract With CC 2.1963
11033 high output in the kidneys and urinary tract With MCC 3.4808
11041 dialysis and elimination methods WITHOUT CC 1 , 2671
11042 dialysis and elimination methods S CC 1.5331
11043 dialysis and elimination methods MCC, 3.0871
11051 less power on kidneys, urinary tract and bladder without CC 0.8544
11052 less power on kidneys, urinary tract and bladder S CC 0.9258
11053 less power on kidneys, urinary tract and bladder MCC, 1.4447
11061 PROSTATECTOMY WITHOUT CC 1.0909
11062 PROSTATECTOMY With CC 1.1842
11063 prostatectomy MCC 1.3010
11071 URETHRAL and transurethral performance without CC 0.5160
11072 URETHRAL and transurethral PERFORMANCE WITH CC 0.6240
11073 URETHRAL and transurethral WITH PERFORMANCE MCC 0.7912
11081 OTHER PERFORMANCE IN disorders and diseases kidney and urinary tract WITHOUT CC 0.4954
11082 OTHER PERFORMANCE IN disorders and diseases kidney and urinary tract With CC 0.7708
11083 OTHER PERFORMANCE DISORDERS A kidney and urinary tract With MCC 1.5658
11301 Malignant kidney and urinary tract and kidney failure not CC 0.4209
11302 Malignant kidney and urinary tract and kidney failure with CC 0.5852
11303 Malignant kidney and urinary tract and kidney failure with the MCC 0.9738
11311 nephritis without CC 0.4776
11312 nephritis with CC 0.5553
11313 nephritis with MCC 0.9825
11321 INFECTION kidney and urinary tract WITHOUT CC 0.4137
11322 kidney infection and urinary S CC 0.5302
11323 INFECTION kidney and urinary tract With MCC 0.7862
11331 urinary calculi with extracorporeal shock wave lithotripsy WITHOUT CC 0.3682
11332 urinary calculi With Extracorporeal shock wave lithotripsy S CC 0.5117
11333 urinary calculi with extracorporeal shock wave lithotripsy with MCC 0.5584
11341 urinary calculi ESWL WITHOUT WITHOUT CC 0.2602
11342 urinary calculi ESWL WITHOUT S CC 0.3626
11343 urinary calculi with ESWL WITHOUT MCC 0.6320
11351 FAILURE, REACTION AND COMPLICATIONS GENITOURETRÁLNÍHO INSTRUMENTS, graft or transplant WITHOUT CC 0.2403
11352 FAILURE, REACTION AND COMPLICATIONS GENITOURETRÁLNÍHO INSTRUMENTS, grafts or transplants S CC 0.4774
11353 FAILURE, REACTION AND COMPLICATIONS GENITOURETRÁLNÍHO INSTRUMENTS, graft or transplant MCC, 0.5565
11361 SIGNS AND SYMPTOMS OF THE kidney and urinary tract WITHOUT CC 0.2892
11362 SIGNS And the symptoms to the kidneys and urinary tract With CC 0.3567
11363 SIGNS AND SYMPTOMS OF THE kidney and urinary tract With MCC 0.4685
11371 Other disorders of kidney and urinary tract WITHOUT CC 0.2888
11372 OTHER DISORDERS kidney and urinary tract With CC 0.4062
11373 Other disorders of kidney and urinary tract With MCC 0.7075
12011 GREAT PERFORMANCES IN THE PAN U MEN WITHOUT CC 1.9482
12012 GREAT PERFORMANCES pelvic U MEN WITH CC 1.9917
12013 GREAT PERFORMANCES IN THE PAN male with MCC 2.8852
12021 performance on the penile CC 0.4522
12022 performance on the penis CC 0.6118
12023 PERFORMANCE OF THE pENIS WITH MCC 0.6118
12031 TRANSURETHRAL pROSTATECTOMY WITHOUT CC 0.9410
12032 TRANSURETHRAL prostatectomy CC 1.0370
12033 TRANSURETHRAL prostatectomy MCC 1.3115
12041 testicular PERFORMANCE WITHOUT CC 0.4806
12042 performance on the testicles CC 0.5962
12043 testicles performance on MCC 0.7906
12051 circumcision WITHOUT CC 0.3603
12052 circumcision S CC 0.3823
12053 circumcision MCC, 0.4651
12061 OTHER performance on male reproductive system without CC 0.6132
12062 other performances on the male reproductive system S CC 0.9425
12063 other performances on the male reproductive system with MCC 1 , 4005
12301 Malignant diseases of the male reproductive system WITHOUT CC 0.3276
12302 Malignant diseases of the male reproductive system S CC 0.5173
12303 Malignant diseases of the male reproductive system with MCC 0.7094
12311 male DISORDERS reproductive system EXCEPT malignant ONEMOCNĚNÍBEZ CC 0.2490
12312 DISORDERS male reproductive system EXCEPT malignant ONEMOCNĚNÍS CC 0.3254
12313 DISORDERS male reproductive system EXCEPT malignant ONEMOCNĚNÍS MCC 0.4404
13011 pelvic exenterations, rADICAL radical hysterectomy and vulvectomy WITHOUT CC 2.7509
13012 pelvic exenterations, radical hysterectomy and radical vulvectomy S CC 3.2110
13013 pelvic exenterations, radical hysterectomy and radical vulvectomy MCC, 3.6068
13021 performance on the uterus A adnexal for malignant disease ovarian adnexal AND WITHOUT CC 1.7212
13022 PERFORMANCE the uterus and adnexal malignant diseases ovarian adnexal S CC 2.2918
13023 PERFORMANCE the uterus and adnexal malignant ovarian diseases adnexal With MCC 3.2750
13031 PERFORMANCE the uterus and adnexa in malignancy other than ovarian adnexal AND WITHOUT CC 1.6537
13032 PERFORMANCE the uterus and adnexa in malignancy other than the ovaries and the adnexal S CC 1 , 9614
13033 PERFORMANCE the uterus and adnexa in malignancy other than the ovaries and the adnexal MCC, 2.7509
13041 uterine adnexal A performance at CA in situ and benign diseases without CC 1.1722
uterine 13042 A adnexal performance at CA in situ and benign diseases with CC 1.3283
13043 uterine adnexal A performance at CA in situ and benign diseases with MCC 1.4585
13051 Gynecological laparoscopy or laparotomy sterilization without CC 0.5347
13052 Gynecological laparoscopy or laparotomy sterilization CC 0.7605 || | 13053 Gynecological laparoscopy or laparotomy sterilization MCC 0.9155
13061 Reconstructive surgery of the female reproductive system without CC 0.8958
13062 Reconstructive surgery of the female reproductive system S CC 1.0582
13063 reconstructive surgery on female With MCC's reproductive system 1.2296
13071 vaginal, cervical and VULVOVÉ performance without CC 0.3005
13072 vaginal, cervical and VULVOVÉ PERFORMANCE WITH CC 0.4167
13073 vaginal, cervical and VULVOVÉ PERFORMANCE WITH MCC 0 , 4167
13081 ENDOSCOPIC WITHOUT INTERRUPTION fallopian tubes CC 0,5756
13,082 ENDOSCOPIC INTERRUPTION fallopian tubes S CC 0.6161
13083 ENDOSCOPIC INTERRUPTION fallopian tubes with MCC 0.6388
13101 OTHER PERFORMANCE IN disorders and diseases of the female reproductive systems without CC 0.8941
13102 OTHER PERFORMANCE IN disorders and diseases of female reproductive system S CC 1.1500
13103 OTHER PERFORMANCE IN disorders and diseases of female reproductive system with MCC 2.2083
13301 MALIGNANCIES female reproductive systems without CC 0.3902
13302 Malignant Disorders of the female reproductive system S CC 0.5022
13303 Malignant Disorders of the female reproductive system with MCC 0.7639
13311 INFECTION female reproductive system WITHOUT CC 0.2874
13312 INFECTION female reproductive system S CC 0.4048
13313 INFECTION female reproductive system with MCC 0.7323
13321 menstrual and other disorders of the female reproductive system WITHOUT CC 0.1853
13322 menstrual and other disorders of the female reproductive system With CC 0.2893
13323 menstrual and other disorders of the female reproductive system with MCC 0.4287
14601 caesareans WITHOUT CC 0.9802
14602 caesareans S CC 1.1486
14603 cHILDBIRTH caesarean With MCC 1.2543
14611 vaginal delivery with sterilization AND / OR dilatation and curettage without CC 0.6261
14612 vaginal delivery with sterilization AND / OR dilation and curettage S CC 0,6959
14613 VAGINAL cHILDBIRTH sterilisations AND / OR dilation and curettage with MCC 0.9103
14621 vaginal deliveries enforcement, other than sterilization and / OR dilatation and curettage without CC 0.8637
14,622 vaginal deliveries enforcement, other than STERILISATION AND / OR dilation and curettage S CC 1.2136
14,623 vaginal deliveries enforcement, other than sterilization and / OR dilation and curettage with MCC 4.2071
14631 vaginal birth WITHOUT CC 0.4350
14,632 vaginal deliveries CC 0 , 4836
14633 vaginal deliveries MCC 0.4836
14641 abortion with dilatation and curettage, aspiration curettage OR HYSTEROTOMIÍBEZ CC 0.2325 14,642
abortion with dilatation and curettage, aspiration curettage OR HYSTEROTOMIÍS CC 0.2716 | 14643 || abortion with dilatation and curettage, aspiration curettage OR HYSTEROTOMIÍS MCC 0.2716
14651 an abortion without the dilation and curettage, aspiration curettage HYSTERECTOMY OR WITHOUT CC 0.1230
14652 an abortion without the dilation and curettage, aspiration curettage OR HYSTERECTOMY With CC 0.2177
14653 an abortion without the dilation and curettage, aspiration curettage and hysterectomy with MCC OR 0.4866
14661 postpartum or POPOTRATOVÉ diagnoses performance without CC 0.2318
14662 postpartum POPOTRATOVÉ AND DIAGNOSIS WITH POWER S CC 0.3818
A POPOTRATOVÉ 14663 postnatal diagnoses of performance with MCC 0.8205
14671 postpartum or POPOTRATOVÉ diagnosis without power without CC 0.1840
14672 postpartum or POPOTRATOVÉ diagnosis without power S CC 0.5259 | || 14673 postpartum or POPOTRATOVÉ diagnosis without exercising with MCC 0.7813
14681 ectopic pregnancy S PERFORMANCE WITHOUT CC 0.9538
14682 ectopic pregnancy with the performance of S CC 1.0439
14683 ectopic pregnancy with the performance of MCC, 1.0439
14691 ectopic pregnancy WITHOUT EXERCISE WITHOUT CC 0.3361
14692 ectopic pregnancy WITHOUT EXERCISE WITH CC 0 , 6337
14693 ectopic pregnancy WITHOUT EXERCISE WITH MCC 1.4082
14701 threatened abortion WITHOUT CC 0.2749
14702 threatened abortion S CC 0.3961
14703 threatened abortion with MCC 0.3961 || | 14711 FAKE birth without CC 0.1316
14712 FAKE births CC 0.1635
14713 FAKE BIRTH WITH MCC 0.2240
14721 OTHER prenatal diagnoses performance without CC 0.2892
14722 OTHER antenatal diagnosis with exercising with CC 0.5772
14723 OTHER prenatal diagnoses of performance with MCC 0.6105
14731 OTHER prenatal diagnosis without power without CC 0.2301
14732 OTHER prenatal diagnosis without power S CC 0,
3386 14733 OTHER prenatal diagnosis without exercising with MCC 0.4206
15601 newborn dead or translated <= 5 days without CC 0.2051
15602 newborn dead or translated <= 5 days with CC 0, 4294
15603 newborn dead or translated <= 5 days with MCC 0.6055
15611 newborn, with organ or extracorporeal membrane oxygenation WITHOUT CC 9.3056
15612 newborn, with organ or extracorporeal membrane oxygenation With CC 13.0304
15613 newborn, with organ or extracorporeal membrane oxygenation MCC, 15621 20.7049
newborn weight at birth <= 1000G, basic performance without CC 54.7340
15622 newborn, weight at birth <= 1000G, SE baseload S CC 54.7340
15623 newborn weight at birth <= 1000G, basic exercising with MCC 54.7340
15631 newborn weight at birth <= 1000G, WITHOUT BASIC PERFORMANCE WITHOUT CC 11.5664
15632 newborn weight at birth <= 1000G, WITHOUT ESSENTIAL PERFORMANCE WITH CC 24.8619
15633 newborn weight at birth <= 1000G, WITHOUT ESSENTIAL PERFORMANCE WITH MCC 36.3792 | 15641 || newborn weight at birth 1000-1499G, basic performance without CC 18.3537
15642 newborn weight at birth 1000-1499G, SE baseload S CC 18.3537
15643 newborn weight at birth 1000-1499G, SE baseload MCC, 15651 33.8645
newborn weight at birth 1000-1499G WITHOUT baseload BEZCC 8.9283
15652 newborn weight at birth 1000-1499G, WITHOUT ESSENTIAL PERFORMANCE WITH CC
15653 11.9210 newborn weight at birth 1000-1499G, WITHOUT ESSENTIAL PERFORMANCE WITH MCC 17.2701
15661 newborn weight at birth 1500-1999G, basic performance without CC 15.9195
15662 newborn , weight at birth 1500-1999G, SE baseload S CC 15.9195
15663 newborn weight at birth 1500-1999G, basic exercising with MCC 23.3690
15671 newborn weight at birth 1500-1999G, WITHOUT baseload BEZCC 3.6252
15672 newborn weight at birth 1500-1999G, WITHOUT ESSENTIAL PERFORMANCE WITH CC 5.5238
15673 newborn weight at birth 1500-1999G, WITHOUT ESSENTIAL PERFORMANCE WITH MCC 7.9346 | 15681 || newborn weight at birth 2000-2499G, basic performance without CC 14.2082
15682 newborn weight at birth 2000-2499G, SE baseload S CC 14.4461
15683 newborn weight at birth 2000-2499G, SE baseload MCC, 15691 23.6192
newborn weight at birth 2000-2499G WITHOUT baseload BEZCC 0.7465
15692 newborn weight at birth 2000-2499G, WITHOUT ESSENTIAL PERFORMANCE WITH CC 2.1226
15693 newborn weight at birth 2000-2499G, WITHOUT ESSENTIAL PERFORMANCE WITH MCC 4.3172
15701 newborn weight at birth> 2499G, basic performance without CC 6.6764
15702 newborn, WEIGHT childbirth> 2499G, SE baseload S CC 6.6764
15703 newborn weight at birth> 2499G, SE baseload MCC, 17.5622
15711 newborn weight at birth> 2499G, with a serious anomaly or hereditary condition without CC 0.4008
15712 newborn weight at birth> 2499G, with a serious anomaly or hereditary condition with CC 0.8429
15713 newborn weight at birth> 2499G, with a serious anomaly or hereditary condition with MCC 4.3205
15720 newborn weight at birth> 2499G, SE respiratory distress syndrome 3.5853
15731 newborn weight at birth> 2499G, With the aspiration syndromes without CC 0.5579
15732 newborn weight at birth> 2499G, with aspiration syndrome and CC 1.4160
15733 newborn weight at birth> 2499G, with aspiration syndrome, with MCC 4.1822 || | 15741 newborn weight at birth> 2499G, with congenital or perinatal infection WITHOUT CC 0.8619
15742 newborn weight at birth> 2499G, with congenital or perinatal infection with CC 0.8619
15743 newborn weight at childbirth> 2499G, with congenital or perinatal infection with MCC 3.0088
15751 newborn weight at birth> 2499G, without basic performance without CC 0.2815
15752 newborn weight at birth> 2499G, WITHOUT PARENT WITH PERFORMANCE CC 0.3404
15753 newborn weight at birth> 2499G, WITHOUT ESSENTIAL PERFORMANCE WITH MCC 0.8483
18011 performance for infectious and parasitic diseases WITHOUT CC 0.7653
18012 performance for infectious and parasitic diseases S CC 3.2022
18013 performance for infectious and parasitic diseases with the MCC 6.7357
18021 performance for postoperative and posttraumatic infection without CC 1.1659
18022 performance for postoperative and posttraumatic INFECTION WITH CC 1.7912 | || 18023 performance for postoperative and posttraumatic INFECTION WITH MCC 3.8982
18301 septicemia in CC 0.9066
18302 septicemia S CC 1.1622
18303 septicemia With MCC 2.1446
18311 POST A posttraumatic infection without CC 0.6465
18312 postoperative and posttraumatic INFECTION WITH CC 0.7868
18313 postoperative and posttraumatic INFECTION WITH MCC 1.4133
18321 fever of unknown origin WITHOUT CC 0.4193
18322 FEVER of unknown origin with CC 0.6027
18323 fever of unknown origin with MCC 0.7830
18331 VIRAL DISEASES WITHOUT CC 0.3805
18332 viral infection CC 0.5023
18333 viral infection MCC 0 , 6581
18341 for other infectious and parasitic diseases WITHOUT CC 0.5627
18342 for other infectious and parasitic diseases S CC 0.7838
18343 other infectious and parasitic diseases with the MCC 1.4088
20301 MALICIOUS USE ALCOHOL, dRUGS, dRUGS, dependence on them, RELEASE RECOMMENDATIONS TO DOCTORS WITHOUT CC 0.1210
20302 harmful use of alcohol, medicines, drugs, addiction to them RELEASE against the advice of doctors with CC 0.1210
20303 MALICIOUS USE ALCOHOL, dRUGS, dRUGS, dependence on them, RELEASE against the advice of doctors with a MCC 0.2475
20311 addictions to drugs and alcohol rehabilitation AND / OR DETOX THERAPY WITHOUT CC 1.1296
20312 addiction to drugs and alcohol with rEHABILITATION AND / OR DETOX THERAPY WITH CC 1.1296
20313 addictions to drugs and alcohol rehabilitation AND / OR DETOX THERAPY WITH MCC 1.1296
20321 harmful use and addiction to opiates and / or cocaine WITHOUT CC 0, 5057
20322 harmful use and addiction to opiates and / or cocaine S CC 0.6615
20323 harmful use and addiction to opiates and / or cocaine with MCC 1.1987
20331 damaging use of and dependence on alcohol WITHOUT CC 0.3296
20332 harmful use and alcohol dependence S CC 0.3967
20333 harmful use and alcohol dependence with MCC 0.7804
20341 MALICIOUS USE OF AND RELIANCE ON OTHER DRUGS WITHOUT CC 0.5507
20342 MALICIOUS USE OF AND RELIANCE ON OTHER DRUGS WITH CC 0.6897
20343 MALICIOUS USE OF AND RELIANCE ON OTHER DRUGS WITH MCC 1.2972
23011 OPERATING PERFORMANCE diagnosed with ANOTHER contact with health services without CC 0.6995
23012 OPERATING PERFORMANCE diagnosed with ANOTHER contact with health services S CC 1.4225
23013 OPERATING PERFORMANCE diagnosed with ANOTHER contact with the health service with MCC 4.0078
23301 REHABILITATION WITHOUT CC 0.9939
23302 REHABILITATION WITH CC
1.0911 23,303 1.1902 rehabilitation MCC
23311 symptoms and abnormal finding without CC 0.3391
23312 symptoms and abnormal findings relating CC 0.4818
23313 symptoms and abnormal findings, With MCC 0.5718
23321 OTHER FACTORS AFFECTING MEDICAL CONDITION WITHOUT CC 0.2363
23322 other factors affecting the health status with CC 0.4496
23323 other factors affecting the health status with MCC 1.0167
EXTENSIVE 88,871 performances that are not related to the main diagnosis WITHOUT CC 0.9956
88,872 EXTENSIVE performance that are not related to the main diagnosis S CC 2.0358
88,873 EXTENSIVE performance that are not related to the main diagnosis with MCC 4.2478 || | 88881 prostatic performance that are not related to the main diagnosis WITHOUT CC 2.0190
88,882 prostatic performance that are not related to the main diagnosis S CC 3.2408
88883 prostatic performance that are not related to the main diagnosis with MCC 5.0870 | || 88891 PERFORMANCE limited extent, unrelated to principal diagnosis WITHOUT CC 0.5826
88,892 PERFORMANCE limited extent, unrelated to principal diagnosis S CC 1.0843
88,893 PERFORMANCE limited extent, unrelated to principal diagnosis with MCC 1.9506
99,980 primary diagnoses INVALID TO DISCHARGE DIAGNOSIS 0.1100 0.1100
99990 classified ----------- ------------------------------------------------------------------------------------------------------- --------------------
Annex 11
Groups related to diagnosis by Klasifikace4) allocated from the settlement of a case-by fee
--------- -------------------------------------------------------------------------------------------------------- ------------------
IR-DRG-4) Name of Index 2012 ---------
-------------------------------------------------------------------------------------------------------- ------------------
00011 HEART TRANSPLANT AND / OR LUNG WITHOUT CC 25.1659
00012 HEART TRANSPLANT AND / OR LUNG S CC 26.1580
00013 HEART TRANSPLANT AND / OR LUNG WITH MCC 37.8522
00021 Liver transplantation WITHOUT CC 15.6351
00022 liver transplant S CC 16.6286
00023 Liver transplantation The MCC 35.7177
00031 allogeneic bone marrow transplantation WITHOUT CC 19.5153
00032 allogeneic bone marrow transplantation with CC 19.7984
00033 allogeneic bone marrow transplantation with MCC 28.6868
00070 LONG mechanical ventilation for> 1,008 hours (more than 43 days) with a heart transplant, lung, 97.2640
Liver, bone marrow
00141 autologous bone marrow transplantation WITHOUT CC 3.3697
00142 autologous bone marrow transplantation with CC 3.3697
00143 autologous bone marrow transplantation with MCC 8.8331
00151 SEPARATION OF BONE MARROW WITHOUT CC 1.5074
00152 SEPARATION OF BONE MARROW S CC 2.4943
00153 SEPARATION bone marrow MCC 3.6624
00161 early rehabilitation after injury or disease of spinal cord with economic SEVERE performance without CC 6.2386
00162 early rehabilitation after injury or disease Spinal Cord ECO POWER WITH SEVERE CC 6.2386
00163 early rehabilitation after injury or disease Spinal Cord ECO POWER WITH SEVERE MCC 16.2219
00171 early rehabilitation after injury or disease of spinal cord WITHOUT CC 5.9596
00172 early rehabilitation after injury or disease Spinal Cord CC 5.9596
00173 early rehabilitation after injury or disease Spinal Cord MCC 5.9596
03100 cochlear implant 23.0389
08,091 skin grafting or tissue for musculo-skeletal disorders SYSTÉMUNEBO connective tissue EXCEPT 0.6624
HAND WITHOUT CC
08,092 skin grafting or tissue for musculo-skeletal disorders SYSTÉMUNEBO connective tissue EXCEPT 1.4830
HAND WITH CC
08093 skin grafting or tissue for musculo-skeletal disorders SYSTÉMUNEBO connective tissue EXCEPT 4.5582
HAND WITH MCC
11011 KIDNEY TRANSPLANTATION WITHOUT CC 7.3443
11012 renal transplant CC 7.3443
11013 renal transplant MCC 8.4571
16011 PERFORMANCE spleen WITHOUT CC 2.3503
16012 Performance on spleen CC 2.9515
16013 performance on MCC spleen 3.2927
16021 OTHER PERFORMANCE FOR BLOOD DISEASES AND WITHOUT CC-forming organs 0.6162
16022 OTHER PERFORMANCE FOR BLOOD DISEASE AND TO forming organs S CC 0.8421
16023 OTHER PERFORMANCE FOR BLOOD DISEASE AND TO forming organs MCC, 1.5841
16301 agranulocytosis WITHOUT CC 0.6786
16302 agranulocytosis S CC 1.0577
16303 agranulocytosis with MCC 1.3797
16311 clotting disorder WITHOUT CC 0.6344
16312 coagulation disorders S CC 0.7161
16313 clotting disorders with MCC 1.1335
16321 sickle cell anemia WITHOUT CC 0.4544
16322 Sickle Cell Anemia with CC 0.4544
16323 Sickle Cell Anemia with MCC 0.4544
16331 RED CELL DISORDERS, EXCEPT Sickle Cell Anemia WITHOUT CC 0.6027
16332 RED CELL DISORDERS, EXCEPT Sickle Cell Anemia With CC 0.7380
16333 RED CELL DISORDERS, EXCEPT Sickle Cell Anemia With MCC 0.9687
16341 Other disorders of blood and blood-forming organs without CC 0.5013
16342 Other disorders of blood forming organs A S CC 0.6955
16343 Other disorders of blood and blood-forming AUTHORITIES MCC 1.0039
17011 Lymphoma and leukemia HIGH PERFORMANCE WITHOUT CC 1.1528
17012 Lymphoma and leukemia with high performance S CC 2.3407
17013 Lymphoma and leukemia with high performance with MCC 5.5698
17021 LEUKEMIA AND LYMPHOMA WITH ANOTHER PERFORMANCE WITHOUT CC 3.6685
17022 LEUKEMIA AND LYMPHOMA WITH ANOTHER POWER S CC 3.6685
17023 LEUKEMIA AND LYMPHOMA WITH ANOTHER PERFORMANCE WITH MCC 6.6897
17031 myeloproliferative disorders, and poorly differentiated tumors with high performance WITHOUT CC 1.5208
17032 myeloproliferative disorders, and poorly differentiated tumors with high performance S CC 2.8235
17033 myeloproliferative disorders, and poorly differentiated tumors with high performance with MCC 4.6291
17041 myeloproliferative disorders, and poorly differentiated tumors WITH ANOTHER PERFORMANCE WITHOUT CC 1.0689
17042 myeloproliferative disorders, and poorly differentiated tumors with different power S CC 1.8798
17043 myeloproliferative disorders, and poorly differentiated tumors with different power with MCC 3.5491
17301 Acute leukemia WITHOUT CC 0.8112
17302 Acute leukemia S CC 0.9570
17303 Acute leukemia with MCC 2.0529
17311 LEUKEMIA LYMPHOMA A non-acute WITHOUT CC 0.8635
17312 lymphoma, and non-acute leukemia with CC 1.3554
17313 lymphoma, and non-acute leukemia with MCC 1.8733
17321 RADIATION THERAPY WITHOUT CC 1.2552
17322 radiotherapy CC 1.6804
17323 radiotherapy MCC 2.3723
17331 chemotherapy without CC 0.6824
17332 chemotherapy with CC 0.6824
17333 chemotherapy with MCC 0.8171
17341 OTHER myeloproliferative disorders and the diagnosis of undifferentiated tumor without CC 0.5696
17342 OTHER myeloproliferative disorders and the diagnosis of undifferentiated tumors with CC 0.6940
17343 OTHER myeloproliferative disorders and the diagnosis of undifferentiated tumors with MCC 0.9732
17351 chemotherapy for acute leukemia WITHOUT CC 0.9015
17352 chemotherapy for acute leukemia with CC 1.0958
17353 chemotherapy for acute leukemia with MCC 6.6935
19011 operational performance with the main diagnosis of a mental disease without CC 1.3036
19012 surgical techniques, primary diagnosis MENTAL ILLNESS WITH CC 1.7774
19013 surgical techniques, primary diagnosis MENTAL ILLNESS WITH MCC 5.7596
19301 schizophrenia without CC 1.5114
19302 schizophrenia CC 1.5114
19303 schizophrenia MCC 2.7376
19311 psychosis WITHOUT CC 1.2315
19312 psychosis with CC 1.2315
19313 psychosis with the MCC 2.5704
19321 personality disorders and moods without CC 0.9164
19322 personality disorder and mood with CC 0.9253
19323 personality disorder and mood with MCC 2.1773
19331 BIPOLAR DISORDER WITHOUT CC 1.4972
19332 bipolar disorder with CC 1.4972
19333 bipolar disorder with MCC 2.6224
19341 depression without CC 0.9175
19342 DEPRESSION WITH CC 1.1392
19343 DEPRESSION WITH MCC 2.2441
19351 acute reactions, psychosocial disorders and neuroses depressive EXCLUDING WITHOUT CC 0.5845
19352 acute reactions, psychosocial disorders and neuroses EXCEPT depressive S CC 0.5845
19,353 acute reactions, psychosocial disorders and neuroses depressive EXCEPT WITH MCC 1.2016
19361 organic mental disorders and mental retardation WITHOUT CC 0.7160
19,362 organic mental disorders and mental retardation S CC 0.7160
19363 organic mental disorders and mental retardation with MCC 1.0420
19371 DEVELOPMENT WITHOUT MENTAL DISORDERS CC 0.8336
19372 DEVELOPMENT WITH MENTAL DISORDERS CC 0.8336
19373 DEVELOPMENT WITH MENTAL DISORDERS MCC 1.0009
19381 NUTRITION compulsive disorder without CC 2.0551
19382 NUTRITION compulsive disorder with CC 2.0551
19383 NUTRITION compulsive disorder with MCC 3.2679
19391 OTHER MENTAL DISORDERS WITHOUT CC 0.4989
19,392 OTHER MENTAL DISORDERS With CC 0.5485
19393 OTHER MENTAL DISORDERS With MCC 1.5960
21011 microvascular tissue transfer or a skin graft for injuries without CC 1.3337
21012 microvascular tissue transfer or a skin graft injury with a CC 2.3739
21013 microvascular tissue transfer or a skin graft in accidents with MCC 7.1876
21021 other procedures for injuries and complications WITHOUT CC 1.2436
21022 other procedures for injuries and complications CC 2.2372
21023 other procedures for injuries and complications with MCC 5.1512
Injuries to 21301 for unspecified place or in more places CC 0.5782
Injuries to 21302 for unspecified site or at multiple sites with CC 0.8812
Injuries to 21303 for unspecified site or at multiple sites with MCC 3.6246
21311 ALLERGY WITHOUT CC 0.2008
21312 allergic reactions with CC 0.2491
21313 allergic reactions with MCC 0.3214
21321 poisoning and toxic effects of drugs (DRUG) NO CC 0.2948
21322 poisoning and toxic effects of drugs (Drugs), S CC 0.4900
21323 poisoning and toxic effects of drugs (drugs) With MCC 1.1931
21331 COMPLICATIONS IN TREATMENT WITHOUT CC 0.2594
21332 COMPLICATIONS IN TREATMENT WITH CC 0.4042
21333 COMPLICATIONS IN TREATMENT WITH MCC 1.1010
21341 SYNDROME abused child or adult WITHOUT CC 0.4494
21342 SYNDROME abused child or an adult with CC 1.6498
21343 SYNDROME abused child or an adult with MCC 4.5941
21351 Other diagnoses Injury, poisoning and toxic effects of NO CC 0.2696
21,352 new diagnoses Injury, poisoning and toxic effects of S CC 0.4179
21353 Other diagnoses Injury, poisoning and toxic effects with MCC 1.2139
22501 BURNS transferred to another acute care facility WITHOUT CC 0.3046
22502 BURNS transferred to another acute care facility with CC 0.3046
22503 BURNS transferred to another acute care facility with MCC 0.3046
22510 severe burns with skin grafts 5.3522
On small 22521 BURNS THROUGH entire skin, skin grafts or inhale. Injury without CC 1.9184
On small 22522 BURNS THROUGH entire skin, skin grafts or inhale. With injuries CC 3.9645
On small 22523 BURNS THROUGH entire skin, skin grafts or inhale. With injuries MCC 7.6972
22530 WITHOUT extensive burns skin graft 1.3026
22541 BURNS limited scope covering all layers of skin, skin graft OR WITHOUT inhaled 0.7014
INJURY NOT CC
22542 BURNS limited scope covering all layers of skin, skin graft OR WITHOUT inhaled 0.8914
Injuries with CC
22543 BURNS limited scope covering all layers of skin, skin graft OR WITHOUT inhaled 3.4641
Injuries with MCC
22551 BURNS limited scope nonvertebral all skin layers WITHOUT CC 0.4898
22552 BURNS limited scope nonvertebral all skin layers with CC 0.9362
22553 BURNS limited scope nonvertebral all skin layers with MCC 1.7097
24010 HIV with performances, with several severe infections with HIV associated 0.9874
24020 HIV S PERFORMANCE, WITH OTHER ASSOCIATED WITH HIV diagnoses 1.1562
24031 HIV with power, without an additional diagnosis of HIV-associated WITHOUT CC 0.3577
24032 HIV with power, without an additional diagnosis of HIV-associated S CC 0.3577
24033 HIV with power, without an additional diagnosis of HIV associated with the MCC 0.3577
24301 HIV patients with ventilation or nutritional support without CC 1.7321
24302 HIV patients with ventilation or nutritional support with a CC 1.9066
With 24,303 HIV ventilating or nutritional support MCC, 4.8940
24311 HIV with other medical conditions associated with HIV, released through medical referrals WITHOUT CC 0.1349
24312 HIV with other medical conditions associated with HIV, RELEASED THROUGH MEDICAL ADVICE S CC 0.1349
24313 HIV with other medical conditions associated with HIV, RELEASED THROUGH MEDICAL ADVICE WITH MCC 0.1349
24320 HIV MULTI severe infections with HIV associated 0.5171
24331 HIV with other medical conditions associated with HIV, WITHOUT several serious infections associated with HIV, with 4.6813
Tuberculosis WITHOUT CC
24,332 HIV diagnoses WITH OTHER ASSOCIATED WITH HIV, WITHOUT several serious infections associated with HIV, with 4.6813
Tuberculosis CC
24333 HIV with other medical conditions associated with HIV, WITHOUT several serious infections associated with HIV, with 4.6813
Tuberculosis MCC
24341 HIV with other medical conditions associated with HIV, WITHOUT several serious infections associated with HIV, WITHOUT 0.6939
TUBERCULOSIS WITHOUT CC
24,342 HIV diagnoses WITH OTHER ASSOCIATED WITH HIV, WITHOUT several serious infections associated with HIV, WITHOUT 0.6939
Tuberculosis CC
24343 HIV with other medical conditions associated with HIV, WITHOUT several serious infections associated with HIV, WITHOUT 0.8274
Tuberculosis MCC
24350 HIV without additional diagnosis of HIV-associated 1.0693
25011 craniotomy, high output in the spine, hips and ends. In multiple serious TRAUMA WITHOUT CC 3.8927
25012 craniotomy, high output in the spine, hips and ends. In multiple serious trauma CC 3.8927
25013 craniotomy, high output in the spine, hips and ends. In multiple serious trauma MCC 7.3516
25021 Other feats in multiple serious TRAUMA WITHOUT CC 3.1578
25,022 other performances in multiple serious trauma CC 3.1578
25023 Other feats in multiple serious trauma MCC 5.6460
25030 long-term mechanical ventilation in polytrauma> 1008 hours (more than 43 days) with ECO 63.2752
ROUGH POWER
25040 long-term mechanical ventilation in polytrauma> 504 hours (22-42 days) with ECO ROUGH 37.7250
PERFORMANCE
25051 long-term mechanical ventilation in polytrauma> 240 hours (11 to 21 days) with ECO ROUGH 19.0766
Power without CC
25052 long-term mechanical ventilation in polytrauma> 240 hours (11 to 21 days) with ECO ROUGH 22.2583
PERFORMANCE WITH CC
25053 long-term mechanical ventilation in polytrauma> 240 hours (11 to 21 days) with ECO ROUGH 24.5104
PERFORMANCE WITH MCC
25061 long-term mechanical ventilation in multiple trauma craniotomy with> 96 hours without CC 13.8626
25062 long-term mechanical ventilation in multiple trauma craniotomy S> 96 HOURS WITH CC 13.8626
25063 long-term mechanical ventilation in multiple trauma craniotomy S> 96 HOURS WITH MCC 13.8626
25071 long-term mechanical ventilation in polytrauma> 96 hours (5-10 days) with economic ROUGH 15.1210
Power without CC
25072 long-term mechanical ventilation in polytrauma> 96 hours (5-10 days) with economically ROUGH 15.1210
PERFORMANCE WITH CC
25073 long-term mechanical ventilation in polytrauma> 96 hours (5-10 days) with economically ROUGH 16.9350
PERFORMANCE WITH MCC
25301 RELATING TO THE DIAGNOSIS head, chest and lower extremities in multiple serious TRAUMA WITHOUT CC 0.8649
25302 RELATING TO THE DIAGNOSIS head, chest and lower extremities in multiple serious trauma CC 0.8649
25303 RELATING TO THE DIAGNOSIS head, chest and lower extremities in multiple serious trauma MCC 1.7024
25311 OTHER diagnosis of multiple SERIOUS TRAUMA WITHOUT CC 0.9391
25312 OTHER SERIOUS diagnosis of multiple trauma CC 0.9391
25313 OTHER SERIOUS diagnosis of multiple trauma MCC 0.9391
25320 long-term mechanical ventilation in polytrauma> 1008 hour (MORE THAN 43 DAYS) 45.0809
25,330 long-term mechanical ventilation in polytrauma> 504 hours (22-42 DAYS) 28.5470
25341 long-term mechanical ventilation in polytrauma> 240 hours (11 to 21 days) without CC 8.0438
25,342 long-term mechanical ventilation in polytrauma> 240 hours (11 to 21 days) with CC 14.4810
25343 long-term mechanical ventilation in polytrauma> 240 hours (11 to 21 days) with MCC 15.1345
25361 long-term mechanical ventilation in polytrauma> 96 hours (5-10 days) without CC 8.2376
25,362 long-term mechanical ventilation in polytrauma> 96 hours (5-10 days) with CC 8.2376
25363 long-term mechanical ventilation in polytrauma> 96 hours (5-10 days) with MCC 8.2376
25370 DEATH IN 5 DAYS FROM RECEIPT FOR polytrauma 2.6616 ---------
-------------------------------------------------------------------------------------------------------- ------------------
Annex 12
The amount of healthcare payments pursuant to § 8. 2
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
Code Performance Regulatory restrictions above
payment
------ ---------------------------------------- ------------------------ -------------------------- ------------------------------------- -------------
00900 --------- Comprehensive examination by a dentist when you register at the registration Lzevykázat insured policyholder newly adopted CZK 398
Examination of the state of the teeth, periodontal tissue, mucous membranes and soft tissues of care, ie. The code 00900 can not be reported if the
the oral cavity, the state of the jaws and jaw relationships, medical history in the ZZ were on the patient in the past two years
and treatment plan under the care of covered health care regularly recognized codes - codes 00901 00902,
Insurance Company (hereinafter referred to as "LC"). Founding documents are recorded, respectively. 00946 and 00,947th in the same calendar year can code
the state of the teeth, periodontal mucosal and soft tissues, including 00,900 combined only with code 00901, respectively. 00,946th
cancer screening, jaw relationships, history and plan of combination codes 00900 and 00901, respectively. 00946 can not be
treatment. Checking and practicing oral hygiene, interdental reported in one calendar quarter, between
hygiene, massage, tartar removal (regardless of individual investigations in the recommended way
embodiment) including conventional treatment of inflammation affections and adhere interval 5 months, in justified
gingiva and oral mucosa, periodontal tissue (periodontal cases, if the patient's condition requires
abscess, the treatment of mouth ulcers, pressure ulcers or herpes caused perform tests earlier, is reported with less
dentures etc.), treatment regardless dentitio difficilis spacing which shall not be less than three months.
the number of visits. Topical application of fluoride using Expertise 014
products under Annex no. 1 of Law No. 48/1997 Coll.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00901 Repeated comprehensive examination and treatment of registered Lzevykázat 2/1 calendar year per insured within 368 CZK
insured - preventive examinations of individual preventive dental care for children and adolescents,
Examination of the state of the teeth, periodontal tissue, mucous membranes and soft tissues 1 / 1kalendářní year insured under preventive
mouth, jaws and state jaw relationships, histories care for adults, twice during pregnancy, among
and treatment plan under the care paid medical examinations in pregnant must pass at least 3
Insurance Company (hereinafter referred to as "LC"). Checking and practicing oral hygiene, měsíce.U children and adolescents can be reported combined codes
interdental hygiene, massage, removal of tartar (no 00901 and 00901, respectively. 00,946 in one calendar
regardless of the method of execution, frequency of reporting in accordance quarter, between individual investigations in the
Annex No. 1 to Act No. . 48/1997 Coll.), including the treatment recommended from a professional point of view and based on a decree
common affections and inflammation of the gingiva and oral mucosa, the Ministry of Health no. 3/2010 Coll., on setting
Periodontal (periodontal abscess, the treatment of thrush, herpes or content and intervals of preventive examinations,
pressure ulcers caused by dentures, etc..), observe dentitio treatment interval is 5 months old, in justified
difficilis regardless of the number of visits. Local application cases, if the patient's condition requires
Fluoride using the products according to Annex no. 1 of the Act to inspect previously, may be reported with less
No. 48/1997 Coll. spacing which shall not be less than three months.
Expertise - 014 with proof of systematic participation
training events in the system of lifelong learning
Dentists ^ 5) ------------------------------------ ------
---------------------- ---------------------------- ----------------------------------------- ---------
------------- 00902 Care of registered insured over 18 years CZK 323
Aggregate performance including: control of oral hygiene, Lzevykázat 1/1 calendar year. Can only be reported after
interdental hygiene, motivation insured person after the landmark recognition code 00901, respectively. 00,946 in the same calendar
examination of teeth, periodontal tissue, mucous membranes and soft tissues of the year and at the same time unless it is recognized code 00900,
oral. Treating common afflictions and gingival inflammation and mucous combination codes 00901 and 00902, respectively. 00947 can not be
oral cavity, periodontal tissue (periodontal abscess, the treatment of thrush, reported in one calendar quarter, between
herpes or pressure ulcers caused by dentures, etc..), removing individual codes in the recommended
dentitio difficilis treatment, regardless of the number of visits to observe the interval of 5 months, in justified
cases, if the patient's condition requires
Treat the sooner you can recognize a smaller
spacing which shall not be less than three months.
Expertise - 014 with proof of systematic participation
training events in the system of lifelong learning
Dentists ^ 5) ------------------------------------ ------
---------------------- ---------------------------- ----------------------------------------- ---------
------------- 00903 Requested examination specialist or specialist can not be combined with code 00,908th CZK 200
Examination specialist or specialist based on the recommendations Lzevykázat 1/1 day.
another doctor (during emergencies without a recommendation) Expertise - 014 with proof of systematic participation
a short written report. Need not establish treatment. training events in the system of lifelong learning
Dentists PA, CH, PE-5); 015; 605
------ ---------------------------------------- ------------------------ -------------------------- ------------------------------------- ------------- ---------
00904 Dental examination registered insured 1 year Lzevykázat 1/1 year only in connection with the second CZK 105
to 6 years in preventive medicine preventive examinations in a given calendar year, code
00901 or 00946 and diagnosis Z 012 - Dental
examination.
Expertise - 014 -------------------------------------- ------
-------------------------- ------------------------ --------------------------------------- -----------
00906 ----------- Dental treatment of insured persons under 6 years of age or Lzevykázat 1/1 day. 95 CZK
hendikepovaného insured Expertise - 014
The payment reflects the increased time required treatment
pojištěnce.Kód can be reported only in the context of
one hundred meters. performances, not products. Children can be reported without
curative power.
It has been continuous participation in training
Events lifelong learning dentists PA, CH, PE-5) can
when requested to deport unregistered insured care.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00907 Dental treatment of insured persons from 6 to 15 years Lzevykázat 1/1 day 68 CZK
The payment reflects the increased time required for treatment only when curative visits (not just declare
insured. 00900.00901 codes, 00903, 00909, 00946, and diagnosis
Holder confirmation of continuous participation in training Z 012 - dental checkup) .
Events lifelong learning dentists PA, CH, PE-5). Expertise can - 014
when requested to deport unregistered care insured
------ ---------------------------------- ------------------------------ -------------------- ------------------------------------------- ------- ---------------
00908 Acute treatment and examination unregistered insured - Can not be combined with code 00903 and 00,909th CZK 295
within the emergency services Lzevykázat 1/1 day.
Acute treatment of accidental insured beyond preventive Expertise - 014
care. Treatment includes testing, palliative treatment
in endodontics, amputation and extirpation of pulp, temporary fillings,
topical treatment of gingival / mucosal conservative treatment
dentitio difficilis or periodontal abscess, implementation and
drain replacement, or repair / modification dentures
the surgery and the like.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00909 Clinical dental examination can not be combined with codes 00900, 00901, 00902, 00903, 410 CZK
Expert examination in the clinic based on the 00908, 00945, 00946 and 00,947th in combination with the code
recommendation of another doctor (during emergencies without 00907 can not be reported separately diagnosed with Z 012 -
recommendations), a short written report. Need not establish treatment. dental checkup. The code can be contracted and inpatient
dental equipment and Research Institute
dental.
Lzevykázat 1/1 day
Přidiagnóze requiring repeated visit can
report only once, in clefts,
oncology and trauma diagnoses can be reported
Only once, at the start of treatment.
Expertise - 014; 015
------ ---------------------------------------- ------------------------ -------------------------- ------------------------------------- ------------- --------- 00,910
Making intraoral radiography Lzevykázat - without restrictions CZK 70
Making a special X-ray dental Expertise - 014; 015; 605
X-ray device or other imaging method
(A condition archiving image).
Has a medical facility that slide indicating
(Even if photo was taken in a medical facility).
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00911 Making extraoral radiograph Lzevykázat - unlimited CZK 225
Making skull radiography different projections for each frame. Expertise - 014; 015; 605
Has a medical facility that slide indicated,
015 in case of expertise and a radiograph of the hand (
determination phase skeletal growth).
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00912 Contents salivary glands contrast agent Lzevykázat - unlimited 581 CZK
Soundings, dilation, filling the salivary glands and ducts contrasting Expertise - 014 with proof of systematic participation
cloth. Subsequent x-ray examination is recognized code in the system of lifelong learning training events
00911 or 00913 medical device that shot dentists CH, PE-5); 605
indicated.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00913 Making orthopantomogram Lzevykázat 1/2 years CZK 275
Making extraoral panoramic image on a special Expertise 014; 015; 605 (frequency restrictions do not apply to
X-ray machines. Expertise 605, 015 and 014 for expertise with proof of
It has medical facilities that frame indicated. Continuous participation in training events
lifelong education for dentists PA, CH PE-5);
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00914 Evaluation orthopantomogram Lzevykázat 1/1 frames / 1 medical device 70 CZK
Evaluation of dental panoramic radiographs Expertise - 014; 015; 605
arches and jaw bone or other extraoral images.
Shows a medical device that frame indicated (
even if photo was taken in a medical facility);
if the insured dispatch to another dentist who
He holds a certificate of continuous participation in training
Events lifelong education for dentists ^ 5), the code can
deport the medical facility.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00915 Making telerentgenového picture of cranium Lzevykázat 1/1 calendar year CZK 270
Making remote radiograph of cranium on a special Expertise - 014 with proof of systematic participation
X-ray device. training events in the system of lifelong learning
Has a medical facility that slide indicated. Dentists CH; PE-5); 015; 605
------ ---------------------------------------- ------------------------ -------------------------- ------------------------------------- ------------- ---------
00916 Anesthesia for mandibular foramen and infraorbitale Lzevykázat - without restrictions. 100 CZK
Applications injectable anesthesia to mandibular foramen (including Expertise - 014; 015; 605
i applications nerve buccalis) and foramen infraorbitale
(Also includes application on the nerve palatinus) in all
cases where anesthesia indicated physician.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00917 Anesthesia infiltration Lzevykázat - without restrictions CZK 80
Application injection of anesthesia for each sextant, including Expertise - 014; 015; 605
Anesthesia at the foramen mentale, foramen palatinum maius
foramen and incisive. Calculates the anesthetized area, not
Number of stitches; in all cases where anesthesia indicated
doctor.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- 00920 --------
treatment of dental caries - permanent tooth - photo composite filling tooth Lzevykázat 1/6 months CZK 315
Treatment of dental caries of permanent teeth photo composite fillings Localization - tooth
For insured up to 18 years in a range including canines, regardless of Expertise - 014; 015; 605
the number of faces filling or any number of small panels on
one tooth.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- 00921 --------
treatment of dental caries - tooth permanent tooth Lzevykázat 1/365 days CZK 220
Treatment of dental caries definitive restorations, regardless of the number of frequencies limitation does not apply in cases where repeated
Fill pads or any number of small panels on a single filler is made from complications treated
tooth, standard material in accordance with Annex no. 1 of the Act of tooth decay or injury - in this case the filler
(When using the Self-curing composite materials presented with another diagnosis. Sooner than 1 year may be in the range
including canines and nedózovaného throughout amalgam filling stations in case of high caries experience in
range). of serious illnesses or professional
dental injuries.
Localization - tooth
Expertise - 014; 015; 605
------ ---------------------------------------- ------------------------ -------------------------- ------------------------------------- -------------
00,922 --------- treatment of dental caries - tooth temporary tooth Lzevykázat 1/6 months CZK 126
Treatment of dental caries deciduous tooth final panel, without limitation rate does not apply in cases where repeated
Regardless of the number of faces filling or any number of small filler is made from complications treated
filling one tooth and the material used. caries or injury - in which case the filler
presented with a different diagnosis. Before 6 months may
filling stations in case of high caries experience in
serious systemic diseases.
Localization - tooth
Expertise - 014; 015; 605
------ ---------------------------------------- ------------------------ -------------------------- ------------------------------------- ------------- ---------
00923 Conservative treatment of complications of caries - the permanent tooth can not be combined with code 00,925th CZK 181
It includes palliative performance, mechanical, chemical Lzevykázat 1.1 channel / 1 tooth
and medical training and temporary fillings. only if it is followed preservative -
After the final endodontic treatment, tooth for every cluttered surgical treatment of complications of caries.
zinkoxydfosfátovým root canal cement. Visits to more than one channel must be accompanied
does not matter. radiograph
Localization - tooth
Expertise - 014; 015; 605
------ ---------------------------------------- ------------------------ -------------------------- ------------------------------------- ------------- ---------
00924 Conservative treatment of complications of caries - tooth temporary Lzevykázat 1.1 channel / 1 tooth 176 CZK
After the final endodontic treatment temporary tooth by Location - tooth
Vital amputation or mortální 1. When eventual extirpation of Expertise - 014; 015; 605
each filled root canal. Treatment is possible if
temporary tooth clinically firm. According to X-ray resorption maximum
half of the root.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00925 Conservative treatment of complications of caries II.- permanent tooth can not be combined with code 265 CZK 00,923th
It includes palliative performance, mechanical, medical Lzevykázat 1.1 channel / 1 tooth
training and temporary fillings. After the final endodontic for more than one channel must be accompanied
Treatment for each tooth filled root canal using radiograph.
material registered by the central pin. Number Location - tooth
Visits irrelevant. Even in tooth treatment method apexifikace. Expertise - 014; 015; 605
------ ---------------------------------------- ------------------------ -------------------------- ------------------------------------- -------------
00,931 --------- Comprehensive treatment of chronic periodontal disease Lzevykázat 1/1 calendar year CZK 700
Expert examination periodontal examination using Expertise - 014 with proof of systematic participation
periodontal index CPITN, treatment plan, the system of lifelong learning training events
initiation of conservative treatment - removal of tartar (without dentists PA; PE-5)
Regardless of the method of implementation), training and motivation of oral
hygiene.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00932 Treatment of chronic periodontal disease can expel 3/1 calendar year CZK 243
Examination of Periodontal disease classification based upon Přitřetím reporting code to be evaluated in the treatment
CPITN examination using an index, which is determined by the CPI 2-3, using an index CPITN.
parodontologických or other indices and investigative expertise - 014
methods during the periodontal therapy. The performance of their contents
does not fall into preventive custody. Continued conservative treatment
(Initial phase or trickle) - control of oral hygiene
using the designated index (such as PBI, API, etc.)
whose values must be recorded in the documentation, eliminating
tartar (regardless of the method of execution) remotivace
and correction of specific methods of oral hygiene, eliminating
Periodontal local irritation. The distance between the codes by removing 00,932
must be in such a minimum interval to allow
demonstrate the effectiveness of treatment. Transient splints free hand to
stabilization of teeth with periodontal disease (code 00938)
and subgingival treatments (code 00935) is reported separately.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00933 Surgical treatment of periodontal disease small-scale Lzevykázat - unlimited CZK 420
Performed surgery in the mucogingival area Localization - tooth
following the conservative treatment of chronic diseases Expertise - 014 with proof of systematic participation
Periodontal (Gingivectomy with sculpture) for each tooth. training events in the system of lifelong learning
Dentists PA; CH; PE-5)
------ ------------------------------------- --------------------------- ----------------------- ---------------------------------------- ---------- ------------
00934 Surgical treatment of periodontal disease Lzevykázat large scale - without any restrictions CZK 1,000
Surgical procedures related to conservative treatment Expertise - 014 with proof of systematic participation
Chronic periodontal disease leading to a deepening of the system of lifelong learning training events
vestibule and performances with detaching mukoperiostálního lobe dentists PA; CH; PE-5)
leading to the removal of periodontal sulci - for each sextant.
Can be reported with surgical procedures with guided tissue
regeneration and implantation.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00935 subgingival tooth treatment Lzevykázat 1.1 / 365 CZK 84 days
Instrumental delete content of periodontal pocket Localization - tooth
(Subgingival plaque and tartar), elimination of Expertise - 014 with proof of systematic participation
necrotic cement, smoothed the surface of the tooth root and training events in the system of lifelong learning
checking in teeth with periodontal pockets (CP 3.4). Dentists can perform PA; PE-5)
hand tools, ultrasonic or laser device or
combinations thereof.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00936 Removing and ensure the transfer of transplant Lzevykázat - without restrictions. 600 CZK
Surgical procedure leading to the mucosa or bone Expertise - 014 with proof of systematic participation
graft. training events in the system of lifelong learning
Dentists PA; CH; PE-5); 605
------ ---------------------------------------- ------------------------ -------------------------- ------------------------------------- ------------- --------- 00,937
Articulation teeth Lzevykázat 1/1 calendar year CZK 433
Following a complete ground joint articulation and occlusion of teeth on Expertise - 014 with proof of systematic participation
the basis of functional examination of the stomatognathic system. Must be in the system of lifelong learning training events
Models demonstrate before and after treatment. Dentists PA; PE-5)
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00938 Temporary splints to stabilize teeth with periodontal disease Lzevykázat 01/01 tooth / 365 CZK 44 days
Transient splints free hand to stabilize the teeth with weakened Localization - tooth
periodontal made pursuant to Annex no. 1 of Law Expertise - 014; 015
(Self-curing composite resin).
Reported for each tooth.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00940 Complex examination and treatment proposal diseases of the oral mucosa Lzevykázat 1/1 calendar year CZK 700
When complete examination of the oral mucosa diagnosis. Expertise - 014 with proof of systematic participation
training events in the system of lifelong learning
Dentists PA; PE-5) --------------------------------- ------
------------------------------- ------------------- -------------------------------------------- ------ ---------------- 00,941
up examination and treatment of diseases of the oral mucosa Lzevykázat - unlimited CZK 300
During follow-up examination during treatment. Expertise - 014 with proof of systematic participation
training events in the system of lifelong learning
Dentists PA; PE-5) --------------------------------- ------
------------------------------- ------------------- -------------------------------------------- ------ ---------------- 00,943
measuring galvanic currents Lzevykázat - without restrictions 88 CZK
Measuring galvanic currents in the mouth during the examination of Expertise - 014 with proof of systematic participation
mucosal changes and impedance measurements. training events in the system of lifelong learning
Dentists PA; PE-5); 605
------ ---------------------------------------- ------------------------ -------------------------- ------------------------------------- ------------- --------- 00,945
Targeted examinations can be reported in conjunction with codes 00900.00901, 00902, CZK 10
Investigations focused on specific problems registered 00903, 00908, 00909, 00931, 00932, 00940, 00941, 00946,
insured, if agreed long-term care and hosts 00947, 00981, 00983, 00,984th
provided under the expertise of even 015 unregistered can be reported - without limitations in the treatment of several
insured. visits (endodontic treatment, making
dentures and others) only once.
Expertise - 014; 015
------ ---------------------------------------- ------------------------ -------------------------- ------------------------------------- -------------
00,946 --------- Repeated comprehensive examination and treatment can be registered expel 2/1 calendar year per insured within 336 CZK
insured - preventive examinations and individual preventive dental care for children and adolescents,
Examination of the state of the teeth, periodontal tissue, mucous membranes and soft tissue 1/1 calendar year per insured under the preventive
mouth, jaws and state jaw relationships, histories care for adults, twice during pregnancy, between
and treatment plan under the care paid medical examinations in pregnant must pass at least 3
Insurance Company (hereinafter referred to as "LC"). Checking and practicing oral hygiene, měsíce.U children and adolescents can be reported combined codes
interdental hygiene, massage, removal of tartar (excluding 00,946 and 00,946, respectively. 00901 in a calendar
regardless of the method of execution, frequency of reporting in accordance quarter, between individual investigations in the
Annex No. 1 to Act No. . 48/1997 Coll.), including the treatment recommended from a professional point of view and based on a decree
common affections and inflammation of the gingiva and oral mucosa, the Ministry of Health no. 3/2010 Coll., on setting
Periodontal (periodontal abscess, the treatment of thrush, herpes or content and intervals of preventive examinations,
pressure ulcers caused by dentures, etc..), observe dentitio treatment interval is 5 months old, in justified cases
difficilis regardless of the number of visits. Topical application if the patient's condition requires performing
Fluoride using the products according to Annex no. 1 of the Act before a tour, is reported with a smaller detachment,
No. 48/1997 Coll. shall not be less than three months.
Expertise - 014 -------------------------------------- ------
-------------------------- ------------------------ --------------------------------------- ----------- ----------- 00,947
Care registered insured over 18 years I can expel 1/1 calendar year. Can only be reported after 263 CZK
Aggregate performance including: control of oral hygiene, reporting code 00901, respectively. 00,946 in the same calendar
interdental hygiene, motivation insured person after the landmark year, and at the same time unless it is recognized code 00900,
examination of teeth, periodontal tissue, mucous membranes and soft tissues of the combination codes 00901 and 00902, respectively. 00947 can not be
oral. Treating common afflictions and gingival inflammation and mucous membranes reported in one calendar quarter, between
oral cavity, periodontal tissue (periodontal abscess, the treatment of thrush, removing individual codes in the recommended
herpes or pressure ulcers caused by dentures, etc..), observe the interval of 5 months, in justified
dentitio difficilis treatment, regardless of the number of visits. cases, if the patient's condition requires
Treat the sooner you can recognize a smaller
spacing which shall not be less than three months.
Expertise - 014 -------------------------------------- ------
-------------------------- ------------------------ --------------------------------------- ----------- -----------
00949 deciduous tooth extraction tooth Lzevykázat 01.01 CZK 87
Extraction of temporary tooth or radix (without subsequent surgical Localization - tooth
intervention), including a possible separation of Radix exkochleace Expertise - 014; 015; 605
granulation, sutures and compressive hemostatic tamponade.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00950 Extraction of permanent tooth tooth Lzevykázat 1/1 CZK 168
Extraction of permanent tooth or radix (without subsequent surgical Localization - tooth
intervention), including a possible separation of Radix exkochleace Expertise - 014; 015; 605
granulation, sutures and compressive hemostatic tamponade.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- 00951 --------
surgery of hard tissues of the oral cavity minor Lzevykázat - unlimited CZK 525
Tooth extraction or radix with detaching mukoperiostálního Localization - tooth
lobe and hemiextrakce or equalizing edentulous alveolar Expertise - 014; 605
outcropping in the range of one sextant or surgical revision
extraction wound.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00,952 surgery of hard tissues of the oral cavity Lzevykázat large scale - no limit 1155 CZK
Tooth extraction or radix with detaching mukoperiostálního Expertise - 014 with proof of systematic participation
lobe near the risk of anatomical structures or in the system of lifelong learning training events
requiring the ablation of a larger part of the bone, primary closure dentists PA; CH; PE-5); 605
oroanthral communications, equalizing edentulous alveolar
headland in a range greater than one sextant, extirpation of cysts
over 1 cm removal sequestrators, arthrocentesis
antrotomie temporomandibular joint or the like.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00953 Surgical treatment of teeth retention Lzevykázat 1/1 tooth CZK 630
Ablation of tissue lying in the path of tooth eruption and tooth mobilization Localization - tooth
in reference direction eruption (including lifting the mukoperiostálního Expertise - 014 with proof of systematic participation
lobe, sculpture soft tissue, bone graft backing, training events in the system of lifelong learning
wire fixation strength, bonding orthodontic bracket). Dentists CH PE-5); 015; 605
------ ---------------------------------------- ------------------------ -------------------------- ------------------------------------- ------------- ---------
00954 preservative-surgical treatment of complications of caries Lzevykázat - unlimited CZK 420
Flipping mukoperiostálního lobe ablation of bone Localization - tooth
periapical, root tip amputation, exkochleace, toilet Expertise - 014; 605
root and bone, suture (including any intraoperative
performance) for each treat roots.
Also apical exkochleace and extirpation of odontogenic cysts in
1 cm.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00955 Surgery of soft tissues of the oral cavity and its surrounding small Lzevykázat - unlimited CZK 420
Expertise range - 014; 015; 605
Perform minor surgical procedures, such as dekapsulace,
frenulectomy, eliminate distractions ligament lanes
sublingual frenulectomy, excision flapping comb - for each
sextant, removal of lesions to 2 cm, suture wounds or mucous membranes
skin to about 5 cm or probe and irrigation duct salivary glands.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00956 Surgery of soft tissues of the oral cavity and its surroundings large Lzevykázat - unlimited 900 CZK
Expertise range - 014 with proof of systematic participation
Removal of sublingual salivary retention cyst excision flapping in the system of lifelong learning training events
Ridge greater extent than one sextant, lesion removal of dentists PA; CH, PE-5); 605
2 cm oral vestibuloplastika without graft - for each sextant,
suture wounds or mucous membranes of the skin above 5 cm extirpation Mucocele
oral mucosa or diagnostic excision,
sialolitotomie.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00957 Accident hard tissues of the oral cavity minor Lzevykázat - unlimited CZK 420
Treatment of accident consequences teeth and alveoli small scale, including Expertise - 014; 015; 605
Simple fixation with plastic material or shortened
wire splint.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00,958 Traumatology hard tissues of the oral cavity Lzevykázat large scale - without any restrictions CZK 750
Reduction and fixation of fractures alveoli upper mandible Localization - jaw
Fractures of the body and neck of the mandible without significant dislocation (for Expertise - 014 with proof of systematic participation
each treated jaw). training events in the system of lifelong learning
Dentists CH PE-5); 605
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00959 Intraoral incision Lzevykázat - unlimited CZK 105
Treatment of inflammation of intraoral incision with possible expansion, localization - quadrant
the launch of exudate and the introduction of a drain. Expertise - 014; 015; 605
------ ---------------------------------------- ------------------------ -------------------------- ------------------------------------- ------------- ---------
00960 outer incision Lzevykázat - unlimited CZK 600
Treatment of inflammation kolemčelistního external incisions, including dilation Expertise - 014 with proof of systematic participation
with the launch of exudate and the introduction of a drain. training events in the system of lifelong learning
Dentists CH PE-5); 605
------ ---------------------------------------- ------------------------ -------------------------- ------------------------------------- -------------
00961 --------- treatment of complications of surgical procedures in the oral cavity Lzevykázat 5/10 days 45 CZK
The introduction of a drain or tamponade, appendices plastic bandage Expertise - 014; 015; 605
wash the wound topical therapeutic agent, further building
Late postextrakčního bleeding revision of the extraction wound,
muscle rehabilitation exercises and physical therapy.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00962 Conservative treatment of temporomandibular disorders can recognize 2 / 1kalendářní year (limit frequency of CZK 300
examination of the temporomandibular joint, not for documenting expertise 605, 015 and 014 with the confirmation of the disease
and conservative treatment of temporomandibular joint disorders continuous participation in training events
(eg intermaxillary fixation, physical therapy or lifelong education for dentists CH PE-5))
manual repositioning). Expertise - 014; 015; 605
------ ---------------------------------------- ------------------------ -------------------------- ------------------------------------- ------------- ---------
00963 Injection im, iv, id, sc Lzevykázat - no limit CZK 53
It involves injecting a medicament, including price, unless Expertise - 014; 015; 605
Applied material covered in another way.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00,965 dentists Time spent on transportation for immobile insured person can not be reported along with the performance of transport. 210 CZK
Performance is paid on the basis of recommendations of a general practitioner and after Expertise - 014; 605
revision doctor's approval.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00966 Signal output - information for a decision on temporary Lzevykázat - without restrictions CZK 5
incapacity or decision on the need for nursing Expertise - 014
(Care)
Exercise has a doctor who issued the decision
of temporary incapacity, or the decision on the need
nursing (care).
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00967 Signal output - information for the issuance of the decision to terminate Lzevykázat - without restrictions CZK 5
temporary incapacity or decision on termination of Expertise - 014
needs of nursing (care)
Exercise has a doctor who Decisions to terminate
temporary incapacity, or the decision to terminate
needs of nursing (care), exhibited.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00968 Dental treatment unregistered insured PZL- can show a 1/1 day only in connection with codes 00951, 1000 CZK
dental surgeon in a medical facility situated in 00952, 00953, 00954, 00955, 00956, 00957, 00958, 00960,
agreed list of dental surgical workplaces 00,962th
Treatments based on the recommendation of another doctor (for emergency Expertise - 014 with proof of systematic participation
states without a recommendation), written report. vsystému training events lifelong learning
Dentists CH ^ 5) ---------------------------------- ------
------------------------------ -------------------- ------------------------------------------- ------- ---------------
00970 Removing fixed restorations - for each pillar structure Lzevykázat 1/730 days 91 CZK
Removing the fixed compensation impulse tool or rozbroušením not report for temporaries.
Crown and its deformation. Localization - tooth
Expertise - 014; 015; 605
------ ---------------------------------------- ------------------------ -------------------------- ------------------------------------- ------------- ---------
00971 Temporary protective crown Lzevykázat 1/730 CZK 69 days
Adaptation and fixation of clothing to protect the crown prep, Location - tooth
frangovaného or otherwise destructed tooth or individual Expertise - 014; 015; 605
protective crown made swage method mouth
patient. It includes repeated deployments.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00973 Repair or adjustment of dentures in office Lzevykázat 5 / 1kalendářní year CZK 39
Repair or simple modification dentures in office can not be reported when submitting new dentures
without staying at the laboratory processing. (Two months after submission of the new removable
compensation).
Localization - jaw
Expertise - 014; 015; 605
------ ---------------------------------------- ------------------------ -------------------------- ------------------------------------- -------------
--------- 00,974 Submission of the dental product Lzevykázat - without restrictions CZK 0
The medical facility has expertise in dental surrender - 014; 015; 605
product (code used only for reporting separately charged
medicines and dental products (evidence 03s). ------------------- ------
--------------------------------------------- ----- -------------------------------------------------- ---------------------- --------
00,981 orthodontic anomalies Lzevykázat 1/1 insured and medical equipment. CZK 600 || | Includes orientation dental examination, comprehensive expertise - 015
orthodontic examination, establishment of medical records.
This code starts orthodontic treatment and reporting codes
expertise 015. Upon receipt been treated insured is required to start their own
orthodontic treatment initial examination, founding his own
documentation and removing code 00,981th
------ ---------------------- ------------------------------------------ -------- -------------------------------------------------- ----- ---------------------- 00,982
initiation of therapy with orthodontic anomalies fixed orthodontic Lzevykázat 1/1 jaw 1300 CZK
apparatus for a dental arch Localization - jaw
Initiation of treatment orthodontic anomalies fixed orthodontic Expertise - 015
apparatus - one dental arch. It includes the deployment of elements
fixed appliance including the preparation of teeth. Material fixed appliance
It is not covered by public health insurance.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00983 Checking the treatment of orthodontic anomalies using fixed Lzevykázat 1/1 quarters for 4 years. CZK 800
orthodontic appliance Expertise - 015
Checking the treatment process and adjustments to fixed camera on one
and both dental arches, after reporting code 00982 or
00994th applies to all controls fixed appliance will be
quarter and used to control simultaneously scanning
apparatus.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00984 Checking the treatment of orthodontic anomalies using techniques other than Lzevykázat 1/1 quarters for 4 years. 210 CZK
using fixed orthodontic appliance you can not be reported for treatment at the stage of retention or
Checking the course of treatment according to the treatment plan and the sensor function monitoring the growth and development of teeth and jaws without the active
apparatuses, including their preparation. To observe the changes after treatment.
Indicated extractions without orthodontic apparatus. Expertise - 015
It applies to all controls sensing apparatus in the
quarter.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00985 Discontinuation of orthodontic anomalies using fixed jaw Lzevykázat 2/1 CZK 700
orthodontic appliance with an interval of 3 years can be reported to the jaw 1
After stopping treatment with orthodontic anomalies removal of fixed following the code 00982 and 1 on the jaw following
orthodontic appliance 1 dental arch, grinding of teeth, including code 00,994th
any analysis models (not including any fabrication Localization -
jaw and cephalometric analysis and OPG). Expertise - 015 -------------------------------------- ------
-------------------------- ------------------------ --------------------------------------- ----------- -----------
00986 Checking phase retention or active monitoring in the growth phase can expel 1/1 calendar half-year, for a maximum of CZK 220
and development of 4 years.
Checking the insured before or after the active Expertise - 015
phase of orthodontic treatment with removable and fixed appliances according
treatment plan. May include the use of fixed or
sensing braces, retainers or other retention apparatus.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00987 Determination growth phase Lzevykázat 2/1 insured CZK 53
Determining the growth phase of the insured - skeletal age evaluation Expertise - 015
radiograph of the hand or cervical vertebrae.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00988 Analysis telerentgenového picture of cranium Lzevykázat 1/1 calendar year CZK 116
Evaluation profile, possibly zadopředního Remote Expertise - 015
radiograph of cranium using special measurement.
00989 Analysis orthodontic models Lzevykázat 1/1 calendar year CZK 315
Evaluation of orthodontic models of dental arches and adjacent Expertise - 015
tissue, including any other special measures.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00,990 diagnostic rebuilding orthodontic model Lzevykázat 1/1 jaw CZK 473
Rebuilding orthodontic tooth model one jaw Localization - jaw
diagnostic purposes or jaw model operation Expertise - 015
for surgical purposes.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
Deploy 00,991 prefabricated intraoral arch Lzevykázat 1/1 jaw CZK 173
Palatal or lingual expansion anchor or wire localization - jaw
arc or lip-bumper, factory-made, their adaptation Expertise - 015
and set up the device on the rings.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
Deploy 00,992 extraoral traction or facial Lzevykázat 1/1 insured CZK 210
Deployment of intra-extraoral wire arc (bridle) or Proficiency - 015
Pelota chin and ortodontní cap and a neck strap or
Delaire facial type, Hickham and the like for the purpose
extraoral anchorage, including instruction on how to use
and illustrative demonstration.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
00,993 Establishing partial arc Lzevykázat 4 / 1kalendářní half (1x per quadrant). CZK 300
Preparation and establish partial wire arch to the extent of Expertise - 015
6-tooth locks or cannulas as part of a fixed appliance.
The material is not covered by public health insurance
00,994 Initiation of treatment with fixed orthodontic anomalies small Lzevykázat 1/1 jaw under the age of 10 years. 900 CZK
orthodontic appliance to a dental arch Localization - jaw
Initiation of treatment orthodontic anomalies fixed orthodontic Expertise - 015
apparatus for a dental arch in the mixed dentition for
protrusion defects with incisal step that 9 mm or more, wry
bite, diastema greater than 4 mm, bite, retention or dystopia
upper permanent incisor.
It includes the deployment of elements of a fixed appliance. Material fixed
the apparatus is not covered by public health insurance.
------ ----------------------------------------- ----------------------- --------------------------- ------------------------------------ -------------- --------
Abbreviations:
PZL dentist
PA
periodontologist CH
dental surgeon PE
Pediatric stomatologist
1) Regulation of the European Parliament and Council Regulation (EC) no. 883/2004 on the coordination of social security systems
, as amended.
Regulation of the European Parliament and Council Regulation (EC) no. 987/2009 laying down
implementing Regulation (EC) no. 883/2004 on the coordination of social security systems
.
Regulation of the European Parliament and Council Regulation (EU) no. 1231/2010 laying
extending Regulation (EC) no. 883/2004 and Regulation (EC) no. 987/2009
to third- countries to which this Regulation
otherwise excluded because of their nationality.
Council Regulation (EEC) no. 1408/71 of 14 June 1971 on the application
social security schemes to employed persons and their families
moving within the Community.
Council Regulation (EEC) no. 574/72 of 21 March 1972 laying down
implementing Regulation (EC) no. 1408/71 on the application of
social security schemes to employed persons and their families moving
within the Community.
2) For example, notification of the Ministry of Foreign Affairs no. 130/2002 Coll. m.
s., on Agreement between the Czech Republic and the Federal Republic of Yugoslavia
Social Security, Ministry of Foreign Affairs
no. 82/2000 Coll. ms of Agreement between the Czech Republic and the Republic of Croatia
Social Security, Communications of the Ministry of Foreign Affairs
no. 135/2004 Coll. ms of Agreement between the Czech Republic and
Republic of Turkey on social security, communication
Ministry of Foreign Affairs no. 2/2007 Coll. ms
on concluding a Treaty between the Czech Republic and the Republic of Macedonia on Social Security.
3) Decree no. 134/1998 Coll., Which publishes a list of medical procedures
with point values, as amended.
4) The CSO no. 339/2011 Coll., On updating the classification
inpatients (IR-DRG).
5) § 22 of Act no. 95/2004 Coll., On conditions for the acquisition and recognition
professional and specialized competencies to perform
profession of a physician, dentist and pharmacist, as amended
.
