Tarmed/DRG
Since 2012, acute hospitals have been charging their services for inpatients according to standardized flat rates per case, the so-called DRGs.
The DRGs are regularly updated by the non-profit SwissDRG AG.
Which parameters are important for the DRG system?
- the main diagnosis
- the procedures carried out in the hospital (operations, complex examinations)
- Additional diagnoses and complications (PCCL severity level system) that have a significant influence on the course of treatment (by requiring an expense)
How are these parameters coded for the calculation basis?
- Diagnosis: ICD (International Classification of Diagnosis)
- Procedures: CHOP (Swiss surgical classification)
The grouper software provided free of charge on the Internet by SwissDRG AG calculates the respective DRG from the ICD and CHOP (https://webgrouper.swissdrg.org/).
What amount does the hospital receive for a DRG?
- Each DRG has a base cost weight (synonym cost weight)
- Service providers (hospitals) have agreed a base rate tariff with the health insurers
- Base cost weight x base rate = payout amount (francs)*.
* The hospital receives this amount if it discharges the patient between the lower limit length of stay
and the upper limit length of stay.
The drainova® or PleurX™ catheter can be used for various diagnoses. On the right-hand side you will find the billing examples for the implantation of a catheter in inpatients.
Billing examples DRG
In the following, we present billing examples for the inpatient sector.
| Main diagnosis | Pleural effusion – ICD = J90 |
| Procedures | Pleural drainage (insertion of an intercostal catheter for drainage) CHOP: 34.04 |
| Calculation | Webgrouper – DRG = E73B Base cost weight: 0.733 Base cost weight x base rate = payment amount |
| Lower limit length of stay 2 days Average length of stay 5.9 days Upper limit length of stay 12 daysCoupon rate per day 0.088 Discount rate per day 0 Current length of stay 10 days |
|
| Main diagnosis | Ascites – ICD = R18 |
| Procedures | Percutaneous abdominal drainage (puncture) CHOP: 54.91 |
| Calculation | Webgrouper – DRG = Z65A Base cost weight: 0.783 Base cost weight x base rate = payment amount |
| Lower limit length of stay 3 days Average length of stay 7.4 days Upper limit length of stay 17 daysAdditional rate per day 0.123 Reduction rate per day 0 Current length of stay 10 days |
|
| Main diagnosis | Alcoholic cirrhosis of the liver – ICD = K70.3 |
| Procedures | Percutaneous abdominal drainage (puncture) CHOP: 54.91 |
| Calculation | Webgrouper DRG = H60B Base cost weight: 0.976 Base cost weight x base rate = payment amount |
| Lower limit length of stay 3 days Average length of stay 8.3 days Upper limit length of stay 17 daysSupplementary rate per day 0.121 Reduction rate per day 0 Current length of stay 10 days |
|
Since 2002, outpatient medical services in doctors’ surgeries and hospitals have been billed using the individual service tariff (TARMED).
Tarmed
We have compiled possible positions for you in the TARMED positions form. It is beyond our knowledge whether the qualitative dignities are fulfilled or whether certain accumulations are permitted. On the other hand, it is possible that further or other items are necessary for an outpatient implantation, which are not listed here.
Tarmed position examples
- 16.0010 Pleural puncture, as sole service - 63.02 TP
- 16.0030 Insertion of a thick thoracic drain, as sole service - 93.50 TP
- 16.0040 Pleurodesis as supplement for insertion of a thick thoracic drain - 79.68 TP
- 19.1850 Ascites puncture/peritoneal puncture/peritoneal abscess puncture, diagnostic,
any method - 60.66 TP - 19.1860 Ascites puncture/peritoneal puncture/peritoneal abscess puncture, therapeutic,
any method - 98.56 TP - 20.0750 Percutaneous placement of peritoneal drainage, long-term (removal after
more than 24 h), as sole service - 187.11 TP - 20.0760 Surcharge for lavage after placement of a peritoneal drainage - 71.02 TP
- 20.0790 Removal of a peritoneal drainage (part of "General basic service")
