[Organized pain management in the DRG reimbursement system].
Multidisciplinary pain management in pain centers can only be guaranteed if the DRG reimbursement system takes into account the multiple risk factors. The German pain associations prospectively analyzed clinical and administrative (DRG-related) data sets (n=3943) of inpatient and day care pain treatment facilities. The index diagnoses of 84% of the patient sample were grouped into nine basic DRGs. The most frequent pain procedure code was 8-918 ("multimodal pain management"). The minimal length of stay for this code set to 7 days was 17.2 days for the study sample. The DRG grouper software 2003 categorized 68.6% of the patients into PCCL 0 despite the proven complexity of risks and secondary diseases. The mean case weight in the sample was set at about 1. The pain-related data set analyzing pain severity, chronicity, and its influence on various functions emphasizes the total severity and burden of disease and thus the necessity for multimodal pain management. The German pain societies carried the motion that a new complex ICD code for chronic pain (with biopsychosocial consequences) should be established in the German Modification of the ICD. The new ICD code F62.80 and the procedure code 8-918 had not yet been implemented into the German DRG algorithm. Due to modifications in DRG systematics and the DRG algorithm, to be activated in 2005, the procedure code 8-918 will now automatically trigger into four special basic pain DRGs corresponding to the index pain diagnosis.
Lindena
G
G
CLARA Klinische Forschung, Kleinmachnow. gabriele.lindena@t-online.de
Gerbershagen
H U
HU
Zenz
M
M
Laubenthal
H
H
Schleppers
A
A
D003131:Combined Modality Therapy / Q000191:economics; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups / Q000458:organization & administration*; D005858:Germany; D006801:Humans; D010146:Pain / Q000191:economics; D059408:Pain Management; D010147:Pain Measurement; D012051:Reimbursement Mechanisms