[ENT relevant changes in the German OPS Procedure Classification System for 2006]

Classifications of Mastoid and Middle Ear Surgery: A Scoping Review

OBJECTIVES

The aim of this scoping review was to evaluate existing classifications of surgical procedures of the middle ear and mastoid and find a suitable classification that could serve as an international standard.

MATERIALS AND METHODS

Scoping review with a systematic literature search using reference tracking and a syntax including all surgical procedures in mastoid and middle ear surgery and their synonyms. Studies were selected based on inclusion and exclusion criteria.

RESULTS

Eleven reported classifications were included; six of which focused on middle ear surgery, two on mastoid surgery, and three on both. However, none of the classifications included all current surgical procedures of mastoid and middle ear surgery.

CONCLUSION

Many classifications have been proposed for innumerable surgical techniques in middle ear and mastoid surgery. Some are outdated, some are incomplete, most are not widely accepted, and only few correspond with all current surgical techniques.

[ENT medicine and head and neck surgery in the G-DRG system 2008]

BACKGROUND

Further developments in the German DRG system have been incorporated into the 2008 version. For ENT medicine and head and neck surgery significant changes concerning coding of diagnoses, medical procedures and concerning the DRG-structure were made.

METHODS

Analysis of relevant diagnoses, medical procedures and G-DRGs in the versions 2007 and 2008 based on the publications of the German DRG institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI).

RESULTS

Changes for 2008 focussed on the development of DRG structure, DRG validation and codes for medical procedures. The outcome of these changes for German hospitals may vary depending on the range of activities.

CONCLUSION

The G-DRG system has gained in complexity again. High demands are made on correct and complete coding of complex ENT and head and neck surgery cases. Quality of case allocation within the G-DRG system has been improved. For standard cases quality of case allocation is adequate. Nevertheless, further adjustments of the G-DRG system especially for cases with complex neck surgery are necessary.

[The German DRG system and its effect on imaging quality in ENT, and head and neck surgery]

BACKGROUND

The new G-DRG system for 2006 was published in September 2005. This article presents, analyses, and comments essential changes in the G-DRG system for 2006 and their consequences for ENT-Medicine.

RESULTS

The complexity of the G-DRG system has increased significantly. In 2006, the case allocation will be more differentiated for common surgical procedures on the middle ear, nose, paranasal sinuses, salivary glands, and for head and neck cancer. Furthermore, the patient's age and the clinical and complexity level (PCCL) will be of increased relevance in selected case constellations. However, diagnostic endoscopies with rigid instruments will still not be regarded as OR procedures.

CONCLUSION

Essential adjustments proposed by the German Association for ENT Medicine (DGHNOKHC) and the ENT Medical Professional Association (HNO-Berufsverband) have been made, and the quality of case allocation of ENT-patients within the G-DRG system improved. Nevertheless, further adjustments to the G-DRG system are necessary.