OPS proposal

 

Creation

OPS proposal procedure

Basics
Creation
Assessment
view OPS

Content and structure of an OPS proposal

The OPS classification contains procedure descriptions for diagnostic, therapeutic and surgical measures that are used in hospitals. When preparing an OPS proposal (application), the subject of the proposal is not a product, but the underlying procedure or agent.

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Points of view in the preparation of an OPS proposal

The Board of Trustees for Questions of Classification in Health Care (KKG) advises the Federal Ministry of Health (BMG) on the preparation, maintenance and further development of official classifications in the health care sector. The office of the KKG is the BfArM formerly DIMDI. The KKG uses the ICD and OPS working groups to advise the BfArM on the further development of the classifications.

The following are represented in the working groups

  • German Medical Association (BÄK)
  • National Association of Statutory Health Insurance Physicians (KBV)
  • Association of the Scientific Medical Societies (AWMF)
  • National Association of Health Insurance Funds (GKV-Spitzenverband)
  • Association of private health insurers (PKV)
  • Medical Federation (MD)
  • Accident insurance institutions (DGUV)
  • German pension insurance (DRV)
  • German Hospital Association (DKG)
  • Institute for the Hospital Remuneration System (InEK)
  • Institute for Quality Assurance and Transparency in Health Care (IQTIG)
  • Institute of the Evaluation Committee (InBA)

A 3-page working document “Points of View for Future Revisions of the OPS” was developed by these working groups and adopted by the KKG on March 6, 2002. The BMG and the BfArM take these points of view into account as a decision-making aid in the processing and further development of the OPS. The latest version is dated February 19, 2019 and can be viewed on the pages of the BfArM.

Points of view

Points of view for the inclusion of procedures in the OPS classification

Relevant due to

  1. economic purposes (DRG, PEPP, EBM)
  2. or legally required external quality assurance
  3. or the necessity for coding outpatient surgery (§115b SGB V – outpatient surgery in hospitals)
  4. or the novelty and the corresponding lack of mapping or the lack of differentiation and the lack of fulfillment of one of the points 1 to 3.

 

The proposal form asks about the following aspects:

  • Relevance (level of evidence, scientifically evaluated, established, etc.)
  • Frequency (number of patients / departments concerned)
  • Costs (differentiation of costs from total case)
  • Distinguishability (differentiation of costs from alternative therapy)
  • Approval (e.g. CE marking)
  • Autonomy (self-contained process that can be carried out alone)

Points of view against the inclusion of procedures in the OPS classification

Proposal includes

  • drug substance groups and manufacturer-related drug information or
  • manufacturer-related material details, devices or device types and / or
  • constantly recurring components typical of the examination and treatment, such as admission examinations or wound closure after surgical intervention.

Despite these aspects, an admission can be made by way of exception, insofar as the compelling necessity of the admission is given due to the assignment to the payment systems or for reasons of the legally prescribed external quality assurance.