Sommer F, Hoffmann T K, Jäckel M, Gerlach R, Schwager K, Deitmer T, Betz C S
Universitätsklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Frauensteige 12, 89075, Ulm, Deutschland.
HNO-Heilkunde, Helios Kliniken Schwerin, Schwerin, Deutschland.
HNO. 2023 Dec;71(12):811-815. doi: 10.1007/s00106-023-01380-0. Epub 2023 Oct 20.
Surgery of the skull base includes interventions between the nose or paranasal sinuses (anterior skull base) or ear/temporal bone (lateral skull base) and the intracranial space. As interventions at the anterior skull base almost exclusively involve complex pathologies in a demanding anatomical region, in many cases two experienced surgeons from different disciplines are required who should be experienced in operating together. The technical and time requirements are also considerable in many cases; however, for many procedures there are no specific skull base operational and procedural keys (OPS) codes that take the considerable personnel and structural effort into account. A change in the diagnosis-related groups (DRG) system, implemented since the beginning of 2023, now adjusts the remuneration of the abovementioned effort for malignant pathologies of the anterior and lateral skull base. The reallocation of procedures 5‑015.0/1/3/4 and 5‑016.0/2/4/6 results in a significant upgrade of anterior and lateral skull base surgery. Since the beginning of 2023 skull base surgery will no longer be charged under DRG D25C with a (former) relative weight of 1.893, but with DRG D25B with a current relative weight of 3.753 when a code of the aforementioned groups is used. Nevertheless, further adjustments are necessary, for example, in the available reconstructive steps in order to provide the Institute for the Remuneration System in Hospitals (InEK) with the most differentiated data possible on the procedural effort of the intervention and to achieve a more balanced distribution of the reimbursements of skull base surgery in the long term.
颅底手术包括在鼻腔或鼻窦（前颅底）或耳/颞骨（侧颅底）与颅内空间之间进行的干预操作。由于前颅底的干预操作几乎都涉及一个要求苛刻的解剖区域内的复杂病变，在许多情况下需要两名来自不同学科的经验丰富的外科医生，他们应具备共同手术的经验。在许多情况下，技术和时间要求也相当高；然而，对于许多手术来说，没有特定的颅底手术操作和程序编码（OPS）来考虑到相当大的人力和结构投入。自2023年初实施的诊断相关分组（DRG）系统的变化，现在对上述前颅底和侧颅底恶性病变的努力报酬进行了调整。对手术编码5‑015.0/1/3/4和5‑016.0/2/4/6的重新分配导致前颅底和侧颅底手术显著升级。自2023年初以来，当使用上述分组的编码时，颅底手术将不再按照相对权重为1.893的DRG D25C收费，而是按照当前相对权重为3.753的DRG D25B收费。然而，还需要进一步调整，例如在可用的重建步骤方面，以便为医院薪酬系统研究所（InEK）提供关于干预程序努力的尽可能详细的数据，并从长远来看实现颅底手术报销的更均衡分配。
