Why do you encode using ICD-10-GM?

A modern healthcare system such as the one in Germany is characterised by a high level of cooperation and communication networking on a functional, sectoral, regional, national, European and international level. To ensure communication between various areas requires common languages, i.d. standardised terminologies/ terminological standards. These do not only have to be unambiguous in human-to-human communication, but have to be equally without ambiguity if the communication chain included electronic system.

Purposeful standardisation: from patient record to billing and statistics

Patient records in a hospital or a doctor's surgery serve to document and optimise treatment. They are individual to each doctor and focus on the treatment; for that reason, they are written in varied and very detailed specialist medical terminology.

ICD-10-GM is a classification of diagnostic terms with parallel machine-readable codes. Its primary purpose is the encoding for billing and statistics; the formation, designation and scope of individual classes is guided by these purposes.

The application of ICD-10-GM to the documented disease descriptions generalises their content and reduces the language to mandatory unambiguous preferred terms; the descriptions in clear text are assigned an unambiguous machine-readable code. Mandatory sector-specific encoding guidelines ensure a uniform application across Germany.

ICD-10-GM in the billing and financing of medical services

ICD-10-GM encoded diagnoses control large cash flows:

Since 2004, inpatient and some semi-inpatient hospital services are billed based on a case-based fixed sum system for hospitals, the so called "G-DRG-System" (German Diagnosis Related Groups). The legal basis for this is § 17b of the German Hospital Finance Act (KHG). Since 2013 there is a special reimbursement system for pschiatric and psychosomoatic institutions pursuant to § 17d of KHG, the "PEPP-Entgeltsystem". ICD-10-GM and OPS form the basis of the G-DRG and PEPP case-based fixed sum systems. The systems are published by the Institute for the Hospital Remuneration System (InEK GmbH, DRG Institute) on behalf of the self-governing partners of the German healthcare system.

The German Uniform Assessment Standard (EBM) is the conclusive catalogue of all items in the doctor's fee schedule that are billable in outpatient medical care. The encoding of diagnoses in accordance with ICD-10-GM and of outpatient procedures in accordance with OPS are part of the service provision and a prerequisite for service remuneration in outpatient medical care.

ICD-10-GM in statistics and quality assurance

ICD-10-GM encoded diagnosis on incapacity certificates control individual sickness benefit payments and are included in federal government reports. Information about case numbers for main diagnoses and competence diagnoses in hospital quality reports are also based on ICD-10-GM encoded diagnoses.