The remuneration systems for hospital and out-patient treatment are based on ICD-10-GM and OPS. The continuous development of these remuneration systems requires regular (currently annual) further development of the above classifications. The desire to ensure utmost transparency and efficiency of this development and adaptation process resulted in the development of the procedure described below.
The desire to ensure utmost transparency and efficiency of this development and adaptation process resulted in the development of the procedure in accordance with the rules of procedure for the establishment of ICD-10-GM and OPS described below.
New versions of ICD-10-GM and OPS generally become effective at the start of a calendar year. However, the introduction of new versions requires a sufficient period of preparation which leaves hospitals and software developers sufficient time for software adaptation and training. For that reason, preliminary versions are generally published by the middle of August, final versions are published until end of October. Please note, though, that there may be changes in the final versions compared to these preliminary ones.
After the publication of the final versions in autumn, the proposal procedure for the next version is generally started in early December. Proposals for changes received by BfArM before the closing date can be considered in the respective current revision process.
The proposal procedure for the next version 2023 of ICD-10-GM and OPS has been opened. Submit your proposals before closing date 28th February 2022. When received timely you will get a confirmation of receipt. If you didn't get this confirmation, please contact our helpdesk classification immediately: 0228 99307-4945.
4. Revision and approval process
Between the receipt of a requirement for OPS or ICD-10-GM and its implementation in a new version is an extensive revision and approval process involving all stakeholders, as illustrated in a flow diagram (see below).
Wherever necessary, submitted proposals are processed for implementation in the respective classifications. This involves consultations with authorised experts to clarify content-related questions.
The processed proposals are then sent to the self-governing partners and the representatives of the professional associations, to the organizations or institutes, who have a legal mandate for the quality assurance in the stationary and outpatient area and to the OPS or respectively ICD-10-GM working groups and - after a sufficient preparatory period - are discussed in the working groups.
The OPS and ICD-10 Working Groups have been set up by the National Board for Classification in Health Care (KKG) with the aim to advise BfArM on the further development of the classifications. The following organisations are represented in the working groups.
- German Medical Association (BÄK)
- National Association of Statutory Health Insurance Physicians (KBV)
- Association of the Scientific Medical Societies in Germany (AWMF)
- The National Association of Statutory Health Insurance Funds (GKV-Spitzenverband)
- Association of Private Health Insurance Funds (PKV)
- Medical Review Board of the Statutory Health Insurance Funds (MDK)
- Staturory Accident Insurance (DGUV)
- German Statutory pension insurance scheme (DRV)
- German Hospital Federation (DKG)
- Institute for the Hospital Remuneration System (InEK)
- Federal Institute for Quality Assurance and Transparency in Healthcare (IQTIG)
- Institut des Bewertungsausschusses (InBA)
The working groups meet regularly; authorised experts can be invited to the meetings to clarify content-related questions. Participants in the AG ICD and the AG OPS disclose potential conflicts of interest to BfArM in accordance with the Annex to § 6 of the rules of procedure.
The outcomes of the consultations in the working groups provide an important decision-making basis for the further development of OPS and ICD-10-GM.
5. Aspects for the further development of OPS
OPS (previously: OPS-301) is a national procedural classification; originally limited to the encoding of surgical procedures, it has gradually been adapted to the requirements of the Australian AR-DRG system. The main focus in its further development is its application for the purposes of the G-DRG and the PEPP remuneration system and, in conjunction with that, on external quality assurance. It is not the intention to develop OPS into a comprehensive catalogue of procedures and individual services to satisfy the full range of conceivable requirements of medical documentation. However, the further expansion of OPS will - as now - continue between the conflicting priorities of different targets.
The OPS Working Group has compiled the most important considerations for the further development of OPS in its memorandum entitled "Gesichtspunkte für zukünftige Revisionen des OPS" and requests that this information may be taken into account in the development of proposals for the future development of the code.
6. Criteria for the further development of the ICD-10-GM
Proposals for the ICD-10 GM will be prioritised and implemented on the basis of the following points:
- Relevance for the further development of pay systems (G-DRG, PEPP, EBM and other billing systems)
- Relevance for the legally required external quality assurance and
- Relevance in terms of mapping current medical knowledge.
Priority must be given to compatibility with ICD-10 of WHO.