Decree of the Ministry of Health No. 45 / 1997 Coll.
Decree of the Ministry of Health issuing a list of health performance with points
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Effective from 01.07.1997
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45
DECLARATION
Ministry of Health
of 28 February 1997
issuing a list of health performance with point values
The Ministry of Health shall, following a conciliation procedure with representatives of the Ministry of Finance, General Health Insurance of the Czech Republic, other health insurance companies, contractual medical institutions, professional organisations established by law and professional scientific companies pursuant to § 13 (3) of the Czech National Council Act No. 550 / 1991 Coll., on General Health Insurance, as amended by Act No. 59 / 1995 Coll. and Act No. 149 / 1996 Coll.:
The list of health performance with points is set out in the Annex, which is part of this decree.
The Decree of the Ministry of Health of the Czech Republic No. 258 / 1992 Coll., which publishes a list of health performance with point values, as amended by Regulations No. 263 / 1993 Coll., No. 90 / 1994 Coll., No. 151 / 1994 Coll., No. 112 / 1995 Coll. and No. 205 / 1996 Coll.
This Decree shall take effect on 1 July 1997.
Minister:
PhDr.
Annex to Decree No 45 / 1997 Coll.
1. TEXT PART
| Kapitoly: | |
| 1 | Vysvětlení základních pojmů použitých v seznamu výkonů |
| 2 | Obecná pravidla pro vykazování výkonů |
| 3 | Výkony klinických vyšetření |
| 4 | Další pravidla pro vykazování výkonů |
| 5 | Ošetřovací dny |
| 6 | Kategorie pacienta |
| 7 | Úhrada nepřímých nákladů |
| 8 | Doprava a náhrady cestovních nákladů |
2. LIST OF HEALTH PERFORMANCE PERFORMANCE
| 001 | praktický lékař pro dospělé |
| 002 | praktický lékař pro děti a dorost |
| 014 | praktický lékař - stomatolog |
| 015 | čelistní ortopedie |
| 101 | interní lékařství |
| 102 | angiologie |
| 103 | diabetologie |
| 104 | endokrinologie |
| 105 | gastroenterologie a hepatologie |
| 106 | geriatrie |
| 107 | kardiologie |
| 108 | nefrologie |
| 109 | revmatologie |
| 201 | fyziatrie, balneologie a léčebná rehabilitace |
| 202 | hematologie |
| 203 | přenosné nemoci |
| 204 | tělovýchovné lékařství |
| 205 | tuberkulóza a respirační nemoci |
| 206 | klinická farmakologie |
| 207 | alergologie a klinická imunologie |
| 208 | lékařská genetika |
| 209 | neurologie |
| 210 | dětská neurologie |
| 222 | transfúzní služba |
| 301 | pediatrie |
| 302 | dětská kardiologie |
| 303 | dorostové lékařství |
| 304 | neonatologie |
| 305 | psychiatrie |
| 306 | dětská psychiatrie |
| 308 | léčba alkoholismu a jiných toxikománií |
| 309 | sexuologie |
| 401 | hygiena práce a nemocí z povolání |
| 402 | klinická onkologie |
| 403 | radioterapie |
| 404 | dermatovenerologie |
| 405 | dětská dermatologie |
| 406 | korektivnídermatologie |
| 407 | nukleární medicína |
| 501 | chirurgie |
| 502 | dětská chirurgie |
| 503 | úrazová chirurgie |
| 504 | cévní chirurgie |
| 505 | kardiochirurgie |
| 506 | neurochirurgie |
| 507 | hrudní chirurgie |
| 601 | plastická chirurgie |
| 602 | popáleninová medicína |
| 603 | gynekologie a porodnictví |
| 604 | dětská gynekologie |
| 605 | maxillofaciální chirurgie |
| 606 | ortopedie |
| 607 | ortopedická protetika |
| 701 | otorinolaryngologie |
| 702 | foniatrie |
| 704 | dětská otorinolaryngologie |
| 705 | oftalmologie |
| 706 | urologie |
| 707 | dětská urologie |
| 708 | ARO a intenzívní péče |
| 709 | zdravotnická záchranná služba (ZZS) |
| 710 | léčba bolesti |
| 801 | klinická biochemie |
| 802 | lékařská mikrobiologie |
| 804 | lékařská parazitologie |
| 805 | lékařská virologie |
| 807 | patologická anatomie |
| 808 | soudní lékařství |
| 809 | radiodiagnostika |
| 812 | laboratoř klinické farmakologie |
| 813 | laboratoř alergologická a imunologická |
| 814 | laboratoř toxikologická |
| 815 | laboratoř nukleární medicíny |
| 816 | laboratoř lékařské genetiky |
| 817 | laboratoř klinické cytologie |
| 818 | laboratoř hermatologická |
| 819 | laboratoř pro universální výkony |
| 822 | laboratoř lékařské mykologie |
| 823 | laboratoř patologie |
| 901 | klinická psychologie |
| 902 | rehabilitační pracovník - absolvent VŠ |
| 903 | klinická logopedie |
| 904 | jiný zdravotnický pracovník - vysokoškolák |
| 910 | psychoterapie |
| 911 | zdravotní sestra |
| 918 | rehabilitační pracovník - absolvent SZŠ |
| 921 | porodní asistentka |
| 925 | sestra domácí péče |
| 927 | ortoptická sestra |
| 931 | dětská psychologie |
| 949 | jiný zdravotnický pracovník s úplným středním odborným vzděláním |
| 999 | univerzální mezioborové výkony |
Chapter 1
Explanation of the basic terms used in the performance list
| zdravotní výkon | základní jednotka seznamu, popisující ucelenou činnost při poskytování zdravotní péče | |
| kategorie výkonu | kategorie úhrady výkonu - řadí výkon mezi výkony plně hrazené, hrazené za určitých podmínek a nehrazené z všeobecného zdravotního pojištění | |
| autorská odbornost | odbornost, která navrhla a odborně garantuje registrační list výkonu | |
| číslo výkonu | pětimístné číslo jednoznačně identifikující výkon v rámci seznamu výkonů | |
| název výkonu | stručný text vystihující jednoznačně podstatu výkonu | |
| popis výkonu | text, rozvíjející název výkonu, popisující výkon a případně jeho provedení | |
| OM omezení místem | omezení pro vykazování výkonu místem jeho provedení | |
| OF omezení frekvencí | omezení pro vykazování výkonu frekvencí jeho provedení vztaženou na jednoho pojištěnce a jedno nebo více časových období | |
| čas výkonu | čas výkonu v minutách. Čas výkonu je rozhodující pro přiřazení minutové režie dané kategorií zdravotnického zařízení, ve kterém byl výkon proveden. Čas výkonu vyjadřuje dobu, po kterou je pracoviště prováděním výkonu plně vytíženo. | |
| nositel výkonu | zdravotnický pracovník, který se podílí na provedení výkonu. U výkonu jsou přiřazeny osobní náklady jednoho nositele výkonu, pouze výjimečně více nositelů (operační výkony a podobně). Je-li nositelem výkonu alespoň jeden lékař nebo jiný vysokoškolský pracovník, nejsou zásadně k výkonu přiřazeny osobní náklady středních zdravotnických pracovníků (jsou obsaženy v úhradě nepřímých nákladů - režii). | |
| čas nositele výkonu | čas, po který je daný zdravotnický pracovník zaměstnán prováděním právě tohoto jediného výkonu | |
| mzdový index nositele výkonu | index, který charakterizuje kvalifikaci nositele k provedení výkonu a obtížnost provedení výkonu | |
| bodová hodnota výkonu | součet všech přímých nákladů na výkon (osobních nákladů nositele výkonu, nákladů na jednoúčelové přístroje a jejich specifickou údržbu, při provedení výkonu přímo spotřebovaný zdravotnický materiál a při provedení výkonu přímo spotřebované léčivé přípravky) kalkulovaný v korunách a vyjádřený v bodech | |
| ZUM | zvlášť účtovaný zdravotnický materiál, který lze zvlášť účtovat k výkonu, pokud byl odůvodněně při výkonu spotřebován | |
| ZULP OD | zvlášť účtovaný léčivý přípravek. Léčivý přípravek, který lze zvlášť účtovat k výkonu, pokud byl odůvodněně při výkonu spotřebován ošetřovací den |
Chapter 2
General rules for performance reporting
1. PERFORMANCE REPORTING
1. Once performed, the health insurance company pays only one health care institution for one insured person.
2. If the name of the exercise, the description of the performance, the chapter does not specify any other rules or limits on the frequency of the performance, the health insurance company shall pay the individual performance for one insured person to one health care institution on one day only once. The performance of the couple's services shall be paid twice by the health insurance company for one insured person on one day, provided that they have been performed both on both sides, on the right and on the left. The performance performed on individual teeth shall be paid by the health insurance company for one insured person on one day once per tooth on which the performance was performed.
3. Only if a new treatment occurs due to a sudden change in the health status of the insured person (a new visit to the same doctor's office or a visit to the medical practitioner or to the LSPP to the insured person) can be used to account for further treatment according to actual retreatment.
4. The performance shall be paid by the health insurance company only if its content has been fulfilled.
5. All health care that has been reported through the health performance of the health insurance undertaking must be properly documented in the health documentation of the insured person. The entry in the documentation is an integral part of all health performance.
6. The power may only be declared if it has been fully implemented. The partially executed performance cannot be reported to the health insurance undertaking.
7. The amount to be reported in column 060 of this row:
8. In one visit, one insured person may be subject to only one clinical examination of one expertise.
9. Where a health care institution reports at the same time two performances that cannot be reported together under the list of performance, the health insurance undertaking shall be entitled not to reimburse the performance declared unduly.
10. If performance can be charged more than once according to the list, it can only be charged as many times as the full execution time specified in the list of performance has been filled. The time of initiation and the time of termination of these tasks is an essential part of the patient's medical documentation. If the time of commencement and termination of execution cannot be clearly determined from the documentation, the health insurance undertaking shall pay the number one performance.
2. AUTOR TRAINING
1. The professional competence of the health performance in question is expressed by the professional company which has proposed the certificate of performance and is responsible for its professional content.
2. The list of performance of the author's expertise is not binding on the contractual relationship between the health care institution and the health insurance undertaking.
3. PERFORMANCE CATEGORIES
1. Performance with category P is fully covered from general health insurance.
2. Performance with category Q is covered by general health insurance only if it is not declared together with performance complex, repeated complex, targeted or control tests
3. Performance with category W is covered by general health insurance under certain conditions. Unless otherwise stated in the performance, this condition is to perform the performance from a health indication.
4. Performance with category Z is covered by general health insurance with the agreement of the medical examiner of the relevant health insurance company.
4. LOCATION LIMITATIONS
1. Power with restricted location And it's only covered by general health insurance if it's done on an outpatient basis.
2. Performance limited to H is covered by general health insurance only if it has been carried out during hospitalisation.
3. Performance with a limited place S is covered by general health insurance only if it was carried out at a specialised place of work.
4. Performance with a restriction on the place of SA is covered by general health insurance only if it has been performed in an outpatient capacity at a specialised workplace.
5. Performance limited to SH's place is covered by general health insurance only if it was performed in hospitalisation at a specialised place of work.
6. The performance for which the limitation is not specified by the place shall be covered by general health insurance without limitation by the place of execution.
5. RESTRICTIONS ON FREQUENCY
The frequency limitation is based on one insured person, one or more periods of time and one medical facility.
If the performance is reported by one health care institution per insured person more frequently than specified in the frequency limitation, the health insurance undertaking shall be entitled to pay the performance up to the frequency limitation limit, unless the medical examiner decides otherwise.
6. COMPETENT PERFORMANCE
Three categories of power carriers are defined in the power registration sheet. They're
1. physician
2. another university-educated health worker
3. Medium health worker
The power registration sheet also defines the times of individual carriers and their wage indices.
The wage indices shall express the level of qualification of the carrier.
For the purpose of a list of health performance with points, a university-educated physiotherapist, a university-educated ergotherapist, a clinical psychologist and a clinical logoed is considered a physician.
The capacity of the carrier used in the calculation is not a necessary condition for the performance of a particular medical establishment.
6.1. Physician's Indices
Six degrees of wage index is defined for the performance-doctor. They're:
1. Index 1 - performance performance is consistent with the doctor's qualification after graduation
2. Index 2 - Performance performance is consistent with the doctor's practice 24 months
3. Index 3 - performance performance is consistent with the qualifications of a doctor with basic athetics in the field
4. Index 4 - performance performance is consistent with the qualification of a doctor with basic athetics in the field and defined functional specialization
5. Index 5 - Performance intensity corresponds to the qualifications of the doctor with another (second or extension) test in the field
6. Index 6 - performance performance is consistent with the qualification of a doctor with exceptional qualifications
6.2.
For performance holders - other university-educated health workers (JSC), five grades of wage index are set. They're:
1. Index 1 - Performance performance is consistent with the qualification of JSC after graduation
2. Index 2 - Performance performance is consistent with JSC qualification with practice 24 months
3. Index 3 - Performance performance is consistent with the JSC qualification with basic attestations or comparable qualifications
4. Index 4 - Performance performance is consistent with the JSC qualification with a basic approach in the field or comparable qualifications and defined functional specialization
5. Index 5 - Performance intensity corresponds to the JSC qualification with another (second or superstructure) test or comparable qualification
6.3. CAP Indices
Three stages of the wage index have been established for performance carriers - medium health professionals (PMI). They're:
1. Index 7 - Performance performance is consistent with the PMI qualification until completion of the initial practice
2. Index 8 - Performance performance is consistent with the PMI qualification after completion of the initial practice
3. Index 9 - Performance performance is consistent with PMI qualification after graduation (PSS)
6.4. Volume Time Limitation
If, in one calendar month, a health care institution reports the number of performances whose total carrier time for a given category exceeds the limit of 12 hours per full working time of the carrier for each working day of the month, the health insurance undertaking shall pay the total amount charged for the medical performance divided by the excess rate. The coefficient shall be calculated as the ratio of the actual time to the limit time.
7. ZUM AND ZULP
7.1. Reporting ZUM
1. A separately charged material may only be declared for execution if the "ZUM yes' note is given for the performance.
2. As separately charged material (ZUM), only material clearly consumed may be declared for execution.
3. If the material is not consumed whole, the proportional part of it may be reported for execution.
7.2. Reporting of ZULP
1. A specifically charged medicinal product may be declared for performance only if the "ZULP yes * is indicated in the performance.
(2) Blood and blood derivatives and radiopharmaceuticals may be reported as ZULP, whether or not the entry "ZULP yes" in performance.
3. As a specifically charged medicinal product, only a medicinal product clearly consumed may be declared for performance.
4. If the medicinal product is not consumed whole, its proportional part may be declared for performance
7.3. As ZUM or ZULP, it cannot be reported:
1. Medicinal products, special medical supplies and medical devices that can be prescribed a recipe or voucher.
2. Medicinal products, special medical materials and consumables included directly in the power value (PMAT and PLP) or aggregated to the treatment day.
3. Medicinal products covered by the flat-rate.
4. Medicinal products and blood products for both acute and chronic haemodialysis - their costs are included in the performance value.
5. Medicinal products, special medical supplies and medical devices obtained by means other than purchase (pharmacological studies, corporate, research grants, sponsorship gifts, etc.)
8. CONSTRUCTION PRESENT (HOSPITALISATION)
8.1. Acceptance to hospitalization
A comprehensive examination of the relevant expertise shall be reported when the insured person arrives at the hospital. If the insured person has been hospitalised in that establishment within the last three months prior to admission and has been declared to have carried out a clinical examination of this expertise upon receipt, only targeted examinations may be reported.
8.2. Discharge from hospitalization
A targeted examination of the relevant expertise shall be reported when the insured person is released from the hospital.
9. VISITS
9.1. Visits of a physician in a patient
Visits by a doctor to a patient are shown in special procedures. In addition to these performances, the performance of clinical examinations and other performance according to the applicable rules shall be reported.
Visiting a physician in a patient may be shown by the following procedures:
1. Visiting a physician in a patient
2. Visiting a doctor between 19 and 22 hours
3. Visiting a doctor between 22 and 06 hours
4. Visiting a doctor on the day of work or on the day of work
The above performance may be combined in addition to those referred to in points 2 and 3.
9.2. Visits of specialists in patients
In addition to a physician, a doctor may also report a visit to a doctor, but only if a visit is made at the written request of a physician registering a patient.
Visiting a doctor in a patient may be shown by the following procedures:
1. Visiting a specialist in a patient
2. Visiting a doctor between 19 and 22 hours
3. Visiting a doctor between 22 and 06 hours
4. Visiting a doctor on the day of work or on the day of work
The above performance can be combined, except 19-22 and 22-06.
The performance of a specialist's visit to the patient shall be borne by the health insurance company only if the visit is requested by a practitioner. This performance can also be reported when visiting a specialist in a social care institution or similar environment, but only per capita in that institution in one day.
9.3. Visiting Sisters
A nurse's visit is reported to be performance of the 911 author's expertise.
The exercise of the nurse between 22 and 06 hours and the exercise of the nurse on the day of work leave or on the day of work leave may be reported together with the performance performed only if it has been performed on the basis of a written indication by the physician. This indication shall always include the date and time of execution in this case.
9.4. Time spent by transport
The time of the doctor spent on the patient's visit can be reported every 10 minutes. At 1 km distance can be reported at most 2 minutes time.
10. LSPP
During the first-aid medical service, the physician reports clinical examinations of competence 001 and 002, depending on the age of the patient. If the patient is under 18 years of age, the performance of the expertise is 002, in other cases the performance of the expertise 001.
Furthermore, it shows all actual and in full performance while respecting the applicable rules.
During the first aid medical service, the performance of a comprehensive and repeated comprehensive examination cannot be reported.
_
Home care activities are reported by home care health care institutions.
Domestic care activities can only be reported
1. in the indication of the registering physician
2. in the case of an indication by the treating physician during hospitalisation, for a period of not more than 14 days after completion of hospitalisation.
The provisions of home care for a registered practitioner shall be valid for a maximum of 1 month.
12. PERFORMANCE OF STATIM
If the doctor indicates that the performance is performed immediately (the static), the entry in the medical documentation is an integral part of this indication.
Chapter 3
Clinical examination procedures
The performance of clinical examinations is the basic performance by which health care institutions report health care to health insurance companies provided to insured persons.
Clinical examinations shall be divided into complex examinations, repeated complex examinations, targeted tests, control tests, minimum contact and consular examinations, administrative and telephone information.
According to individual authorial expertise, material and instrumentation costs of performance aggregated into clinical examinations are aggregated into the performance of clinical examinations. These are performances for which the "Q - cannot be reported with clinical examination 'is indicated in the performance category list.
1. REPORTING OF CLINICAL INVESTIGATION
1. Only one of the results of the clinical trials may be reported during one visit.
2. It is not possible to combine administrative and telephone information with clinical investigations.
3. For authorial expertise in which there are clinical examinations performed for doctors with one and for doctors with additional tests, the reporting physician shall apply the performance corresponding to his qualifications. A doctor with one athesis in the field shows the performance of clinical examinations by a doctor with one athesis (clinical examination 1), a doctor with a second, or an extension of an athesis in the field shows the performance of clinical examinations by a doctor with another (clinical examination 2).
4. If a doctor with a basic degree is working in a specialised workplace and his qualifications do not allow him to report clinical examinations of the respective author's expertise, he shall report clinical examinations of a doctor with one degree of qualification from which he has passed a basic degree.
5. Clinical examinations can be combined with visitor service.
2. COMPLEX INVESTIGATION
2.1 The performance of a comprehensive examination shall be reported:
1. examination of the patient when taking care of a physician, a doctor for children and adolescents, a female doctor and a dental practitioner
2. examination of the patient when taking over into regular long-term care of an outpatient specialist
3. examination of the patient when receiving hospitalization if hospitalisation has not been preceded by hospitalisation in the same workplace in the last three months
2.2 The content of the performance of the complex examination is mainly:
1. detailed history including family, work and social history
2. assessment of subjective difficulties
3. evaluation of previous clinical, laboratory and imaging examinations
4. general objective examination, in general physicians, internal and surgical fields including perrectum
5. Measurement of height, weight, blood pressure, pulse, breath rate, or rate of exhalation by the peakflowmeter
6. basic indicative preventive oncological examination
7. diagnostic balance sheet and conclusion
8. decision on further diagnostic procedure, including the request of further clinical, laboratory or imaging examinations
9. Decision on therapeutic procedure, including prescription of drugs or PZT
10. small therapeutic performance
11. decision on the date of further inspection
12. provision of adequate information to the sick or family
13. psychotherapy interview
14. Individual health education
15.
16. medical report - finding
17. administrative activity associated with performance (PN, Czech Republic, confirmation of the duration of PN, mandatory reports, request for medical transport and so on), provision of information to the physician, including a record of patient consent or disagreement with the proposed diagnostic - therapeutic procedures
18. entry of the whole procedure into the health file
3. REPEATED COMPLEX INVESTIGATION
A repeat comprehensive examination may be reported only by a physician and a physician for children and adolescents.
3.1. The performance of repeated comprehensive examination is reported
Preventive search.
3.2 The content of the repeated complete examination is mainly:
1. detailed history including family, work and social history with emphasis on changes since the previous comprehensive or repeated comprehensive examination
2. assessment of subjective difficulties
3. evaluation of previous clinical, laboratory and imaging examinations
4. General objective examination, including perrectum, general practitioner and general practitioner for children and initial sensory examination and psychomotor development
5. Measurement of height, weight, blood pressure, pulse, breath rate, possible exhalation rate by the peakflowmeter
6. basic indicative preventive oncological examination
7. diagnostic balance sheet and conclusion
8. decision on further diagnostic procedure, including the request of further clinical, laboratory or imaging examinations
9. Decision on therapeutic procedure, including prescription of drugs or PZT
10. small therapeutic performance
11. decision on the termine of further checks
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Regulation Information
| Citation | Decree of the Ministry of Health No. 45 / 1997 Coll., which publishes a list of health performance with points |
|---|---|
| Regulation Type | Order |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 26.03.1997 |
|---|---|
| Effective from | 01.07.1997 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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