Guideline on reporting of PHC in the DRG system

The CKS team issues Guidance on the reporting of PHC in the DRG system. The document is being issued as guidance on the 274e data interface and applies to situations occurring from 1.1.2025. The document describes the basic features of the reporting and calculation of case lump sums in the situation where the PHC has, but also does not have, a contracted PHC in the DRG. From both perspectives it looks at and describes approaches such as:

• to proceed with reporting at sites 1 or 4,

• what data interfaces to use,

• calculate the case lump sum when classified in the PICU and non-ICU DRG groups,

• use the List of Medical Procedures and Attributable Items for different situations.
  

This document is intended to help smooth the implementation of PHC in DRGs. If you have suggestions or questions on how to ensure a smoother implementation of UHC in DRGs, please feel free to send us your suggestions in the Feedback section of the newly created Overnight Healthcare category.