Dutch Healthcare Authority published the second release of the 2023 DRG package

On September 22, 2022, the Dutch Healthcare Authority (NZa) published the second release of the DRG package for the year 2023 (RZ23b) that applies to specialist medical care and geriatric rehabilitation care. It includes one new procedure code for multi-day research into hypersensitivity to light, one new procedure code for hysterosalpingo-foam sonography, as well as the split of nine existing procedure codes for breast reconstruction into eighteen new procedure codes specifying primary or secondary intervention and other (including tertiary breast reconstruction and cosmetic procedures). Some examples of new procedure codes include:

• 039486 “Hysterosalpingo Foam Sonography (Hysterosalpingo Foam Sonography - HyFoSy)”;
• 033978 “Insertion of a breast prosthesis for augmentation, primary or secondary reconstruction”;
• 033988 “Insertion of a breast prosthesis for augmentation, excluding insertion in primary or secondary reconstruction”.

Eight new supplementary payments (OZPs) will be implemented, including two new OZPs for expertise advice performed by another institution, two new OZPs for oral surgery (defect repair with microvascular free skin and muscle flap with or without bone), two new OZPs for molecular diagnostics requested by specialists who do not register the DRG (dental surgeon, general practitioner), and two new OZPs for medical specialist examination for driver's license. Some examples of new OZP codes include:

• 039041 “Repair of defect with microvascular free skin and boneless muscle flap, including tissue graft acquisition and placement”;
• 190174 “Expert advice performed by another institution, without patient contact”;
• 190175 “Expert advice performed by another institution, with patient contact”.

Seven new DRGs will be implemented, including six new DRGs for light therapy or diagnostic examination with light and one new DRG for treatment and/or examination in the abdominal cavity via laparoscopy for assistance related to reproduction in women. Some examples of new DRG codes include:

• 029499057 “Light therapy or diagnostic examination with light for skin cancer or its early signs”;
• 120201015 “Light therapy for a skin condition with blisters”;
• 210301019 “Treatment and/or examination in the abdominal cavity via keyhole surgery for assistance related to reproduction (woman)”.

Since 2023, new funding models will be implemented for telemonitoring and molecular diagnostics.

Telemonitoring (039133 “Telemonitoring”) will be reimbursed as OZP under the category “Add-on other” with a national tariff of €164.13. It will be used for reimbursement of the remote monitoring as a part of medical specialist care outside the walls of the medical institution. Before 2023 the procedure code for telemonitoring was used for registration only and did not attack any reimbursement;

The payment model for molecular diagnostics will change from DRG to OZP under the category “Add-on other” with negotiable tariffs. The new payment model concerns the following codes for molecular diagnostics:

• 050541 “Pathological research – simple molecular diagnostics on tissues and/or cells for a limited number of genes and/or micro-organisms”;
• 050542 “Pathological research – simple molecular diagnostics on tissues and/or cells for multiple genes and/or micro-organisms”;
• 050543 “Pathological research – complex molecular diagnostics on tissues and/or cells for a limited number of genes”;
• 050544 “Pathological research – complex molecular diagnostics on tissues and/or cells based on multiple genes”;
• 050545 “Pathological research – complex molecular diagnostics on tissues and/or cells for many genes”.

The effective date of the release is January 1, 2023.

The full details in Dutch can be found here.

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