A new standardised nomenclature in ophthalmology: Criteria and quantitative evaluation indicators of medical procedures

• Published in: Archivos de la Sociedad Española de Oftalmología (English ed.) 2020-12, Vol.95 (12), p.591-602
• Main Authors: Gegúndez-Fernández, J.A., Piñero-Bustamante, A., Benítez-del-Castillo, J.M., García-Feijoo, J., Muñoz-Negrete, F.J., Figueroa, M.S., Encinas-Martín, J.L.
• Format: Article
• Language: English
• Subjects: Acto médico; Criterios de baremación; Grading indicators; Medical act; Nomenclature; Nomenclátor; Oftalmología; Ophthalmology; Relative value unit; Unidad relativa de valor
• ISSN: 2173-5794; 2173-5794
• DOI: 10.1016/j.oftale.2020.07.002

To create a new list of medical procedures in ophthalmology based on the International Classification of Diseases ICD-9-CM. To establish the general principles that define criteria, quantitative indicators, and scales. To develop the algorithms needed to calculate fees for medical procedures. The out-of-date processes were removed from the list, and new techniques were added, descriptors were modified, procedures with similar descriptions were grouped together, and others were relocated to other group according to surgical complexity conditions. The criteria to calculate the medical fees were defined: training and complexity (U), proficient responsibility (R), and health value (V), with their respective quantitative indicators: period of training necessary to master a technique, frequency of complications that worsen the preoperative situation, and days of incapacity for work due to the process. The Relative Value Unit (RVU) was defined as the score sum of R, V and U. The final fee per medical procedure was calculated as the product of the RVU by its unit cost and by the weighting coefficient (WC). A new catalogue was prepared with 161 medical procedures, grouped into consultations, diagnostic procedures (DX.PR), therapeutic procedures (TX.PR), and surgical interventions, increasing in complexity from group 0 to group 8. The following characters were described for each one of the procedures: OMC and ICD-9-MC code, descriptor term, group, proposed modification: no changes or minimums in the descriptors, grouping of acts by similar definitions, change of origin group, new procedures, and procedures removed. The indicators for assessment were also scored: U between 1−4 points, and R and V between 0−3 points. Using their sum, the number of RVUs per medical procedure (between 1 and 10) was calculated which, together with the unit cost of the RVU and the WC (between 0.05 and 1), will determine the final rate. The new standardised ophthalmological nomenclature updates and improves the old classification, adapting the procedures to the descriptors included in the ICD-9-CM, and incorporating all the new techniques. Additionally, the declaration of the general principles allows defining new criteria, quantitative indicators, rating scales, and algorithms to calculate fees for medical procedures. Elaborar un nuevo nomenclátor de actos y procedimientos médicos en oftalmología basado en la Clasificación Internacional de Enfermedades CIE-9-MC. Establecer los principios