Purposeful standardisation: from patient record to billing and statistics

Patient records in a hospital or a doctor's surgery serve to document and optimise treatment. They are individual to each doctor and focus on the treatment; for that reason, they are written in varied and very detailed specialist medical terminology.

OPS is a classification of operations, procedures and general medical measures with parallel machine-readable codes. Its primary purpose is the encoding for billing and statistics; the formation, designation and scope of individual classes is guided by these purposes.

The application of OPS to the documented procedure descriptions generalises their content and reduces the language to mandatory unambiguous preferred terms; the descriptions in clear text are assigned an unambiguous machine-readable code. Mandatory sector-specific encoding guidelines ensure a uniform application across Germany.

OPS in the billing and financing of medical services

OPS encoded procedures and measures control large cash flows:

Since 2004, inpatient and some semi-inpatient hospital services are billed based on a case-based fixed sum system for hospitals, the so called "G-DRG-System" (German Diagnosis Related Groups). The legal basis for this is § 17b of the German Hospital Finance Act (KHG). Since 2013 there is a special reimbursement system for psychiatric and psychosomatic institutions pursuant to § 17d of KHG, the "PEPP-Entgeltsystem". ICD-10-GM and OPS form the basis of the G-DRG and PEPP case-based fixed sum systems. The systems are published by the Institute for the Hospital Remuneration System (InEK GmbH, DRG Institute) on behalf of the self-governing of the German healthcare system.

The German Uniform Assessment Standard (EBM) is the conclusive catalogue of all items in the doctor's fee schedule that are billable in outpatient medical care. The encoding of diagnoses in accordance with ICD-10-GM and of outpatient procedures in accordance with OPS are part of the service provision and a prerequisite for service remuneration in outpatient medical care.

OPS in statistics and quality assurance

Information about case numbers for main procedures included in federal government reports and competence procedures in hospital quality reports are also based on OPS encoded procedures and measures.