How do you calculate procedures performed by video technique?

“How do you calculate procedures performed by video technique?”

Rivio answers

Procedures performed by video technique should be calculated in the same way as other surgical procedures, following the guidelines of the Brazilian Hierarchical Classification of Medical Procedures (CBHPM), especially items 3.2 and 3.3 of the General Instructions.

According to the CBHPM, surgical procedures performed by video have their own tiers, independent of their counterparts performed by conventional technique.

These tiers are defined using the same criteria that apply to traditional procedures, such as surgical time, cognition, complexity and risk, and are subject to the rules set out in item 6 of the General Instructions.

Reference: CBHPM 2016 – General Instructions, p. 2, item 3.2

Item 6 deals with valuing the surgical tier in cases where the patient opts, of their own accord or because of a higher-tier plan, for hospital accommodation different from that provided for in the original plan. In these situations, the CBHPM allows the tier to be charged at double, except for procedures in Chapter IV (Diagnostic and Therapeutic Procedures).

When the higher-tier accommodation is chosen voluntarily by the patient, the supplement to the tier must be negotiated directly between physician and patient, using the criteria in item 6.2 as a reference.

For higher-tier plans offered by health plans, the CBHPM provides for the tier to be valued at double in cases of admission to an apartment, private room, day hospital or ICU. Any operational agreements between health plans and hospitals cannot reduce the tiers established for the medical team.

Reference: CBHPM 2016 – General Instructions, p. 2, items 6.1, 6.2 and 6.3

Another relevant point in calculating video procedures is the ownership of the equipment used. When the equipment belongs to the medical team, the team is entitled to the equipment use fee, duly valued in the CBHPM’s Operating Cost column.

If the equipment belongs to the hospital, this fee must be negotiated between the provider and the health plan, as is the case with the room fee for surgical and invasive procedures.

Reference: CBHPM 2016 – General Instructions, item 3.3

A practical calculation example

Procedure: 31005497 – Laparoscopic cholecystectomy without cholangiography
Accommodation: standard
CBHPM reference: October 2016

Procedure data:

• Surgical tier: 9C

• Anesthetic tier: 5

• Operating cost: 34.470 UCO

• Number of assistants: 2

• UCO value: R$ 19.36

Calculated amounts:

• Surgical tier (9C): R$ 1,122.76

• Anesthetic tier (7C): R$ 730.18

• Operating cost (34.470 × R$ 19.36): R$ 667.34

• 1st assistant (30% of the tier): R$ 336.83

• 2nd assistant (20% of the tier): R$ 224.55

Total procedure amount:
R$ 3,081.66