The problem: these are so-called "new treatment methods" within the meaning of Section 135 SGB V. The costs are only covered by statutory health insurance if there is a positive recommendation from the Federal Joint Committee (GBA), which is currently not the case.
Even if patients are successfully stabilised with the help of blood purification procedures, hospitals must expect that the billing of the operation and procedure code (OPS) no. 8-821.2 with the corresponding additional charge will be objected to by health insurance companies. The reason given for this is that the current evidence does not yet permit a recommendation on guideline quality.
This argument appears dubious. According to the so-called "Nikolaus decision" of the Federal Constitutional Court in 2005, it is not compatible with fundamental rights to exclude patients with life-threatening illnesses from a medical treatment method if this is the only available option and there is a prospect of a cure. Studies show a significantly higher chance of survival through the use of the blood purification procedure. The Federal Social Court has recently relaxed its decision-making practice and the first decisions of the social courts confirm this argument.
There are therefore good reasons for hospitals to defend themselves against objections to the billing of OPS No. 8-821.2 for treatment with CytoSorb or Oxiris.
Dr Christoph Bialluch Sophie Erbersdobler