Excluded Services

Excluded services are services that can be reimbursed separately of a flat rate. Excluded services are specified in annex B (6.1) and B2 (Pathology) and contain blood products, implants in certain flat rates and pathology services. The Tarifmatcher does not automatically handle excluded services. For pathology services a helper method is provided to identify pathology services in a patient case which is documented below. Pathology is the only excluded service that is reimbursed by TARDOC and hence has to be mapped.

Pathology Services

According to annex B2 Pathology services can be reimbursed separately of a flat rate. Pathology services are identified by their specialty (Fachbereich) codes “M800.02” Dermapathologie, “M990.08” Molekularpathologie, “M990.10” Pathologie.

In order to identify pathology services, the specialty code must be assigned to the session or the service itself.

Example code snippet to separately reimburse/map pathology services in a patient case using the helper method extractPathologyServices() of PatientCase:

PatientCase pc = new PatientCase();
/** pathology service  */
Service s1 = new Service("JM.10.0010");
s1.setSpecialty("M990.10");
pc.addService(s1);
/** Add other services. */
/** ... */

/** Group. Assign group result in order to determine if the case is reimbursed by flat rates. */
/** ... */

/** Map services to TARDOC tariff positions. */
Mapper mapper = new Mapper(new ServiceCatalog(), new TardocCatalog());
MapperResult mapperResult = null;

if ("No.ambP".equals(pc.getGrouperResult().group)){
    /** no flat rate. map all services. */
    mapperResult = mapper.map(pc);
} else {
    /** flat rate. map only pathology services. (can be reimbursed separately.) */
    List<Service> pathologyServices = pc.extractPathologyServices();
    PatientCase pathologyOnlyCase = new PatientCase(pc);
    pathologyOnlyCase.setServices(pathologyServices);
    mapperResult = mapper.map(pathologyOnlyCase);
}