Nuevo nomenclátor estandarizado en oftalmología: Criterios e indicadores cuantitativos de baremación de actos médicos / A new standardised nomenclature in ophthalmology: Criteria and quantitative evaluation indicators of medical procedures

OBJETIVO: Elaborar un nuevo nomenclátor de actos y procedimientos médicos en oftalmología, basado en la Clasificación Internacional de Enfermedades CIE-9-MC. Establecer los principios generales y definir los criterios de baremación, indicadores cuantitativos y escalas de valoración. Determinar los algoritmos necesarios para el cómputo de las tarifas retributivas por acto médico. MÉTODOS: Sobre el nomenclátor vigente, se eliminaron los procesos obsoletos, añadieron otros nuevos, modificaron descriptores, agruparon procedimientos con descripciones similares y trasladaron de grupo otros, por razones de complejidad quirúrgica. Se definieron los criterios de baremación para el cálculo de las retribuciones médicas: formación y complejidad (U), responsabilidad profesional (R) y valor salud (V), con sus indicadores cuantitativos, respectivamente: periodo de formación necesario para dominar una técnica, frecuencia de complicaciones que agravan la situación preoperatoria, y días de incapacidad laboral que ocasiona el proceso. Se definieron las Unidades Relativas de Valor (URV) como la suma de puntos de U, R y V. La tarifa final por acto médico se calculará como el producto del número de URV por su coste unitario y por el coeficiente de ponderación (CP). RESULTADOS: Se elaboró un nuevo nomenclátor con 161 actos médicos agrupados en consultas, procedimientos diagnósticos (PR.DX), procedimientos terapéuticos (PR.TX) e intervenciones quirúrgicas (IQ) crecientes en complejidad desde el grupo 0 hasta el grupo 8. Para cada uno de los actos se describieron los siguientes caracteres: códigos OMC y CIE-9-MC, término descriptor, grupo, modificación propuesta: sin cambios o mínimos en los descriptores, agrupación de actos por definiciones similares, cambio de grupo de origen, actos eliminados y nuevos procedimientos. Asimismo, fueron puntuados los tres criterios de baremación: U entre 1-4, R entre 0-3 y V entre 0-3. Mediante su suma se calcularon el número de URV por acto médico (entre 1 y 10), que junto con el coste unitario de la URV y el CP (entre 0,05 y 1) determinarán la tarifa final. CONCLUSIONES: El nuevo nomenclátor de oftalmología actualiza y mejora el catálogo antiguo, adecuando los procedimientos a los descriptores recogidos en la CIE-9-MC e incorporando todas las técnicas actuales. Adicionalmente, la declaración de los principios generales permite definir nuevos criterios de baremación, indicadores cuantitativos, escalas de valoración y algoritmos de cómputo de las tarifas por acto médico

PURPOSE: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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

A new standardised nomenclature in ophthalmology: Criteria and quantitative evaluation indicators of medical procedures. / Nuevo nomenclátor estandarizado en oftalmología: Criterios e indicadores cuantitativos de baremación de actos médicos.

PURPOSE: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.

[Guidelines of clinical practice of the SERV: treatment of exudative age-related macular degeneration (AMD)]. / Guías de práctica clínica de la SERV: tratamiento de la degeneración macular asociada a la edad (DMAE) exudativa.

OBJECTIVE: Age related macular degeneration (ARMD) in its neovascular form is a serious disease which produces legal blindness in many patients with poor prognosis if left untreated. We intend to establish a clinical guide with the different therapeutic options that exist nowadays, which may help the ophthalmologists in their clinical practice. METHODS: A group of medical retina experts selected by SERV have evaluated the results of different published studies with the drugs currently available, obtaining an evidence-based consensus. Some recommendations have been established for diagnosis, treatment and monitoring of patients with neovascular ARMD. RESULTS: The intravitreal injection of ranibizumab at a dosage of 0.5 mg produces significant improvement of visual acuity in subfoveal lesions, according to data obtained from studies with the highest level of evidence. It should be considered as a first choice drug. The use of bevacizumab, a drug with not approved indication for intraocular use, nor for the treatment of neovascular ARMD can reach a result which is closer to the ones obtained with ranibizumab than to those obtained with photodynamic therapy (PDT) and pegaptanib. The use of intravitreal pegaptanib sodium in intravitreal injection at a dosage of 0.3 mg as a treatment for subfoveal lesions can obtain similar results to the TFD, but with a wider range of injuries. CONCLUSION: The results of the evidence-based studies are a good guide for the treatment of this disease.

Guías de práctica clínica de la SERV: tratamiento de la degeneración macular asociada a la edad (DMAE) exudativa / Guidelines of clinical practice of the SERV: treatment of exudative age-related macular degeneration (AMD)

Objetivo: La Degeneración Macular Asociada a laEdad (DMAE) en su forma húmeda supone unagrave enfermedad que condiciona ceguera legal enmuchos pacientes y con mal pronóstico si no es tratada.Pretendemos establecer una guía de actuaciónclínica con las diferentes opciones terapeúticas queexisten en el momento actual, que puedan ayudar aloftalmólogo en su práctica clínica.Métodos: Un grupo de expertos en retina médicaseleccionados por la SERV han evaluado los resultadosde los diferentes estudios publicados con losfármacos actualmente disponibles, llegando a un consenso basado en la evidencia. Se han establecidounas recomendaciones para el diagnóstico, tratamientoy seguimiento de los enfermos con DMAEhúmeda.Resultados: La inyección intravítrea de ranibizumaba la dosis de 0,5 mg permite obtener mejoríassignificativas de la agudeza visual en lesiones subfoveales,según los datos obtenidos de estudios conmáximo nivel de evidencia. Debe ser consideradocomo el fármaco de primera elección. El empleo debevacizumab, fármaco sin indicación aprobada parauso intraocular, ni para el tratamiento de la DMAEhúmeda, puede aportar un beneficio más próximo alos resultados obtenidos con el ranibizumab que alos obtenidos con la terapia fotodinámica (TFD) yel pegaptanib. El uso de pegaptanib sódico eninyección intravítrea a la dosis de 0,3 mg como tratamientode lesiones subfoveales permite obtenerresultados parecidos a la TFD, pero en un abanicomás amplio de lesionesConclusiones: Los resultados de los estudios basadosen la evidencia constituyen una buena guía deactuación en el tratamiento de esta enfermedad(AU)

Objective: Age related macular degeneration(ARMD) in its neovascular form is a serious diseasewhich produces legal blindness in many patientswith poor prognosis if left untreated. We intend toestablish a clinical guide with the different therapeuticoptions that exist nowadays, which may helpthe ophthalmologists in their clinical practice.Methods: A group of medical retina experts selectedby SERV have evaluated the results of differentpublished studies with the drugs currently available,obtaining an evidence-based consensus. Somerecommendations have been established for diagnosis, treatment and monitoring of patients with neovascularARMD.Results: The intravitreal injection of ranibizumabat a dosage of 0.5 mg produces significant improvementof visual acuity in subfoveal lesions, accordingto data obtained from studies with the highestlevel of evidence. It should be considered as a firstchoice drug. The use of bevacizumab, a drug withnot approved indication for intraocular use, nor forthe treatment of neovascular ARMD can reach aresult which is closer to the ones obtained with ranibizumabthan to those obtained with photodynamictherapy (PDT) and pegaptanib. The use of intravitrealpegaptanib sodium in intravitreal injection at adosage of 0.3 mg as a treatment for subfoveallesions can obtain similar results to the TFD, butwith a wider range of injuries.Conclusion: The results of the evidence-based studiesare a good guide for the treatment of this disease(AU)

[Herpes simplex keratitis following laser in situ keratomileusis]. / Queratitis por herpes simplex tras láser in situ keratomileusis.

CASE REPORT: A 40-year-old woman underwent bilateral Laser In Situ Keratomileusis (LASIK) for the correction of myopia and astigmatism. The day after, four dendritic ulcers appeared in her left eye. She was treated with topical antiviral agents until complete recovery. She had a history of recurrent labial herpetic infection. DISCUSSION: Reactivation of herpes simplex virus type 1 can occur, even without any previous history of corneal infection. Although this does not contraindicate surgery, all patients with a history of herpetic infection should be made aware of the complications related to this technique.

Queratitis por herpes simplex tras láser in situ keratomileusis / Herpes simplex keratitis following laser in situ keratomileusis

Caso clínico: Paciente mujer de 40 años de edad que se intervino de miopía y astigmatismo en ambos ojos mediante láser in situ keratomileusis (LASIK). Al día siguiente presentaba cuatro úlceras corneales dendríticas en su ojo izquierdo. Fue tratada mediante agentes antivirales tópicos hasta su total recuperación. La paciente refería antecedentes de herpes labial recidivante. Discusión: El virus del herpes simplex tipo 1 puede reactivarse tras el LASIK, incluso sin que exista historia previa de herpes corneal. Aunque no contraindica la cirugía, debería tenerse en cuenta el antecedente de infección herpética al explicar las posibles complicaciones de esta técnica (AU)

[Contrast vision in patients with aphakia and pseudophakia]. / Etude sur la vision de contraste chez les aphakes et les pseudophakes.

A study was carried out on contrast vision in 26 aphakic patients (48 operated eyes) and 37 pseudophakic patients (37 operated eyes); in some cases an intraocular PMMA lens had been implanted, in others an IOGEL (polimacon) had been implanted. The level of sensitivity to contrast in both cases was found to be lower than expected by the Vistech company for aphakics. At the same time a comparative study was carried out of the results obtained for sharpness of vision in aphakic and pseudophakic patients, with the traditional tests of Snellen (long sightedness) and Parinaud (short sightedness) and those obtained with the Contrast Sensitivity Test System (VCTS-6500 for long sightedness and VCTS-6000 for short sightedness). The former tests were found to overestimate the visual results. Corrected aphakia was found to affect the sensitivity to contrast more than in pseudophakic cases. Nevertheless no significant differences were found between contrast vision in eyes with PMMA lens implantation and eyes with IOGEL (polimacon) lens implantation. Summing up, alterations in the sensitivity to contrast undetected by the simple measurement of visual sharpness were found.

[Prediction of post-surgical astigmatism in pseudophakia]. / Prédiction de l'astigmatisme post-chirurgical dans la pseudophakie.

After cataract surgery, the patient wants its vision to be as he remembers it was. We known that this is very difficult to reach; however it is quite possible to approach what would be a practically normal vision, since rather than attaining maximum vision possible (10/10), we must attain what the patient sees as normal dimensions in the space. If there is a high degree of astigmatism left, this goal will not be fully attained even with an intraocular lens. Therefore, we have analyzed the degree, type and evolution of astigmatism along the time, after EICC in some cases and planned EECC in other cases, using in the first ones resorptive sutures and in the second ones non-resorptive sutures, so to predict, through a statistical study, and in each one of the two groups, the astigmatism the patients will have in each one.