On approval of the nomenclature of medical services. How are additional paid medical services provided according to the Nomenclature of Medical Services? Innovations in the range of medical services
Ministry of Health Russian Federation
(Ministry of Health of Russia)
On approval of the nomenclature of medical services
In accordance with Article 14 Federal Law dated November 21, 2011 N 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” (Collected Legislation of the Russian Federation, 2011, N 48, Art. 6724; 2012, N 26, Art. 3442, 3446; 2013, N 27 , Art. 3459, Art. 4038; Art. 4883; Art. 6951; , 4247, 4257; Art. 5798; 2015, Art. 72, 85; Art. N 27, Art. 3951; Art. 4339, 4359; 4219) I order:
1. Approve the attached nomenclature of medical services.
2. To recognize as invalid:
Order of the Ministry of Health of the Russian Federation dated October 28, 2013 N 794n "On amendments to the order of the Ministry of Health and Social Development of the Russian Federation dated December 27, 2011 N 1664n "On approval of the range of medical services" (registered by the Ministry of Justice of the Russian Federation on December 31, 2013 city, registration N 30977);
order of the Ministry of Health of the Russian Federation dated December 10, 2014 N 813n "On introducing changes to the nomenclature of medical services approved by order of the Ministry of Health and Social Development of the Russian Federation dated December 27, 2011 N 1664n" (registered by the Ministry of Justice of the Russian Federation on January 19, 2015 ., registration N 35569);
order of the Ministry of Health of the Russian Federation dated September 29, 2016 N 751n "On introducing changes to the nomenclature of medical services approved by order of the Ministry of Health and Social Development of the Russian Federation dated December 27, 2011 N 1664n" (registered by the Ministry of Justice of the Russian Federation on October 25, 2016 ., registration N 44131);
order of the Ministry of Health of the Russian Federation dated August 24, 2017 N 548n "On introducing changes to the nomenclature of medical services approved by order of the Ministry of Health and Social Development of the Russian Federation dated December 27, 2011 N 1664n" (registered by the Ministry of Justice of the Russian Federation on September 13, 2017 ., registration N 48161).
Approved
by order of the Ministry of Health
Russian Federation
dated October 13, 2017 N 804n
Nomenclature of medical services
I. General provisions
1. Nomenclature of medical services(hereinafter referred to as the Nomenclature) is a systematic list of codes and names of medical services in healthcare.
2. Medical service coding algorithm in the Nomenclature is presented in the diagram:
The service code consists of an alphanumeric code from 8 to 11 (12<*>) signs. The first character indicates the section of the service, the second and third characters indicate the type of medical service, the fourth and fifth (sixth<*>) signs – class of medical service (anatomical-functional area and/or list of medical specialties), from the sixth to the eleventh signs (from the seventh to the twelfth<*>) – type, subtype of service.
––––––––––––––––––––––––––––––––
<*>For section "B".
3. The list of medical services is divided into two sections: “A” and “B”, built on a hierarchical principle.
Section "A" includes medical services, which are certain types of medical interventions aimed at the prevention, diagnosis and treatment of diseases, medical rehabilitation and having an independent, complete meaning.
Section "B" includes medical services, which are a complex of medical interventions aimed at the prevention, diagnosis and treatment of diseases, medical rehabilitation and having an independent, complete meaning.
4. Section "A":
4.1. Section "A" indicates a specific type of medical service:
4.2. Section class "A" (from 01 to 31) indicates the anatomical and functional area:
01 – skin, subcutaneous fat, skin appendages
02 – muscular system
03 – skeletal system
04 – joints
05 – hematopoietic system and blood
06 – immune system
07 – oral cavity and teeth
08 – upper Airways
09 – lower respiratory tract and lung tissue
10 – heart and pericardium
11 – mediastinum
12 – large blood vessels
13 – microcirculation system
14 – liver and bile ducts
15 – pancreas
16 – esophagus, stomach, duodenum
17 – small intestine
18 – large intestine
19 – sigmoid and rectum
20 – female genital organs
21 – male genital organs
22 – endocrine glands
23 – central nervous system and brain
24 – peripheral nervous system
25 – organ of hearing
26 – organ of vision
27 – olfactory organ
28 – kidneys and urinary system
29 – mental sphere
30 – others.
The class of medical service is identical in all standard sections. If a specific service is not allocated for a class in a certain typical section, then this class is not registered, while its serial number is retained.
The “Other” class includes medical services that cannot be classified in the corresponding anatomical and functional subsection (for example, performed during pregnancy, childbirth, a newborn, diagnostic laparoscopy, survey of the abdominal organs).
4.3. Type of medical service(001 to 999) denotes medical services that have a complete diagnostic or therapeutic value.
5. Section "B":
5.1. Section "B" indicates a specific type of medical service:
5.2. Classes of section "B" (from 001 to 070) indicate a list of medical specialties:
001 – obstetrics and gynecology
002 – allergology and immunology
003 – anesthesiology and resuscitation
004 – gastroenterology
005 – hematology
006 – genetics
007 – geriatrics
008 – dermatovenerology and cosmetology
009 – pediatric oncology
010 – pediatric surgery
011 – pediatric endocrinology
012 – diabetology
013 – dietetics
014 – infectious diseases
015 – cardiology, pediatric cardiology
016 – clinical laboratory diagnostics
017 – clinical pharmacology
018 – coloproctology
019 – laboratory genetics
020 – physical therapy and sports medicine
021 – social hygiene, sanitation and epidemiology
022 – manual therapy
023 – neurology
024 – neurosurgery
025 – nephrology
026 – general medical practice (family medicine)
027 – oncology
028 – otorhinolaryngology
029 – ophthalmology
030 – pathological anatomy
031 – pediatrics
032 – neonatology
033 – occupational pathology
034 – psychotherapy
035 – psychiatry and forensic psychiatric examination
036 – psychiatry-narcology
037 – pulmonology
038 – radiology and radiotherapy
039 – radiology
040 – rheumatology
041 – reflexology
042 – sexology
043 – cardiovascular surgery, endovascular diagnostics and treatment
044 – emergency medical care
045 – forensic medical examination
046 – audiology-otorhinolaryngology
047 – therapy
048 – toxicology
049 – thoracic surgery
050 – traumatology and orthopedics
051 – transfusiology
052 – ultrasound diagnostics
053 – urology, pediatric urology–andrology
054 – physiotherapy
055 – phthisiology
056 – functional diagnostics
057 – surgery, surgery (organ and tissue transplantation) and combustiology
058 – endocrinology
059 – endoscopy
060 – bacteriology
061 – virology
062 – epidemiology
063 – orthodontics
064 – pediatric dentistry
065 – therapeutic dentistry and general dentistry
066 – orthopedic dentistry
067 – surgical dentistry
068 – Maxillofacial Surgery
069 – osteopathy
070 – others.
The class of medical service is identical in all standard sections. If a specific service is not allocated for a class in a certain standard section, then this class is not registered, while its serial number is retained.
The "Other" class includes medical services that cannot be classified in the appropriate subsection (for example: medical psychologist services).
5.3. Type of medical service(001 to 099) denotes medical services that have a complete diagnostic or therapeutic value.
The subtype of medical service (from 001 to 999) denotes medical services depending on the methods (techniques) of their implementation.
Some medical services may not contain subtypes of services.
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Is it possible to provide paid medical services that are not specified in the Nomenclature of Medical Services approved by Order of the Ministry of Health of October 13, 2017 No. 804? The Ministry of Health provides clarification on this issue in its Letter dated July 4, 2018 No. 17-2/10/2-4323 “On the rules for the provision of paid medical services by medical organizations.”
The information is relevant for course participants professional retraining and advanced training in the following areas:
Paid medical services must comply with the Nomenclature and List of Medical Services
Today there are a number of fundamental legal acts that regulate the provision of medical services. These primarily include the Federal Law of May 4, 2011 No. 99-FZ “On licensing of certain types of activities,” which clearly states that medical activities must be licensed. In accordance with this requirement, there are 2 main legal acts: Regulations on licensing with a List of services and Nomenclature of medical services.
- The Decree of the Government of the Russian Federation of April 16, 2012 No. 291 “On licensing of medical activities” approved the Regulations on Licensing, which provides a List of works (services) that constitute medical activities.
- The departmental order No. 804 dated October 13, 2017 approved the Nomenclature of Medical Services.
Respectively , medical organizations, when creating a list of paid medical services, should focus on these documents.
At the same time, the Ministry of Health indicates in its Letter that the Nomenclature contains generalized names of medical services, and the provided list of medical services is not exhaustive.
How to navigate the Nomenclature of Medical Services?
The nomenclature of medical services is a system of lists of codes and names of medical services provided in the healthcare system. The list itself is divided into two main sections:
- Section A
- Section B.
Each of them is built on a hierarchical principle.
What does Section “A” include in the Nomenclature of Medical Services?
Section “A” includes medical services in the form of certain medical interventions that are aimed at the prevention, diagnosis and treatment of diseases, and medical rehabilitation. Such services have an independent, complete meaning.
- Numbers from 01 to 27 indicate types of medical services.
- Classes denoting anatomical and functional area - numbers from 01 to 30.
Classes of medical services may not include a specific service
The fourth and fifth digits indicate the class of medical service. The class of medical service is identical in all standard sections. If a specific service is not allocated for a class in a certain typical section, then this class is not registered, while its serial number is retained.
Medical services that cannot be classified into any specific class
The “other” class includes such medical services that cannot be classified in the corresponding anatomical and functional subsection (for example, performed during pregnancy, childbirth, a newborn, diagnostic laparoscopy, survey of the abdominal organs).
Types and subtypes of medical services in section “A” of the Nomenclature
Numbers from 001 to 999 indicate the type of medical service. These services have a complete diagnostic or therapeutic value.
The last numbers from 001 to 999 indicate the subtype of medical service. They are determined depending on the methods (methods) of performing a particular service.
It is important to note that some medical services may not contain subtypes of services.
What does Section “B” include in the Nomenclature of Medical Services?
This includes medical services that are complex medical interventions. They are also aimed at the prevention, diagnosis and treatment of diseases, medical rehabilitation and have an independent, complete meaning.
Here, in contrast to section A, after the code “Type of service” there is a code value from 001 to 070, which denotes not the anatomical and functional area, as in the first section,” but a medical specialty.
Classes in section “B” of the Nomenclature
It is also possible that there is no assigned class in this section. This is possible if a specific service is not allocated for a class in a particular type section. It is important to take into account that the class has a serial number. There are also services classified as “other”, for example, the service of a medical psychologist. These services, as in section “A”, cannot be classified in one or another subsection.
Absence of subspecies in section “B”
It is important to take into account that a certain part of medical services may not contain subtypes of services.
We note that the Nomenclature contains generalized names of medical services, and the provided list of medical services is not exhaustive.
What place do paid medical services occupy in the list?
Paid medical services can be an addition to the legally guaranteed volume of free medical care to citizens within the framework of the program of state guarantees of free medical care to citizens and the corresponding territorial programs approved on its basis in the constituent entities of the Russian Federation.
The Rules for the provision of paid medical services by medical organizations (according to the Decree of the Government of the Russian Federation of October 4, 2012 No. 1006) indicate that medical organizations can provide paid medical services based on the list of works (services) that constitute medical activities and specified in the license to carry out medical activities issued in accordance with the established procedure.
At the same time, it is important that paid medical services must be provided in compliance with the procedure for providing medical care, which was approved by the Ministry of Health. This is stated in parts 3 and 4 of Article 84 of Federal Law No. 323-FZ and paragraphs 9 and 10 of the Rules for the provision of paid medical services.
Compliance with standards of medical care when providing paid medical services
The Ministry of Health in the Letter indicated that paid medical services can be provided in full standard of medical care or partially at the request of the patient:
- in the form of individual consultations
- individual medical interventions.
It is also possible to provide medical services in a volume exceeding the scope of the standard of care provided.
Paid services are possible in the list of services of medical organizations participating in the implementation of the program of free medical care to citizens.
In accordance with paragraph 7 of the Rules (Resolution of the Government of the Russian Federation dated October 4, 2012 No. 1006), such medical organizations can provide paid medical services in 4 cases:
A) on conditions other than those provided for by the program, territorial programs and (or) target programs, at the request of the consumer (customer), including but not limited to:
- establishment of an individual medical observation post during treatment in a hospital setting;
- the use of medications not included in the list of vital and essential medications, if their prescription and use is not due to vital indications or replacement due to individual intolerance to medications included in the specified list, as well as the use of medical devices, nutritional therapy, including number of specialized medical nutrition products not provided for by the standards of medical care;
B) when providing medical services anonymously, except for cases provided for by the legislation of the Russian Federation;
C) citizens of foreign states, stateless persons, with the exception of persons insured under compulsory health insurance, and citizens of the Russian Federation who do not permanently reside on its territory and are not insured under compulsory health insurance, unless otherwise provided by international treaties of the Russian Federation;
D) when independently applying for medical services, with the exception of the cases and procedures provided for in Article 21 of Federal Law No. 323-FZ, and cases of emergency, including specialized emergency medical care and medical care provided in an urgent or emergency form.
Additional types of medical care
According to Part 3 of Article 81 of Federal Law No. 323-FZ, territorial programs of state guarantees of free provision of medical care to citizens, subject to the fulfillment of financial standards established by the program of state guarantees of free provision of medical care to citizens, may contain additional types and conditions for the provision of medical care, as well as additional volumes medical care, including those providing for the possibility of exceeding the average indicators established by the standards of medical care.
How to create a list of paid and additional medical services?
The Ministry of Health believes that after specifying a medical service according to the Nomenclature, the service can be further specified depending on the specifics of its implementation.
Since the law allows for the possibility of providing paid medical services in excess of the standard of medical care, medical organizations can expand the list of medical services relative to those provided for in the Nomenclature when providing medical services not included in the Nomenclature.
Taking into account the above, it follows that when providing paid medical services in mandatory procedures for the provision of medical care must be observed, and at the request of the consumer (customer), these services can be provided in full standard of medical care or in the form of separate consultations or medical interventions, including in a volume exceeding the volume of the standard of medical care being performed And.
Order of the Ministry of Health and Social Development of Russia No. 1664n dated December 27, 2011
On approval of the nomenclature of medical services
In accordance with Article 14 of the Federal Law of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” (Collected Legislation of the Russian Federation, 2011, No. 48, Art. 6724) orders in a yu:
Approve the nomenclature of medical services in accordance with the appendix.
Minister T.A. Golikova
www.minzdravsoc. ru/docs/mzsr/spa/117 (date of access: 01/30/2012)
Appendix to the order
Ministry of Health
and social development
Russian Federation
dated___________ 2011 No. ___
Nomenclature of medical services
I. General provisions
1. Nomenclature of medical services(hereinafter referred to as the Nomenclature) is a list of medical services.
The Nomenclature is presented in the diagram:
The service code consists of an alphanumeric code from 8 to 11 (12*) characters. The first character indicates the class of service, the second and third characters - the section (type of medical service), the fourth and fifth (sixth*) characters - the subsection (anatomical-functional area and/or list of medical specialties), from the sixth to the eleventh characters (from the seventh to twelfth*) - serial number (group, subgroup).
* - for class “B”
3. The list of medical services is divided into two classes: “A” and “B”, built on a hierarchical principle.
Class “A” includes medical services, which are certain types of medical interventions aimed at the prevention, diagnosis and treatment of diseases, medical rehabilitation and having an independent, complete meaning.
Class “B” includes medical services, which are a complex of medical interventions aimed at the prevention, diagnosis and treatment of diseases, medical rehabilitation and having an independent, complete meaning.
4. Class "A":
4.1. Class “A” sections designate a specific type of medical service:
4.2. Subsections of class “A” (from 01 to 31) indicate the anatomical and functional area:
01 Skin, subcutaneous fat, skin appendages
02 Muscular system
03 Skeletal system
04 Joints
05 Hematopoietic system and blood
06 Immune system
07 Oral cavity and teeth
08 Upper respiratory tract
09 Lower respiratory tract and lung tissue
10 Heart and pericardium
11 Mediastinum
12 Large blood vessels
13 Microcirculation system
14 Liver and bile ducts
15 Pancreas
16 Esophagus, stomach, duodenum
17 Small intestine
18 Large intestine
19 Sigmoid and rectum
20 Female genital organs
21 Male genital organs
22 Endocrine glands
23 Central nervous system and brain
24 Peripheral nervous system
25 Hearing organ
26 Organ of vision
27 Olfactory organ
28 Kidneys and urinary system
29 Mental sphere
30 Other.
The subsection is identical in all sections. If a specific service is not allocated for a subsection in a certain section, then this subsection is not registered, while its serial number is retained.
The “Other” subsection includes medical services that cannot be classified in the corresponding anatomical and functional subsection (for example, performed during pregnancy, childbirth, a newborn, diagnostic laparoscopy, survey of the abdominal organs, etc.).
4.3. Group serial number(001 to 999) denotes medical services that have a complete diagnostic or therapeutic value.
Some groups may not contain subgroups.
5. Class "B":
5.1. Class “B” sections designate a specific type of medical service:
5.2. Subsections of class “B” (from 001 to 069) indicate a list of medical specialties:
001 - obstetrics and gynecology
002 - allergology and immunology
003 - anesthesiology and resuscitation
004 - gastroenterology
005 - hematology
006 - genetics
007 - geriatrics
008 - dermatovenereology and cosmetology
009 - pediatric oncology
010 - pediatric surgery
011 - pediatric endocrinology
012 - diabetology
013 - dietetics
014 - infectious diseases
015 - cardiology, pediatric cardiology
016 - clinical laboratory diagnostics
017 - clinical pharmacology
018 - coloproctology
019 - laboratory genetics
020 - physical therapy and sports medicine
021 - social hygiene, sanitation and epidemiology
022 - manual therapy
023 - neurology
024 - neurosurgery
025 - nephrology
026 - general medical practice (family medicine)
027 - oncology
028 - otorhinolaryngology
029 - ophthalmology
030 - pathological anatomy
031 - pediatrics
032 - neonatology
033 - occupational pathology
034 - psychotherapy
035 - psychiatry and forensic psychiatric examination
036 - psychiatry-narcology
037 - pulmonology
038 - radiology and radiotherapy
039 - radiology
040 - rheumatology
041 - reflexology
042 - sexology
043 - cardiovascular surgery, endovascular diagnostics and treatment
044 - emergency medical care
045 - forensic examination
046 - audiology-otorhinolaryngology
047 - therapy
048 - toxicology
049 - thoracic surgery
050 - traumatology and orthopedics
051 - transfusiology
052 - ultrasound diagnostics
053 - urology, pediatric urology-andrology
054 - physiotherapy
055 - phthisiology
056 - functional diagnostics
057 - surgery, surgery (organ and tissue transplantation) and combustiology
058 - endocrinology
059 - endoscopy
060 - bacteriology
061 - virology
062 - epidemiology
063 - orthodontics
064 - dentistry and pediatric dentistry
065 - therapeutic dentistry
066 - orthopedic dentistry
067 - surgical dentistry
068 - maxillofacial surgery
069 – others.
The subsection is identical in all sections. If a specific service is not allocated for a subsection in a certain section, then this subsection is not registered, while its serial number is retained.
The “Other” subsection includes medical services that cannot be classified in the corresponding subsection (for example: medical psychologist services).
5.3. Group serial number(001 to 099) denotes medical services that have a complete diagnostic or therapeutic value.
The subgroup serial number (from 001 to 999) designates medical services depending on the methods of their implementation.
Some groups may not contain subgroups.
In November 2017 Order of the Ministry of Health of Russia No. 804n dated October 13, 2017 was published on the official Internet portal of legal information pravo.gov.ru. and the Nomenclature of Medical Services approved by this order. The nomenclature came into force on January 1, 2018, thereby canceling the old Nomenclature of Medical Services that was previously in force (since 2011). Let’s find out what has changed in the work of the clinic.
Why do we need a list of medical services?
Concluding our discussion of the purpose of the Nomenclature, it should be said that the absence of any medical service in the Nomenclature does not negate the possibility of its provision in a medical organization. This legal feature, however, complicates the determination of the legal status of the service, although it does not prohibit its provision.
Innovations in the range of medical services
Without dwelling on the general provisions of the old and new Nomenclatures, let’s talk about the changes that are reflected in the new Nomenclature of Medical Services 2018.
The new Nomenclature of Medical Services eliminates a number of contradictions that occurred in the old one. Thus, in the old Nomenclature in class “A” of the General Provisions there were medical services with type 25, designated as “microbiological research on basic infectious diseases”, while the actual services presented in this section related to treatment. The microbiological studies themselves had type 26, which is absent in General provisions old Nomenclature.
Several medical services for genetic research are reflected in the old Nomenclature. They were divided into two types of services: morphological examination of tissues (08) and examination of the functions of organs and tissues using special procedures, devices and techniques (12). In the new Nomenclature, firstly, the list of genetic studies has been significantly expanded, and, secondly, they have been combined into a separate type (28). Also in the new Nomenclature, class “A” is supplemented by expanding service type 21, which includes osteopathy.
The changes also affected section “B”. For example, from type 04, dispensary observation services, medical physical education and health activities are excluded, and preventive medical services themselves are expanded through preventive examinations by a specialist and preventive counseling.
Also, a new medical specialty 069 has been added to section “B” - “osteopathy”, while in the old Nomenclature the appointment of an osteopathic doctor was classified as “other medical specialties”. Since the specialty “osteopathy” was added to the list of specialties requiring higher medical or pharmaceutical education in 2015 and, in connection with this, the qualification requirements for these specialists were approved, the New Nomenclature of Medical Services 2018 was added a large number of medical services of this particular profile, including hardware examination of patients in various options and treatment using simple physical influences (for example, manual therapy).
IMPORTANT!
In addition to the above, the new Nomenclature includes interventional methods for treating pain, such as continuous injection of medication into the epidural space and implantation of an intratectal pump.
Also, the new Nomenclature of Medical Services reflects such a popular and socially significant service as the provision of palliative care. It should be noted, however, that at present there is a certain legislative vacuum: there is a service, but there is no corresponding medical specialty. Despite the fact that the palliative care doctor in the Procedures for Providing Palliative Care and the Nomenclature of Positions medical workers and pharmaceutical workers are present, there are no qualification requirements for this specialty. It is not noted either in the Unified Qualification Directory, or in any of the professional standards of doctors, or in the List of specialties and areas of higher education training.
Despite this, the new 2018 nomenclature includes medical services for seeing a doctor for palliative care, and the nomenclature also includes a prescribing service dietary nutrition when providing palliative care.
Among the controversial issues of the new Nomenclature, it is interesting to highlight the services of a pathologist for intravital studies, introduced into it in connection with the adoption of the Rules for pathological studies in 2016. In the new Nomenclature, the list of such services has been significantly expanded. At the same time, such a service as consultation (examination) of a pathologist (B01.030.001) has been retained in the new Nomenclature. As you can see, the medical joke “a pathologist was invited to consult a patient” was embodied in the old Nomenclature and consolidated its position in the new one.
However, although a pathologist may participate in patient examinations in accordance with the Nomenclature of Medical Services, such a function is not specified either in the Rules for Pathological Research or in the Unified Qualification Handbook. And in general, a lifetime consultation of a patient by a pathologist looks, to put it mildly, strange.
Of course, in a small review it is difficult to describe all the changes in the new Nomenclature of Medical Services. However, it should be said that further improvement of the list of medical services will certainly simplify interaction and mutual understanding between all participants in this market. It should be noted, however, that it is extremely important for the legislator to maintain a certain parity so that, on the one hand, the list of services does not grow to cosmic proportions, and on the other hand, doctors do not rack their brains over what to call the perfect manipulation so that it finds its legitimate place in the Nomenclature and reporting cards.
