## Odluka o izmjeni Odluke o osnovama za sklapanje ugovora sa zdravstvenim ustanovama i privatnim zdravstvenim radnicima za 2003. godinu

### NN 107/2003 (4.7.2003.), Odluka o izmjeni Odluke o osnovama za sklapanje ugovora sa zdravstvenim ustanovama i privatnim zdravstvenim radnicima za 2003. godinu

# HRVATSKI ZAVOD ZA ZDRAVSTVENO OSIGURANJE

1418

Na
osnovi odredbi članka 85. Zakona o zdravstvenom osiguranju (»Narodne novine«
broj 94/01., 88/02. i 149/02.) i članka 19. Stauta Hrvatskog zavoda za
zdravstveno osiguranja (»Narodne novine« broj 16/02. i 24/02.), Upravno vijeće
Hrvatskog zavoda za zdravstveno osiguranje je na 26. sjednici održanoj 14. svib­nja
2003. godine, uz suglasnost ministra zdravstva, po prethodno pribavljenom
mišljenju nadležnih komora, donijelo

## ODLUKU

### o izmjeni Odluke o osnovama za sklapanje ugovora sa zdravstvenim ustanovama i privatnim zdravstvenim radnicima za 2003. godinu

Članak
1.

U
Odluci o osnovama za sklapanje ugovora sa zdravstvenim ustanovama i privatnim
zdravstvenim radnicima za 2003. godinu (»Narodne novine« broj 2/03., 13/03.,
32/03 i 60/03.) u članku 26. Tablica 3. »Plaćanje po terapijskom postupku –
PPTP – grupe za ugovaranja« mijenja se i glasi:

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*Tablica
3.* Plaćanje po terapijskom postupku – PPTP – grupe za ugovaranje

**VRSTA**

**R.b.     Naziv PPTP-a            K = kirurški KRITERIJ
        KRITERIJ                    Opis                    CIJENA          GRANIČNA**

**M
=                DG                     šifre                                                                                  CIJENA**

**medicinski                                postupaka**

     1       Kolecistektomija
                 K                                   55110                                                                   6.386,00            27.708,00

     2       Histerektomija                      K                                   56820,
56830,
                                                                                                   56840,
56850,
                                                                                                   56860,
56870                                                       8.642,00            22.171,00

     3       Operacija
katarakte             K                                   51440, 51450,                                                      3.346,00              9.930,00

                                                                                                   51470,
51480            ultrazvučna                      5.020,00              9.930,00
                                                                                                                                      operacija
katarakte

     4       Operacija
ingvinalne           K                                   55301                                                                   3.266,00            10.476,00
              hernije

     5       Apendektomija                    K                                   54701                                                                   4.181,00            12.895,00

     6       Tonzilektomija                     K                                   52810                                                                   1.448,00              3.253,00

     7       Operacija
meniska               K                                   58040                                                                   3.456,00              9.456,00

     8       Transplatacija
bubrega      K                                   55551                                                                 55.815,00

     9       Transplatacija
srca              K                                   53750                                                               187.941,00

    10       Transplatacija
rožnice        K                                   51250                                                                   5.176,00            14.246,00

    11       Operacija
varikoziteta         K                                   53840                                                                   3.136,00              8.017,00

    12       Operacija
halux                    K                                   57820                                                                   3.356,00              7.874,40
              valgusa

    13       Mastektomija                       K                                   58601,
58610,                                                      7.278,00            18.419,00
                                                                                                   58620,
58630,
                                                                                                   58640

    14       Pulmektomija                        K                                   53220,
53230,                                                    21.276,00            48.430,00
                                                                                                   53240,
53250,
                                                                                                   53260,
53270

    15       Adenomektomija                 K                                   56010,
56011,                                                      7.994,00            22.505,00
              prostate                                                                      56012,
56013,
                                                                                                   56020,
56040

    16       Plastika
žila nogu                K                                   53806, 53816,                                                    15.569,00            53.263,00
                                                                                                   53823

    17       Operacija
aneurizme            K                                   53894, 53895,                                                    28.538,00            90.545,00
              abdominalne aorte                                                    53896

    18       Ugradnja
kompletne           K                                   58150, 58151            bescementna         11.182+11.365    35.298+11.365
              endoproteze kuka                                                                                                                             = 22.547,00         = 38.350,00

                                                                                                                                     cementna               11.182 + 4.593    26.985 + 4.593
                                                                                                                                                                           = 15.775,00         = 31.578,00

    19       Ugradnja
parcijalne             K                                   58152                                                         11.182 + 1.290    35.298 + 1.290
              endoproteze kuka                                                                                                                             =
12.472,00         = 36.588,00

    20       Artroplastika
koljena          K                                   58142                                                                 24.863,00            39.381,00

    21       Ugradnja
pacemakera         K                                   53770, 53771,           VVI                            7.078 + 9.422    30.524 + 9.422
                                                                                                   53772,
53780,                                                 = 16.500,00         = 39.946,00

                                                                                                   53781,
53782            VVIR                       7.078 + 13.922    30.524+13.922
                                                                                                                                                                           = 21.000,00         = 44.446,00

                                                                                                                                      DDR                        7.078 + 24.922    30.524+24.922
                                                                                                                                                                           = 32.000,00         = 55.446,00

    22       Operacija
hernije                 K                                   58101, 50301                                                       7.911,00            25.374,00
              diska

    23       Fuzija
kralježaka                   K                                   58102, 58103,                                                    18.717,00            48.437,00
                                                                                                   58104

    24       Ugradnja
koronarne            K                                   53601, 53611,                                                    65.000,00          135.103,00
              premosnice                                                                 53612,
53613,
                                                                                                    53614,
53620,
                                                                                                   53630

    25       Dijagnostička                      M                                  Uključuje
12780       »Nekirurški«                    6.000,00            20.000,00
              koronarografija                                                          Isključuje
bolesnikebolesnici kojima
                                                                                                   s
bilo kojim od         je učinjena
                                                                                                   postupaka
sa           dijagnostička
                                                                                                   šiframa:
39936;        perkutana
                                                                                                   5010-59801;              koronarografija
                                                                                                   81030-85012;            bez PTCA/STENT
                                                                                                   88390-88527;
                                                                                                   12740

    26       PTCA/STENT                                                            Uključuje
12740       Ugradnja 1 do 2             22.000,00            48.000,00
                                                                                                   Isključuje                 stenta

                                                                                                   bolesnike
iz grupa  Ugradnja 3 ili                 28.000,00            48.000,00
                                                                                                   9,
21, 24                    više stenta

    27       Jednoplodni
spontani        M                 O 80                                                                                       2.558,00            12.935,00
              porođaj

    28       Jednoplodno
rađanje          K                 O 82                                                                                       6.407,00            20.656,00
              carskim rezom

    29       Moždani
udar                      M              I61; I62;                                         Moždani udar                  5.324,00            21.958,00
                                                                               I63;
I64

    30       Prijelom
bedrene                  K                 S 72          Bilo koja šifra od     Kirurško
liječenje            9.714,00            28.012,00
              kosti – kirurško                                                          50101-59801
osim    prijeloma bedrene
              liječenje                                                                       58150,
58151,           kosti osim totalne
                                                                                                   58152                        ili parcijalne
                                                                                                                                      endoproteze
kuka

    31       Prijelom
bedrene                 M                 S 72          Isključuje bolesnikePrijelom bedrene             3.850,00            17.322,00
              kosti – konzeravtivno                                               sa
šiframa                 kosti bez
kirurških
              liječenje                                                                       50101-59801             postupaka

    32       Angina
pectoris                  M                  I 21           Isključuje bolesnikeBolesnici s                       5.000,00            21.653,00

                                                                                                   bez
kronarografije   dijagnozom angine
                                                                                                   s
bilo kojim od         pektoris, bez
                                                                                                   sljedećih
kodova:   kirurških postupaka
                                                                                                   39936;
50101-           i bez invanzivnih
                                                                                                   59801;
81030-           dijagnostičkih
                                                                                                   85661;
88390-           postupaka
                                                                                                   88603;
12701;
                                                                                                   12702;
12730;
                                                                                                   12731;
12740;
                                                                                                   12780

    33       Akutini
infarkt                     M                  I 21           Isključuje bolesnikeBolesnici s                       7.745,00            21.229,00

              miokarda bez                                                              s
bilo kojim od         dijagnozom AMI
              invazivnih                                                                   sljedećih
kodova:   bez kirurških
              dijagnostičkih /                                                          39936;
50101-           postupaka i bez
              terapijskih                                                                   59801;
81030-           invanzivnih
              postupaka                                                                  85661;
88390-           dijagnostičkih
                                                                                                   88603;
12701;           postupaka
                                                                                                   12702;
12730;
                                                                                                   12731;
12740;
                                                                                                   12780

    34       Hemodijaliza                        M                                                                     Kronička
acetatna              924,00              1.350,00
                                                                                                                                      ili
bikarbonatna
                                                                                                                                      hemodijaliza
s
                                                                                                                                      uračunatim
                                                                                                                                      eritropoetinom
u
                                                                                                                                      prosjeku
pri
                                                                                                                                      svakom
trećem
                                                                                                                                      slučaju

    35       Obrada
i čuvanje                 K                                                                     Enukleacija
                      3.528,00              3.528,00
              rožnice za potrebe                                                                                       bulbusa
i
              transplantacije                                                                                             preparacija
                                                                                                                                      korneosleralnog
                                                                                                                                      prstena

    36       Preparacija
i                          K                                                                                                                   649,00                 649,00
              čuvanje amnijske
              membrane za potrebe
              transplantacije

    37       Transplantacija
jetre           K                                                                                                                 222.000               350.000

    38       Transplantacija
pluća         K                                                                                                                 250.000               350.000

    39       Transplantacija                    K                                                                                                                   91.000               180.000
              koštane srži

    40       IVF/ICSI                               M                                   do 3 pokušaja          uključuje sve                        9.890                 11.000
                                                                                                   za
žene do 38           lijekove s Liste
                                                                                                   godina
starosti        lijekova Zavoda
                                                                                                                                      potrebne
za
                                                                                                                                      stimulaciju
                                                                                                                                      ovulacije

    41       Embolizacija
AV                  M                                                                                                                   27.000                 40.000
              malformacija

    42       Multiorganska                     K                                                                     bez
ekplantacijskog           44.000
              eksplantacija                                                                                                tima

                                                                                                                                      s
eksplantacijskim              56.000
                                                                                                                                      timom

    43       Ugradnja                               K                                   50175, 50176,
          u cijenu je                            77.200
              neurostimulatora                                                       50177,
50231            uključen
                                                                                                                                      neurostimulator

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Članak
2.

Ova
Odluka stupa na snagu danom objave u »Narodnim novinama«, a primjenjuje se od
1. lipnja 2003. godine.

Klasa:
025-04/03-01/137
Urbroj: 338-01-05-03-1
Zagreb, 14. svibnja 2003.

Predsjednik
Upravnog vijeća Hrvatskog zavoda
za zdravstveno osiguranje
**doc****. dr****. sc****.** **Nikica Gabrić,** v. r.

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Odluka, NN 107/2003-1418
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