Alpha medical / Indikačné obmedzenia

Nové pravidlá v preskripcii onkomarkerov VšZP (zmena od 13.05.2011), Dôvera ZP a UNION ZP (od 01.07.2011)

Vážení kolegovia,

v súvislosti so zmenou pravidiel v akceptovaní indikácií onkomarkerov jednotlivými odbornosťami vydali zdravotné poisťovne pravidlá stanovujúce preskripciu konkrétnych vyšetrení onkomarkerov.

V súvislosti s touto zmenou uverejňujeme tabuľky, v ktorých je uvedený zoznam onkomarkerov, diagnóz a odborností, ktorých indikáciu budú ZP akceptovať. Iné indikácie, ako sú uvedené, nebudú dané poisťovne akceptovať a z toho dôvodu ich nebudú ani laboratóriu, ktoré ho vykoná, uhrádzať.

anatomická oblasť	ZP	názov onkomarkeru	diagnóza výkonu	kód	odbornosť
Nádory hlavy, krku a pažeráka	všzp	SCCA	C00-C15	4481	001,010,019, 037,043,060,319,329,350,591, 047, 014
		CYFRA 21-1	C00-C15	4480	001,010,019, 037,043,060,319,329,350,591, 047, 014
		CEA	C00-C15	4353	001,010,019, 037,043,060,319,329,350,591, 047, 014
	dôvera	SCCA	C00-C15	4481	010,019, 037,319,591
		CYFRA 21-1	C00-C15	4480	001,010,019, 037,319,350,591
		CEA	C00-C15	4353	001,010,019, 048,222,319,250,591
	union	SCCA		4481	001,010,014,019,037,043,047,060,319,329,350,591
		CYFRA 21-1		4480	001,010,014,019,037,043,047,060,319,329,350,591
		CEA		4353	001,010,014,019,037,043,047,060,319,329,350,591
Nádory žalúdka	všzp	CEA	C16	4353	001,010,019,043,048,060,222,319,350,591, 047
		Ca-19-9	C16	4446	001,010,019,043,048,060,222,319,350,591, 047
		Ca 72-4	C16	4470	001,010,019,043,048,060,222,319,350,591, 047
	dôvera	CEA	C16	4353	001,010,019, 048,222,319,250,591
		Ca-19-9	C16	4446	001,010,019, 048,222,319,250,591
		Ca 72-4	C16	4470	001,010,019, 048,222,319,250,591
	union	CEA		4353	001,010,019,043,047,048,060,222,319,350,591
		CA 19-9		4446	001,010,019,043,047,048,060,222,319,350,591
		CA 72-4		4470	001,010,019,043,047,048,060,222,319,350,591
Nádory čreva	všzp	CEA	C 17-20	4353	001,010,019,319,043,048,060,222,350,591. 047
		Ca 19-9	C 17-20	4446	001,010,019,319,048,222,350,591,043,060, 047
		Chromogranin A /CgA/	C 17-20	4466	001,010,019,319,048,222,350,591,043,060, 047
		CEA - IgM	C 17-20	4464	001,010,019,319,048,222,350,591,043,060, 047
	dôvera	CEA	C 17-20	4353	001,010,019,319,048,222,350,591
		Ca 19-9	C 17-20	4446	001,010,019,319,048,222,350,592
		Chromogranin A /CgA/	C 17-20	4466	001,010,019,319,048,222,591
		CEA - IgM	C 17-20	4464	001,010,019,319,048,222,350,591
	union	CEA		4353	001,010,019,043,047,048,060,222,319,350,591
		CA 19-9		4446	001,010,019,043,047,048,060,222,319,350,591
		chromogranin		4466	001,010,019,043,047,048,060,222,319,350,591
Nádory pečene a žlčových ciest	všzp	AFP	C 22-24	4361	001,002,010,019,216,319,222,350,591,043,048,060, 047
		CEA	C 22-24	4353	001,010,019,216,319,222,350,591,043,048,060, 047
		Ca 19-9	C 22-24	4446	001,010,019,216,319,222,350,591,043,048,060, 047
		Ferritin	C 22-24	4350	001,010,019,216,319,222,350,591,043,048,060, 047
	dôvera	AFP	C 22-24	4361	010,019,216,319,222,591
		CEA	C 22-24	4353	001,010,019,216,319,222,350,591
		Ca 19-9	C 22-24	4446	001,010,019,216,319,222,350,591
		Ferritin	C 22-24	4350	001,010,019,216,319,222,591
	union	AFP		4361	001,002,010,019,043,047,048,060,216,222,319,350,591
		CEA		4353	001,010,019,043,047,048,060,216,222,319,350,591
		CA 19-9		4446	001,010,019,043,047,048,060,216,222,319,350,591
Nádory pankreasu	všzp	Ca 19-9	C25	4446	001,010,019,319,048,222,350,591,043,060, 047
		CEA	C25	4353	001,010,019,319,048,222,350,591,043,060, 047
		Chromogranin /CgA/	C25	4466	001,010,019,319,048,222,350,591,043,060, 047
		NSE	C25	4451	001,010,019,319,048,222,350,591,043,060, 047
	dôvera	Ca 19-9	C25	4446	001,010,019,319,048,222,350,591
		CEA	C25	4353	001,010,019,319,048,222,350,591
		Chromogranin /CgA/	C25	4466	010,019,319,048,222,591
		NSE	C25	4451	010,019,319,048,222,591
	union	CA 19-9		4446	001,010,019,043,047,048,060,222,319,350,591
		CEA		4353	001,010,019,043,047,048,060,222,319,350,591
		chromogranin		4466	001,010,019,043,047,048,060,222,319,350,591
		NSE		4451	001,010,019,043,047,048,060,222,319,350,591
Nádory pľúc a pleury	všzp	CEA	C34,C45	4353	001,003,019,319,350,591,043,060, 047
		CYFRA 21-1	C34,C45	4480	001,003,019,319,350,591,043,060, 047
		NSE	C34,C45	4451	001,003,019,319,350,591,043,060, 047
		Chromogranin /CgA/	C34,C45	4466	001,003,019,319,350,591,043,060, 047
		Ca125	C34,C45	4444	001,003,019,319,350,591,043,060, 047
	dôvera	CEA	C34,C45	4353	001,003,019,319,350,591
		CYFRA 21-1	C34,C45	4480	001,003,019,319,350,591
		NSE	C34,C45	4451	003,019,319,591
		Chromogranin /CgA/	C34,C45	4466	003,019,319,591
		Ca125	C34,C45	4444	003,019,319,591
	union	CEA		4353	001,003,019,043,047,060,319,350,591
		CYFRA 21-1		4480	001,003,019,043,047,060,319,350,591
		NSE		4451	001,003,019,043,047,060,319,350,591
		chromogranin		4466	001,003,019,043,047,060,319,350,591
		CA 125		4444	001,003,019,043,047,060,319,350,591
Nádory hrtana	všzp	SCCA	C32	4481	014,019,591,319,043, 047
		CYFRA 21-1	C32	4480	014,019,319,591,043, 047
		CEA	C32	4353	014,019,319,591,043, 047
	dôvera	SCCA	C32	4481	014,019,591
		CYFRA 21-1	C32	4480	014,019,319,591
		CEA	C32	4353	014,019,319,591
	union	SCCA		4481	014,019,043,047,319,591
		CYFRA 21-1		4480	014,019,043,047,319,591
		CEA		4353	014,019,043,047,319,591
Nádory prsníka	všzp	Ca 15-3	C50	4445	009,019,229,271,591,043, 047
	všzp	CEA	C50	4353	009,019,229,271,591,043, 047
	dôvera	Ca 15-3	C50	4445	009,019,229,271,591
	dôvera	CEA	C50	4353	009,019,229,271,591
	union	CA 15-3		4445	009,019,043,047,229,271,591
	union	CEA		4353	009,019,043,047,229,271,591
Nádory krčka maternice a vonkajšieho genitálu	všzp	SCCA	C51-53	4481	009,019,229,591,043, 047
		CEA	C51-53	4353	009,019,229,591,043, 047
		Cyfra 21-1	C51-53	4480	009,019,229,591,043, 047
	dôvera	SCCA	C51-53	4481	009,019,229,591
		CEA	C51-53	4353	009,019,229,591
		Cyfra 21-1	C51-53	4480	009,019,229,591
	union	SCCA		4481	009,019,043,047,229,591
		CEA		4353	009,019,043,047,229,591
		CYFRA 21-1		4480	009,019,043,047,229,591
Nádory tela maternice	všzp	HE- 4	C54-55	4464	009,019,229,591,043, 047
	všzp	Ca 125	C54-55	4444	009,019,229,591,043, 047
	dôvera	HE- 4	C54-55	4464	009,019,229,591
	dôvera	Ca 125	C54-55	4444	009,019,229,591
	union	HE- 4		4464	009,019,043,047,229,591
		CA 125		4444	009,019,043,047,229,591
		HCG		4440	009,019,043,047,229,591
Nádory ovárií	všzp	Ca 125	C56	4444	009,019,229,591,043, 047
		HE- 4	C56	4464	009,019,229,591,043, 047
		Ca 72-4	C56	4470	009,019,229,591,043, 047
		Ca 19-9	C56	4446	009,019,229,591,043, 047
		AFP	C56	4361	009,019,229,591,043, 047
		HCG	C56	4440	009,019,229,591,043, 047
	dôvera	Ca 125	C56	4444	009,019,229,591
		HE- 4	C56	4464	009,019,229,591
		Ca 72-4	C56	4470	009,019,229,591
		Ca 19-9	C56	4446	009,019,229,591
		AFP	C56	4361	009,019,229,591
		HCG	C56	4440	009,019,229,591
	union	CA 125		4444	009,019,043,047,229,591
		HE- 4		4464	009,019,043,047,229,591
		CA 72-4		4470	009,019,043,047,229,591
		CA 19-9		4446	009,019,043,047,229,591
		AFP		4361	009,019,043,047,229,591
		HCG		4440	009,019,043,047,229,591
Nádory testes	všzp	AFP	C62	4361	012,019,319,322,591,043, 047
		HCG	C62	4440	012,019,319,322,591,043, 047
		LDH	C62	3698	012,019,319,322,591,043, 047
	dôvera	AFP	C62	4361	012,019,319,322,591
		HCG	C62	4440	012,019,319,322,591
		LDH	C62	3698	012,019,319,322,591
	union	AFP		4361	012,019,043,047,319,322,591
	union	HCG		4440	012,019,043,047,319,322,591
Nádory prostaty	všzp	PSA	C61	4355	012,019,319,322,591,043, 047
		f - PSA	C61	4355	012,019,319,322,591,043, 047
		CEA	C61	4353	012,019,319,322,591,043, 047
		CgA	C61	4466	012,019,319,322,591,043, 047
	dôvera	PSA	C61	4355	012,019,319,322,591
		f - PSA	C61	4355	012,019,319,322,591
		CEA	C61	4353	012,019,319,322,591
		CgA	C61	4466	012,019,319,322,591
	union	PSA		4355	012,019,043,047,319,322,591
		f - PSA		4355	012,019,043,047,319,322,591
		chromogranin		4466	012,019,043,047,319,322,591
		CEA		4353	012,019,043,047,319,322,591
Nádory obličiek a močových ciest	všzp	CEA	C64-66	4353	001,012,019, 063,322,591,043,060, 047
		CgA	C64-66	4466	001,012,019, 063,322,591,043,060, 047
		CYFRA 21-1	C64-66	4470	001,012,019, 063,322,591,043,060, 047
		beta2-mikroglobulín	C64-66	4354	001,012,019, 063,322,591,043,060, 047
	dôvera	CEA	C64-66	4353	001,012,019, 063,322,591
		CgA	C64-66	4466	012,019, 063,322,591
		CYFRA 21-1	C64-66	4470	001,012,019, 063,322,591
		beta2-mikroglobulín	C64-66	4354	012,019, 063,322,591
	union	CEA		4353	001,012,019,043,047,060,063,322,591
		chromogranin		4466	001,012,019,043,047,060,063,322,591
		NSE		4350	001,012,019,043,047,060,063,322,591
		CYFRA 21-1		4470	001,012,019,043,047,060,063,322,591
Nádory nadobličiek	všzp	CgA	C74	4466	012,019,063,322,064,591,043,060, 047
	všzp	NSE	C74	4451	012,019,063,322,064,591,043,060, 047
	dôvera	CgA	C74	4466	012,019,063,322,064,591
	dôvera	NSE	C74	4451	012,019,063,322,064,591
	union	chromogranin		4466	012,019,043,047,060,063,064,322,591
	union	NSE		4451	012,019,043,047,060,063,064,322,591
Nádory kože	všzp	Protein S - 100	C43, C44	4466	018, 019, 591,043, 047
	všzp	SCCA	C43, C44	4481	018, 019, 591,043,047
	dôvera	Protein S - 100	C43, C44	4466	018, 019, 591
	dôvera	SCCA	C43, C44	4481	018, 019, 591
	union	protein S - 100		4466	018,019,043,047,319,591
		SCCA		4481	018,019,043,047,319,591
		tymidín kináza		4358	018,019,043,047,319,591
Nádory spojiva	všzp	TK	C40-41,49	4358	018, 019, 011,591,043,047
Nádory spojiva	dôvera	TK	C40-41,49	4358	018, 019, 011,591
Nádory nervového tkaniva	všzp	NSE	C70-72	4451	004, 019, 037, 545, 591,043, 047
	dôvera	NSE	C70-72	4451	004, 019, 037, 545, 591
	union	NSE		4451	004,019,037,043,047,545,591
Hematologické nádory	všzp	beta2-mikroglobulín	C81 - 96	4354	019,031,043,329,591, 047
		Timidín kináza /TK/	C81 - 96	4358	019,031,043,329,591, 047
		Ferrrtin	C81 -96	4350	019,031,043,329,591, 047
	dôvera	beta2-mikroglobulín	C81 - 96	4354	019,031,329,591
		Timidín kináza /TK/	C81 - 96	4358	019,031,329,591
		Ferrrtin	C81 -96	4350	019,031,329,591
	union	tymidín kináza		4358	019,031,043,047,329,591
Nádory hypofýzy	všzp	PRL	C75	4326	019,037,043,064,591, 047
	všzp	CgA	C75	4466	019,037,043,064,591, 047
	dôvera	PRL	C75	4326	019,037,064,591
	dôvera	CgA	C75	4466	019,037,064,591
	union	chromogranin		4466	019,037,043,047,064,591
Nádory príštitných teliesok	všzp	Parathormón /PTH/	C73	4471	019,043,064,591, 047
	všzp	CgA	C73	4466	019,043,064,591, 047
	dôvera	Parathormón /PTH/	C73	4471	019,064,591
	dôvera	CgA	C73	4466	019,064,591
	union	chromogranin		4466	019,043,047,064,591
Nádory štítnej žľazy	všzp	Tyreoglobulín /TG/	C73	4435	001,019,043,064,350,591, 047
		Kalcitonín /CT/	C73	4371	001,019,043,064,350,591, 047
		CEA	C73	4353	001,019,043,064,350,591, 047
		CgA	C73	4466	001,019,043,064,350,591, 047
	dôvera	Tyreoglobulín /TG/	C73	4435	019,064,591
		Kalcitonín /CT/	C73	4371	019,064,591
		CEA	C73	4353	001,019,064,350,591
		CgA	C73	4466	001,019,064,350,591
	union	kalcitonin		4371	001,019,043,047,064,350,591
		CEA		4353	001,019,043,047,064,350,591
		chromogranin		4466	001,019,043,047,064,350,591

Neonkologické diagnózy:
anatomická oblasť	ZP	názov onkomarkeru	diagnóza výkonu	kód	odbornosť
Nádory ovárií	všzp	Ca 125	Z01; Z12.8; Z80.4	4444	009,229
	dôvera	Ca 125	Z01,Z12.8,Z80.4	4444	009,229
	union	Ca 125	Z01,Z12.8,Z80.4	4444	009,229
Nádory prostaty	všzp	PSA	Z01; Z12.5; N40	4355	012,322
	dôvera	PSA	Z01,Z12.5,N40	4355	012,322
	union	PSA	Z01,Z12.5,N40	4355	012,322

Vysvetlivky ku kódom odborností:
001	vnútorné lekárstvo
004	neurológia
009	gynekológia a pôrodníctvo
010	chirurgia
011	ortopédia
012	urológia
014	ORL
018	dermatovenerológia
019	klinická onkológia
031	hematológia a transfuziológia
037	neurochirurgia
043	radiačná onkológia
047	nuklearna medicína
048	gastroenterológia
060	geriatria
063	nefrológia
064	endokrinológia
216	hepatológia
222	gastroenterologická chirurgia
229	onkológia v gynekológii
271	mamológia
319	onkológia v chirurgii
322	onkológia v urológii
329	pediatrická hematológia a onkológia
350	onkológia vo vnútornom lekárstve
545	neurologická onkológia
591	chemoteralia nádorov

Nové pravidlá v preskripcii onkomarkerov VšZP (zmena od 13.05.2011), Dôvera ZP a UNION ZP (od 01.07.2011)

Aktuality

Indikačné obmedzenia