[The "simple" laparoscopic cholecystectomy as a hybrid DRG in 2026 : Critical appraisal and practical orientation]

With approximately 175,000 procedures per year (IQTIG, reporting year 2024), laparoscopic cholecystectomy is among the most common visceral surgical procedures in Germany. Since 2026, "simple" laparoscopic cholecystectomy (H08M) has been included in the cross-sectoral hybrid diagnosis-related groups (DRG) scheme under § 115f of the German Social Code Book V (SGB V).

To critically analyze the hybrid DRG classification with respect to the underlying evidence, coding/grouping logic, real-world care patterns and economic implications, including a model calculation of the expected case distribution.

The current context factor logic does not consistently distinguish between hybrid and full inpatient DRG by severity: acute cholecystitis without gallstones (K81.0) is defined as a context factor (triggering the inpatient DRG H08C), whereas acute cholecystitis with gallstones (K80.00/K80.01) is not, despite comparable or greater treatment complexity. Based on a model calculation using routine data from the Institute for Quality Assurance and Transparency in the Healthcare System (IQTIG) for 2022-2024, an estimated 93,000-96,000 cases per year (≈ 60-65% of "simple" laparoscopic cholecystectomies) are likely to be uncomplicated and therefore eligible for the hybrid DRG, while approximately 52,000-55,000 cases per year (≈ 35-38%) involve acute cholecystitis, for which the classification is inconsistent and in some cases implausible. The actual outpatient share is likely to remain below 1%.

Hybrid DRG eligibility is not equivalent to suitability for outpatient care. What is required are diagnosis-specific, more precisely defined context factors, a correct and sanction-free coding logic, and adequate reimbursement reflecting standby capacity costs and training obligations.