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Reimbursement summary for angioplasty of arteries of lower extremities

This post presents an extract from our reimbursement analysis for angioplasty of arteries lower extremities using plain and drug-coated balloons (DCBs) for peripheral artery disease in England, France and Germany. Plain balloon angioplasty is reimbursement via DRG solely and DCBs are reimbursement via combination of DRG and add-on reimbursement.
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Eleven new procedure and thirteen diagnostic codes were added to private reimbursement schedule in England in June

The Clinical Coding and Schedule Development (CCSD) develops and maintains procedural and diagnostics nomenclature for private payers in England. Once codes are added to the Schedule, private insurance company can develop reimbursement tariff for these procedures and tests.

The CCSD Group has approved the following procedure codes for publication to the CCSD Schedule in June:

  • Insertion of leadless (wireless) pacemaker (K6120);
  • Robotic assisted unicompartmental knee replacement - bilateral (W5821);
  • Arthroscopic labral reconstruction of the hip (including allograft and harvesting) (W8410);
  • Arthroscopic labral reconstruction of the hip (including autograft and harvesting) (W8411);
  • Percutaneous release of constriction of sheath of tendon (e.g. trigger finger) (T7232);
  • Open release of constriction of sheath of tendon (e.g. trigger finger) (T7231);
  • Biodegradable subacromial spacer insertion for rotator cuff tears (W8170);
  • Patella resurfacing (as sole procedure) (W5810);
  • Platelet rich plasma injections for knee osteoarthritis (W9046);
  • Transpupillary thermotherapy for intraocular tumours (C8810);
  • Peroral endoscopic myotomy (POEM) for achalasia (including autograft and harvesting) (E2810).

The narrative for 15 procedure codes has been changed, one code for release of constriction of sheath of tendon (T7230) has been inactivated.

The CCSD Group has approved the following diagnostic codes for publication to the CCSD Schedule in June:

  • 3D saline infusion sonohysterography (IM365);
  • Cholestasis Gene Panel (5013B);
  • FLT3-ITD/D835/NPM1 (5014B);
  • TP53 mutation (marsden) (5015B);
  • SDH B Gene analysis (5016B);
  • Copeptin (5017B);
  • Serum Beta-Crosslaps (5018B);
  • Colindale Organism Id & Sensitivity (5019B);
  • LYSO-GB3 (5020B);
  • IgHV Mutation (Marsden) (5021B);
  • AML Translocation Panel (5022B);
  • ALL Translocation Panel (Marsden) (5023B);
  • Adalimumab level (5024B).

See original documents here

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