Endovascular aneurysm repair

Procedure coding

Typically, procedure coding is well-established for EVAR in European countries. 

Procedure codes for EVAR may differ depending on the anatomical part of the aorta (e.g., thoracic aorta, abdominal aorta, etc.) and the type of graft (e.g., number of fenestrations, branches, etc.). 

For example, in Germany, OPS procedure coding for endovascular implantation of stent grafts in the abdominal aorta distinguishes between stent graft without opening (code 5-38a.c0), stent graft with one opening (code 5-38a.c1), stent graft with two openings (code 5-38a.c2) or stent graft with three or more openings (code 5-38a.c3).

Policy considerations

Due to high costs, EVAR can be subject to specific policies from payers or national decision-makers in the countries where such frameworks exist. 

For example, in England, the national payer, NHS England, developed the clinical commissioning policy “Use of Complex Endovascular Stent Grafts in the Management of Abdominal Aortic Aneurysm”, in which NHS England outlined categories of patients eligible for elective EVAR surgery. 

Future challenges 

EVAR has established reimbursement and funding in most of the European countries. New health technology assessments are unlikely to be relevant. 

Novel devices for EVAR with unique designs and properties or different cost profiles might need to develop specific procedure codes and adjust payment mechanisms to leverage their unique technology or cost profile fully. 

An important topic for EVAR is the establishment of reimbursement and funding for devices used in secondary procedures in patients with an existing EVAR.