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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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2022 DRG catalog (Fallpauschalen-Katalog) published in Germany

In late November 2021, the INeK (Institute for the Hospital Remuneration System) has published the DRG catalog (Fallpauschalen-Katalog) with the list of DRGs and add-on reimbursement categories (ZEs) for 2022. Seven new DRGs and seventeen ZE categories were added to the catalog in 2022.

Some examples of newly introduced DRGs and ZE categories are provided below:

  • F75D Other diseases of the circulatory system without extremely severe complications (CC) or one day of stay, age >9 years and age <16 years, without severe CC or age >15, without specific cardiovascular disease;
  • I87K Complex treatment of pathogens requiring isolation in diseases and disorders of the musculoskeletal system and connective tissue, COVID-19, virus detected;
  • E02F Other operating room (OR) procedures on the respiratory organs, age >17 years, without specific interventions on the larynx or trachea, without moderately complex interventions, without extremely severe complications (CC), without endoscopic lung volume reduction, without other moderately complex interventions, one day of stay without specific intervention.

Some examples of newly introduced ZE categories are provided below:

  • ZE2022-198 Molecular monitoring of the residual tumor burden [MRD]: Molecular genetic identification of disease-specific markers;
  • ZE2022-199 Molecular monitoring of the residual tumor burden [MRD]: Disease-specific molecular genetic quantification.

There is no national tariff for these categories (the tariffs will be agreed upon between the individual hospitals and health insurance).

The full details in German can be found here.

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