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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 (LKF) model announced in Austria

28 Jun 2021

In mid-June 2021, the document "Changes and innovations in the 2022 LKF model" (Änderungen und Neuerungen in den LKF-Modellen 2022) was published. The document summarizes the most significant changes and innovations in the LKF model for inpatient and outpatient care. The newly added procedure codes concern mainly the cardiovascular, E-Health, and gastrointestinal area.

For 2022, the main changes will include the addition of 66 new procedure codes (including two provisional codes), the introduction of eight new procedure codes for billing in the day-case settings and two procedure codes for billing in outpatient settings, the addition of ten new DRGs, update of cases flat rates, adjustments of the cases daily component calculation and re-evaluation of the length of stay indicators. The 2022 model will enter into force on January 1, 2022. Some examples of the introduced procedure codes are listed below:

  • AH031 Implantation of a pulse generator for neuromodulation - 4-pin, rechargeable (LE = per application);
  • AH041 Implantation of a pulse generator for neuromodulation - 8-pin, rechargeable (LE = per application);
  • DA150 Correction of acquired (acute) defects of the heart septa with the heart-lung machine (HLM) (LE = per session);
  • DD075 Percutaneous transluminal lithotripsy of a coronary artery (LE = per application);
  • DE532 Telemedical control of a pacemaker (one and two-chamber system) (LE = per session);
  • DE536 Telemedical control of an implanted, automatic cardioverter or defibrillator, a system for cardiac resynchronization therapy (CRT) or a cardiac monitor (LE = per session);
  • HE145 Correction of congenital malformations of the esophagus - thoracoscopic (LE = per session);
  • HH023 Endoscopic full-thickness resection (EFTR) - colon (LE = per session);
  • HL510 Liver function test with the application of a C13-labeled substrate (LE = per session);
  • XN160 Short-term circulatory support with micro-axial flow pump - percutaneous (LE = per session);
  • XN170 Minimally invasive implantation of self-expanding prostheses in the anal sphincter apparatus (LE = per session).

The XN codes are provisional and temporarily included in the DRG system until the benefits of the procedures are established.

The newly introduced DRGs are provided below:

  • MEL01.18 Complex interventions on the spine;
  • MEL32.02 Treatment in the unit for psychosomatics and psychotherapy (PSO) in a regular cycle (children and adolescents);
  • AMG20.13 Ambulatory day treatment on a unit for PSO (children and adolescents);
  • APG01.04 Sleep-laboratory;
  • APG01.10 Structured diagnostics/therapy/follow-up care for neurological diseases;
  • APG01.32 Electroconvulsive therapy;
  • APG02.15 Cryocoagulation of the retina;
  • APG10.12 Ambulatory interventions - musculoskeletal system;
  • APG21.01 Observation/therapy/aftercare in children with specific diseases;
  • APG00.10 Outpatient contact with other services.

The full details in German can be found here.

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