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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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2022/23 HRG4+ Local Payment Grouper came into force on April 1, 2022, in England

On March 31, 2022, NHS Digital released HRG4+ Local Payment Grouper for 2022/23 for use from April 01, 2022. In general, there are significant changes in base HRG design. A total of 120 new HRGs were created, and multiple HRGs were removed, so the total number increased by 62 from 2,838 to 2,900.

Many HRG chapter/subchapter labels and individual HRG names have been amended to ensure they accurately reflect the content. The grouping logic was updated to accommodate National coding recommendations and new guidelines from NICE. This includes the remapping of existing codes and the creation of new combination codes, where appropriate.

Some changes and new HRGs are presented below.

Four new HRGs were created to specifically identify additional expected resource usage of patients that have implantation of ICD or ICD-CRT alongside major surgery, e.g., CABG or valve repair, or complex patients that require device extraction before renewal. For example:

  • EY14B Implantation of Cardioverter Defibrillator with Cardiac Resynchronisation Therapy, with Extraction or Major Open Procedure, with CC Score 0-8;
  • EY15B Implantation of Cardioverter Defibrillator, with Extraction or Major Open Procedure, with CC Score 0-8.

Four new HRGs were created to accommodate multiple complex percutaneous coronary interventions, for example, EY44D Very Complex Percutaneous Transluminal Coronary Angioplasty with CC Score 0-3.

Six new HRGs concerning transvaginal ultrasound were created to identify activity largely undertaken at gynecological "one-stop" clinics and to differentiate these based on expected resource use associated with undertaking multiple exams or minor procedures concurrently. For example:

  • MA41Z Transvaginal Ultrasound with Biopsy and Implantation of Intrauterine Device;
  • MA43Z Transvaginal Ultrasound with Salpingography;
  • MA46Z Diagnostic Hysteroscopy with Transvaginal Ultrasound, with Biopsy;
  • MA47Z Diagnostic Hysteroscopy with Transvaginal Ultrasound and Implantation of Intrauterine Device;

New HRG RD98Z "Admission or Attendance for Diagnostic Imaging under General Anaesthetic" was created to accommodate patients admitted for diagnostic imaging or nuclear medicine scan under general anesthetic.

Three new HRGs were added under the newly created subchapter YC "Head and neck imaging interventions." New combination codes classifying imaging interventions are mapped to this subchapter, and existing combinations from subchapters CA "Ear, nose, mouth, throat, head and neck procedures" and KA "Endocrine system procedures and disorders" were remapped to this subchapter. An example of a new HRG is YC02Z "Percutaneous Fine Needle Aspiration Biopsy of Lesion of Head or Neck".

Fourteen new HRGs were created under subchapter FE "Digestive system endoscopic procedures" to differentiate expected resource use between pre-school and school-aged children and redesign combined upper and lower gastrointestinal tract endoscopy HRGs to differentiate between colonoscope and sigmoidoscope. For example:

New HRG FF43Z "Minimal Anal Procedures" was created to accommodate the destruction of hemorrhoids.

Three new HRGs were created to improve the identification of highly complex gastrointestinal surgery activity, for example, FF70B Multiple Very Complex Gastrointestinal Tract Procedures, 19 years and over, with CC Score 0-6.

One new HRG YL30Z "Percutaneous Ablation of Lesion of Prostate" was introduced under subchapter YL "Urological imaging interventions".

Twenty-six new HRGs were added under subchapter YR "Vascular imaging interventions", including the following:

  • YR60Z Complex Endovascular Repair of Thoracoabdominal Aortic Aneurysm using Branched Stent Graft;
  • YR63B Standard Endovascular Repair of Thoracoabdominal Aortic Aneurysm using Fenestrated Stent Graft, with CC Score 0-5;
  • YR66B Complex Endovascular Repair of Abdominal Aortic Aneurysm, with CC Score 0-5;
  • YR40C Insertion of Non-Tunnelled Central Venous Catheter, between 6 and 18 years;
  • YR59Z Prostate Artery Embolisation.

See the full details here.

This news is just one of about 300 market access news collected by our team in the subscription services "HTA Alerts" and "Reimbursement Alerts" every two weeks from more than 80 organizations. Access our paid subscription services to stay on top of all developments specifically for your products in Europe (reimbursement news) and globally (HTA news). First EU issues of both newsletters are available for download free-of-charge.

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