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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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2023 DRG (LKF) model announced in Austria

18 Jul 2022

On June 22, 2022, the document "Changes and innovations in the 2022 LKF model" (Änderungen und Neuerungen in den LKF-Modellen 2023) 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 mainly concern cardiovascular, extracorporeal treatments, and peripheral vascular fields.

For 2023, the main changes will include the addition of 34 new procedure codes (including five provisional codes), the introduction of seven procedure codes for billing in the day-case settings and one procedure code for billing in outpatient settings, and the addition of two new DRGs, update of cases flat rates, adjustments of the cases daily component calculation and re-evaluation of the length of stay indicators. The 2023 model will enter into force on January 1, 2023. Some examples of the introduced procedure codes are listed below:

  • AJ180 Partial implantation of a pulse generator for neuromodulation - 4-pin (LE = per session);
  • DD105 Percutaneous recanalization of chronically occluded coronary arteries (LE = per session);
  • DZ075 Ex vivo perfusion of donor organs - heart (LE = per session);
  • GF195 Ex vivo perfusion of donor organs - lungs (LE = per session);
  • PA042 Osteosynthesis with homologous bone or substitute materials (LE = per session);
  • XN190 Implantation of a fenestrated stent-graft - aortic arch (LE = per session);
  • XN200 Cardiac pacemaker implantation, His bundle pacing (LE = per session);
  • XN210 Implantation of a system for breathing-controlled stimulation of the hypoglossal nerve (LE = per session);
  • XN220 Percutaneous aspiration thrombectomy of the pulmonary artery (LE = per session);
  • XN230 Percutaneous aspiration thrombectomy heart/large veins with extracorporeal circulation (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:

  • MEL01.19 Partial implantation of a pulse generator;
  • APG18.60 Victim protection.

The full details in German can be found here.

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