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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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Changes and innovations in the Austrian service catalog of the LKF 2020 model

The document “Changes and innovations in the 2020 models” provides the most significant changes and innovations in the LKF models for the inpatient and outpatient area and in their documentation bases.

Sixty-three new procedure codes were introdused in the LKF service catalog for the inpatient and outpatient area:

  • AK520 Blockade/analgesia/lysis vegetative ganglia (LE = per session)
  • AP541 Sedation (LE = per session)
  • BE530 Needling after glaucoma surgery (LE = per session)
  • BL520 Optical biometry Eye (LE = per session)
  • CB522 Dilation of the Eustachian tube (balloon tuboplasty) (LE = per session)
  • DE132 Transvenous extraction of cardiac pacemaker probes (LE = per session)
  • DF025 Catheter angiography and percutaneous transluminal angioplasty (PTA) - pulmonal artery (LE = per session)
  • FC170 Lympho-venous anastomoses (LE = per site)
  • FC180 Vascularized lymph node transfer (LE = per session)
  • FZ120 Administration of modified T-cells with chimeric antigen receptor (CAR) (LE = per stay with completed therapy)
  • GE540 Operative closure of a trachea stomas (LE = per session)
  • GF091 Anatomical segment resection of the lungs - open (LE = per session)
  • GF092 Anatomical segment resection of the lungs - thoracoscopic (LE = per session)
  • GF141 Lobectomy with bronchial sleeve resection- open (LE = per session)
  • GF142 Lobectomy with bronchial sleeve resection- thoracoscopic (LE = per session)
  • GF181 Extrapericardial pneumonectomy – open (LE = per session)
  • GF182 Extrapericardial pneumonectomy – thoracoscopic (LE = per session)
  • GZ530 Tissue removal/coagulation in the nasal pharynx (LE = per session)
  • HA555 Wound care/hemostasis in the oral cave (LE = per session)
  • HC510 Diagnostic sialendoscopy without removal of a concrement (LE = per session)
  • HK520 Proctoscopy (LE = per session)
  • HK530 Proctoscopy with polypectomy (LE = per session)
  • HZ542 Rectoscopy/sigmoidoscopy (LE = per site tongue)
  • HZ552 Rectoscopy/sigmoidoscopy with polypectomy (LE = per session)
  • JE530 Meatotomy/internal urethral slit (LE = per session)
  • JN550 External version in breech position with standby team for Cesarean section (LE = per session)
  • LG020 Arthrodesis of the sacroiliac joint (LE = each meeting)
  • NG090 Inlay change of an endoprosthesis of the ankle (LE = per side)
  • NJ065 Lower extremity tendon transfer excluding foot (LE = per side)
  • NJ130 Removal of a phlegmon on the foot (LE = per side)
  • NZ200 Correction surgery on tarsal/hind foot (LE = per side)
  • NZ210 Correction operation on the first ray of the foot (LE = per side)
  • NZ220 Correction operations on 2nd – 5th ray of foot (LE = per side)
  • PA531 Removal of an external fixator (LE = each meeting)
  • QE550 Reconstructive breast lipofilling resection (LE = per side)
  • QZ540 Excision/resection of skin and soft rush fabric (> 3cm) incl. Rag plastic (LE = per session)
  • QZ550 Secondary wound closure with reconstruction by local flap plastic (LE = per session)
  • XA051 Oncological therapy – monoclonal antibody Gemtuzumab Ozogamicin: 3mg / m 2 (LE = per application)
  • XA084 Oncological therapy – monoclonal antibody Ipilimumab: 1 mg / kg body weight iv (LE = per application)
  • XA085 Oncological therapy – monoclonal antibody Nivolumab: 1 mg / kg body weight iv (LE = per application)
  • XA116 Oncological therapy – monoclonal antibody Dinutuximab beta: 20mg / m 2 (LE = per application)
  • XA117 Oncological therapy – monoclonal antibody durvalumab: 10mg / kg body weight (LE = per application)
  • XB100 Pediatric oncological therapy: Ta- chemotherapy (LE = per treatment day)
  • XB110 Pediatric oncological therapy: Che- inpatient motherapy (LE = per started week)
  • XB210 Pediatric oncological therapy: Adult Erwinia asparaginase (LE = per administration)
  • XB220 Pediatric oncological therapy: PEG Asparaginase (LE = per administration)
  • XB230 Pediatric oncological therapy: Clofarabine (LE = per cycle)
  • XB240 Pediatric oncological therapy: Dactinomycin (LE = per cycle)
  • XB250 Pediatric oncological therapy: Methotrexat HD (> = 1g) (LE = per cycle)
  • XB260 Pediatric oncological therapy: Nelarabine (LE = per cycle)
  • XB270 Pediatric oncological therapy: Trabectedin (LE = per administration)
  • XC394 Daunorubicin/Cytarabin - liposomal (Vyxeos) (day 1)
  • ZN565 Infiltration - image converter targeted (LE = each meeting)
  • ZZ532 Subject-specific initial examination (anamnesis, subject-specific basic examination) (LE = per session)
  • ZZ533 Subject-specific follow-up examination (Medical history / basic diagnosis / controls) (LE = per session)
  • ZZ581 Diabetes training (LE = per day of action)
  • ZZ582 Incontinence training (LE = per day of action)
  • ZZ583 Instructions for stoma care (LE = per day of action)
  • ZZ584 Instructions for dealing with pain pump (LE = per day of action)
  • ZZ585 Instructions for peritoneal dialysis (LE = per day of action)
  • ZZ586 Functional training, memory training (LE = per day of action)
  • ZZ630 Detailed medication analysis for polypharmacy (LE = per day of action)
  • ZZ720 Outpatient care (LE = per day of action)

Twenty-six codes were replaced, and the following seven codes were deleted:

  • HE150 Implantation of an esophageal endoprosthesis – open (LE = per session)
  • JB020 Pyelotomy with concrement removal (LE = per side)
  • JC070 extraction of a ureteral stone - open (LE = per side)
  • XN020 Implantation of a system for cardiac contractility modulation (LE = per session)
  • ZZ610 Emergency examination and treatment (LE = per session)
  • ZZ640 Diagnosis without image acquisition (LE = per session)
  • ZZ670 Other (partial) services provided as part of an outpatient contact or other services (LE = other)

Changes in the day clinic model include the addition of four services:

  • NZ200 Correction surgery on the tarsus/hindfoot (LE = per side)
  • NZ210 Corrective surgery on the first ray of the foot (LE = per side)
  • NZ220 Corrective operations on the 2nd – 5th ray of the foot (LE = per side)
  • QZ540 Excision/resection of skin and soft tissue (> 3 cm) including any rag plastic (LE = per session),

and deletion of one service:

  • ME080 Reconstruction of the capsular ligament apparatus of the shoulder joint - arthroscopic (LE = per side)

Five codes were added into the hospital services:

  • AV510 Lumbar puncture (LE = per session)
  • FC520 Lymph node scintigraphy (LE = per session)
  • GF510 Perfusion scintigraphy of the lungs (LE = per session)
  • GF520 Ventilation scintigraphy of the lungs (LE = per session)
  • ZN690 Other scintigraphy (LE = per session)

Code AJ140 for percutaneous destruction of peripheral nerves, which has been under discussion since the 2017 maintenance, was subjected to another HTA review because of the still insufficient evidence. It is suspended from 2020

See the full details here

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