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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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The final version of the 2021 procedure coding (OPS) system released in Germany

12 Nov 2020

In late October 2020, the BfArM (Federal Institute for Drugs and Medical Devices) has published the final version of the OPS 2021 (Operation and Procedure Keys) system. The OPS, together with the ICD-10-GM (International Statistical Classification of Diseases and Related Health Problems, 10th revision, German Modification), forms the basis for the reimbursement systems in outpatient and inpatient care.

Two hundred seventy-eight (278) proposals, submitted by representatives of the professional societies and associations, health insurance companies, and healthcare institutions, were incorporated in the OPS 2021.

Numerous content updates and new procedure codes inclusion concern chapters 1 "Diagnostic measures", 5 "Operations" and 8 "Non-operative therapeutic measures". In chapter 9, "Supplementary measures," the sub-chapter 9-20, "Elaborate patient care," was excluded, and multiple content updates were made. Also, minor changes (mostly descriptive) were introduced in chapter 3, "Diagnostic imaging".

The most important content changes in OPS 2021 include:

  • Introduction of new codes for the determination of the ventilation status and the ventilation weaning potential and the prolonged ventilation weaning within specialized intensive care and non-intensive care ventilation weaning unit (1-717 ff., 8-718.7 ff., 8-718.8 ff.)
  • Revision of the codes for stroke treatment (8-981 ff., 8-98b ff.)
  • Introduction of multiple codes for genetic diagnostics, including codes for low-resolution and high-resolution HLA typing in myeloid and lymphatic neoplasms (1-941.2, 1-941.3), as well as codes for the (targeted) analysis of genetic changes in solid malignant neoplasms and high-throughput sequencing methods [NGS] for the study of genetic alterations in solid malignant neoplasms (1-992 ff., 1-995 ff., 1-996 ff.)
  • Restructuring of the codes for operations on the spine (5-83).

Also, the additional localization specification for the vascular prosthesis is added for the procedure codes 5-380 to 5-383, 5-386, 5-388, 5-389, and 5-395 to 5-397 (9m↔, a7↔).

The OPS 2021 can be found 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 are available for download free-of-charge.

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