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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 2023 OPS procedure coding classification released in Germany

On October 27, 2022, the BfArM (Federal Institute for Drugs and Medical Devices) published the final version of the 2023 OPS procedure coding classification. 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 in Germany.

Two hundred three (203) proposals submitted by representatives of professional societies, associations of health insurance companies, and healthcare institutions were incorporated in the OPS 2023.

Numerous content updates and new procedure codes inclusion concern chapters 5 "Operations" and 8 "Non-operative therapeutic measures". Also, changes were made in chapter 1 “Diagnostic measures”. The examples of newly introduced codes per technology group are provided below:

Cardiovascular

  • 1-274.30 Exploration of the atrial septum: Using a needle;
  • 5-377.n2 System for stimulating the conduction system: With 1 electrode;
  • 8-83d.9 Other percutaneous transluminal vascular interventions in the heart and coronary vessels: Insertion of a guidewire prior to termination of balloon angioplasty.

Endoscopy

  • 5-429.jh Measures for self-expanding prosthesis: Reopening, endoscopic;
  • 5-44a.3 Further operations on the stomach: Endoscopic reopening of a prosthesis;
  • endoscopic removal of pancreatic necrosis via puncture channel;
  • 8-530.e Therapy with open radionuclides: Endosonographically controlled implantation of P-32-labeled microparticles in the pancreas.

Orthopedics

  • 5-802.a↔ Refixation (reinsertion) of the medial capsular ligament apparatus of the bone;
  • 5-80a.y Open surgical operations on the acetabular labrum: Not specified;
  • 5-86a.22 Computer-assisted planning of operations on the bones of the extremities: Using patient-specific target instruments;
  • 5-935.1 Use of coated osteosynthesis material: With precious metal coating.

Peripheral vascular

  • 5-38a.90 Endovascular implantation of stent prostheses: V. cava: Stent prosthesis without valve function;
  • 5-38a.9x Endovascular implantation of stent prostheses: V. cava: Other;
  • 5-393.63 Creation of another shunt and bypass of blood vessels: A. poplitea: Popliteopopliteal.

The full details in German can be found here. The 2023 version of the OPS classification can be found here.

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