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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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Four new procedure and six diagnostic codes were added to private reimbursement schedule in England in April

The Clinical Coding and Schedule Development (CCSD) Group develops and maintains procedural and diagnostics nomenclature for private payers in England. The Clinical Coding & Schedule Development (CCSD) Group consists of representatives from four major private healthcare insurers: Aviva, AXA-PPP healthcare, Bupa and VitalityHealth. Once codes are added to the Schedule, private insurance company can develop reimbursement tariff for these procedures and tests.

The CCSD Group has approved the following procedure codes for publication to the CCSD Schedule in April:

  • Oophorectomy and salpingectomy, +/- biopsy eg. omentum, peritoneum, lymph node (as sole procedure) – unilateral (Q2231);
  • Flexible pouchoscopy +/- biopsy and/or removal of polyp(s) (H6840);
  • Intralesional immunotherapy injections for treating unresectable, metastatic melanoma +/- image guidance (S5320);
  • Multivisceral resection of retroperitoneal sarcoma (T3920).

The request for relief of intestinal obstruction for adhesions, acute or chronic, has been declined, because the suggested new narrative is too restrictive as there will be other instances for use of this code not just intestinal obstruction.

The CCSD Group has approved the following diagnostic codes for publication to the CCSD Schedule in April:

  • IHS Multi Gene panel (BRAF, EGFR, KRAS and NRAS) (4198B);
  • Group and Save (5000B);
  • 16s PCR (5001B);
  • ENAP Profile (5002B);
  • Galactomannan Ag Elisa (5003B);
  • One-step nucleic acid amplification (ONSA) (5004B).

Details can be found here.

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