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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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New procedure codes in Belgian Nomenclature came into force in May 2019

17 Jun 2019

The health benefit Nomenclature of the Belgian National Institute for Health and Disability Insurance (INAMI/RIZIV) includes the benefits (with specific hospital and ambulatory codes) that are reimbursed by the compulsory health care insurance, wholly or partially. The Nomenclature and its changes are published in the Belgian Official Gazette.

On February 19, 2019, the Nomenclature was updated. The update brought changes in chapter V of Nomenclature, regarding the creation of new codes for ultrasound examination during pregnancy. 

Article 17-bis (ultrasound) and Article 17-quater (ultrasound, except radiodiagnosis physician) were changed with the latest update of the Nomenclature, and these changes will come into force on May 1, 2019.

The following new codes have been introduced:

  • Ultrasonographic evaluation of the pregnancy during the first trimester, with protocol and documents, attestable maximum once per pregnancy (461731-461742)
  • Ultrasound assessment of pregnancy during the third trimester, with protocol and documents, attestable maximum once per pregnancy (461753-461764)
  • A morphological ultrasound examination during the second trimester starting from the 20th week of gestation which includes, besides a biometrics and viability assessment, the exploration of the fetal organ systems, with protocol and documents (461775-461786)
  • Ultrasound examination in case of clinical symptoms or unknown duration of pregnancy only performed until the 20th week of gestation (461790-461801)
  • Additional ultrasound examination including biometrics and biophysical profile of the fetus, with or without measurement of umbilical blood flow, in case of documented feto-maternal pathology (461812-461823)
  • Ultrasound examination with an examination of all fetal organ systems, with protocol and documents, in case of severe congenital malformation or proven risk (461834-461845)

There are the following conditions of reimbursement for the above-mentioned services:

  • The services 461731-461742 and 461753-461764 include a basic ultrasound for evaluation of the fetus and placenta and the detection of possible fetal abnormalities respectively during the first and third trimesters of pregnancy
  • Service 461775-461786 is performed maximum once per pregnancy
  • Service 461812-461823 can only be performed from the 20th week of gestation. The indication for this service must be mentioned in the medical file
  • The service 461834-461845 includes a thorough examination of the the central nervous system, the spine, the cardiovascular and urogenital system, the locomotor system, the face, the oropharynx, gastrointestinal tract, liver and gall bladder, diaphragm and abdominal wall, with photographic documentation and protocol, and may only be reimbursed after prior approval by the medical officer
  • For services 461731-461742, 461753-461764, 461775 461786, 461790-461801, 461812-461823, and 461834-461845, the relative value is increased by 50% for multiple pregnancies

Three codes regarding ultrasound examination during pregnancy were deleted from the Nomenclature.

See full details here.

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