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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 in February and March 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 and VI of Nomenclature, regarding the creation of new codes for laser destruction of congenital port-wine stains, hearing aids and cone beam computed tomography.

The following new codes have bean introduced in February (Article 21 “Dermato-venereology”):

  • Destruction of congenital wine stain(s) from a total area ≤ 200 cm2 on the head, neck or hands, with the laser (codes 532873-532884 and 532895-532906)

There are the following conditions of reimbursement for the service 532873-532884 and 532895-532906:

  • Destruction applies to the stains that warranted treatment test (532733-532744) and for which this treatment proved to be effective
  • A phase of treatment may, if necessary, be spread over several sessions. The benefit is granted maximally 8 times. The benefit covers the cost of the equipment and the medical procedure

Key changes in the audiologists article in February (Article 31 “Audiologists”):

Increase in reimbursement for beneficiaries aged 18 to 65 in the target group "Abnormal hearing progression concerning age":

  • Benefits for beneficiaries aged 18 and over are replaced by two new benefits for beneficiaries aged 18 to 65 and beneficiaries aged 65 and over. These new services are created for monophonic, stereophonic and contralateral devices and complementary interventions for bone conduction equipment

Increased reimbursement for bone anchored hearing aids:

  • The benefit relating to the complementary intervention for equipment in bone conduction is divided into a provision for bone conduction without bone anchorage and six new bone conduction services with bone anchorage. For the three age categories, provision is made for the first apparatus and service for the renewal
  • Under the repayment conditions, 2.4. 'Complementary intervention of the bone conduction insurance, a paragraph is added to differentiate between devices with and without bone anchorage and to provide clarification concerning the equipment with a magnet ("Bone attract-conduction")
  • There can be no intervention for the first delivery of a bone conduction device with bone anchorage if in the past delivery of bone conduction equipment with bone anchorage has already taken place

The following new codes have been introduced in March (Article 17 “Radiodiagnostics”):

  • Cone beam computed tomography (CBCT) without the contrast medium, for the entire examination (458474-458485)
  • Cone beam computed tomography (CBCT) of a peripheral joint of an upper or lower limb, with intraarticular injection of a contrast medium, for the entire review (458496-458500)

There are the following conditions of reimbursement for the service 458474-458485:

  • The procedure 458474-458485 can only be performed when one of the following conditions is met:
  • X-ray did not provide enough information:
  • For the re-evaluation or monitoring of subtle or complex fractures, tear fracture (avulsion), subluxations;
  • For the diagnosis or reassessment of a lesion clinically suspected fracture in case of prior negative radiographs;
  • For the evaluation of delayed healing or "non-union";
  •  In case of evaluation or pre-operative planning of a fracture of complex dislocation;
  •  In case of postoperative control of the peripheral bone with the presence of osteosynthesis equipment or surgical complications.

The procedures 458474-458485 and 458496-458500 can only be prescribed by a specialist doctor.

See full details here.

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