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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 OPCS-4.10 to come into force from April 2023 in England

In November 2022, NHS Digital published a final summary of core changes from OPCS-4.9 to OPCS-4.10 and documents for implementation within NHS systems. OPCS-4 is a statistical classification for clinical coding of interventions and procedures undertaken within the NHS. The OPCS-4 is updated every three years to reflect current NHS clinical practice through the addition of new content as necessary to support aggregate data for statistical purposes and reimbursement. The OPCS-4.10 version will be implemented from April 01, 2023.

A total of 34 new three-character (sub-chapter) codes and 236 new four-character codes will be introduced in OPCS-4.10.

One new procedure code will be introduced in the cardiovascular field:

  • K62.6 Percutaneous transluminal intermittent occlusion of coronary sinus. The code includes percutaneous transluminal pressure controlled intermittent occlusion of coronary sinus.

Multiple codes will be implemented in gastrointestinal and endoscopy fields, including the following (provided as examples):

  • G20.2 Fibreoptic endoscopic coagulation of bleeding lesion of oesophagus using haemostatic spray;
  • H38.1 Fibreoptic endoscopic cryotherapy to lesion of colon;
  • H73.1 Diagnostic examination of anus and biopsy of anus using high resolution anoscope.

Several codes will be implemented in the ENT field, including the following (provided as examples):

  • F35.1 Bilateral intracapsular tonsillectomy NEC;
  • E32.1 Endoscopic cricoid split.

Newly developed nephrology and urology codes include the following:

  • M51.3 Insertion of autologous sling. Includes insertion of autologous fascial sling, sling on a string, native tissue sling;
  • M56.4 Endoscopic removal of inert substance from outlet of female bladder;
  • M66.4 Endoscopic removal of inert substance from outlet of male bladder.

Newly developed neurology and neurosurgery codes include the following:

  • A71.1 Primary microsurgical transfer of peripheral nerve;
  • A71.3 Microsurgical transfer of multiple peripheral nerves.

Several codes will be implemented in the obstetrics and gynecology field, including the following (provided as examples):

  • P29.6 Oversewing of mesh in vagina. Includes oversewing of eroded or exposed mesh in vagina, oversewing of eroded or exposed tape in vagina;
  • Q05.2 Insertion of osmotic dilator into cervix;

Multiple codes will be implemented in the orthopedic field, including the following:

  • T67.7 Primary repair of tendon to bone using fixation. Includes primary repair of tendon to bone using anchor;
  • T68.7 Secondary repair of tendon to bone using fixation. Includes secondary repair of tendon to bone using anchor.

New codes will also be implemented in relation to breast surgery, neuromodulation, spine, and peripheral vascular procedures.

See more information 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 of both newsletters are available for download free-of-charge.

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