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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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Nine new procedure and one diagnosis codes added to private reimbursement schedule in England

30 Apr 2019

The Clinical Coding and Schedule Development (CCSD) group develop and maintains procedural and diagnostics nomenclature for private payers in England. New diagnostic codes concern circulating tumor DNA profile for the different type of cancers, myriad Prolaris test, PET Scan with florbetapir, etc. and a procedure code for robotic-assisted radical hysterectomy and lymphadenectomy. The codes are introduced with a recommended adoption date being the 1st of May 2019. The documents also contain a list of textual changes in codes and an updated list of unacceptable combinations of codes.

The CCSD Group has approved the following diagnostic codes for publication to the CCSD Schedule in February 2019 with a recommended adoption date being the 1st of May 2019:

  • Circulating tumor DNA profile for breast cancer (Guardant 360) (3100G)
  • Circulating tumor DNA profile for upper gastrointestinal cancer (Guardant 360) (3101G)
  • Circulating tumor DNA profile for colorectal cancer (Guardant 360) (3102G)
  • Circulating tumor DNA profile for cancer of unknown primary (Guardant 360) (3103G)
  • Myriad Prolaris (3015G)
  • PET Scan with florbetapir (IM371)
  • Gene Panel Myriad Colaris Plus with the colorectal high-risk panel (3016G)
  • B Cell Clonality (3017G)
  • ALCA – Anti-Liver Cytosol (LC1) Antibodies (0101B)

See full details here.

The new procedure code “Robotic-assisted radical hysterectomy and lymphadenectomy (Wertheim's) +/- ureterolysis” (Q0711) was also recommended for adoption. See full details here.

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