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Cost-efficient European adaptations of global health economic models

Experience with model adaptations in Austria, Belgium, France, Germany, Italy, Norway, Netherlands, Spain, Sweden, the UK

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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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OPCS-4.10 procedural classification came into force in England

OPCS-4 is the clinical coding classification of interventions and procedures undertaken within the NHS (National Health Service) in England. It is updated every three years to reflect current NHS clinical practice to be used for statistical purposes and reimbursement. The OPCS-4.10 version came into force on April 1, 2023.

A total of 34 new three-character category codes and 236 four-character sub-category codes were introduced in OPCS-4.10. Some examples of newly implemented codes are provided below.

The following code was introduced concerning therapeutic transluminal operations on the heart:

  • K62.6 Percutaneous transluminal intermittent occlusion of coronary sinus. Includes percutaneous transluminal pressure controlled intermittent occlusion of coronary sinus.

Multiple codes were added in the gastrointestinal field, including the following:

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

Several new codes were implemented in the ENT area, including

  • E32.1 Endoscopic cricoid split. Includes endoscopic cricoid split with balloon dilation, anterior cricoid, posterior cricoid;
  • F35.2 Bilateral intracapsular coblation tonsillectomy.

Examples of new codes in the urology field are:

  • M44.5 Endoscopic removal of mesh from bladder. Includes endoscopic removal of eroded or exposed mesh from bladder;
  • M51.3 Insertion of autologous sling. Includes insertion of autologous fascial sling, sling on a string, native tissue sling.

Multiple codes were added for orthopedic and spine procedures, including the following:

  • T67.7 Primary repair of tendon to bone using fixation. Includes primary repair of tendon to bone using anchor;
  • V44.6 Augmentation vertebroplasty of fracture of spine using intravertebral implant. Includes insertion of intravertebral implant with cement for fracture of spine.

An example of new codes for breast reconstruction is:

  • B42.1 Reconstruction of breast using free myocutaneous gracilis flap. Includes reconstruction of breast using free transverse upper gracilis flap, reconstruction of breast using free diagonal upper gracilis flap, reconstruction of breast using free L-shaped upper gracilis flap.

Furthermore, new codes were introduced in the areas of neurology and neurosurgery, obstetrics and gynecology, peripheral vascular, and others.

See more details 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). Contact us to get a free, three-month, no-obligation trial.