Orthopedic procedures

Surgery for rotator cuff tears has been evaluated within the "New Method" framework since 2020. In January 2023, the method assessment phase was completed, and the National Institute of Public Health (NIPH) report was published. As the recommendations from HTA are now available, the Decision Forum needs to make a coverage decision regarding the method.

On January 1, 2023, the annual update of the Finnish NordDRG system came into force. There are 947 DRGs in the 2023 DRG system, compared to 930 DRGs in 2022. Among other changes, 34 new DRGs were introduced, including the DRGs in the cardiovascular, endocrine, endoscopy, gastrointestinal, obstetrics and gynecology, orthopedics, peripheral vascular, surgical procedures, and some other fields.

On December 19, 2022, the Dutch Healthcare Authority (NZa) issued a draft release of the DRG package for 2024, including new procedure codes, new diagnosis codes, and several new DRGs. These changes concern pulmonary, gynecology, ENT, orthopedics, and other technology groups.

In December 2022, the Clinical Coding and Schedule Development (CCSD) working group, which develops and maintains procedural and diagnostics nomenclatures for private payers in England, published Bulletin 187 with changes to be implemented in procedural classification no later than February 8, 2023. Five new procedure codes were introduced concerning orthopedic, surgical procedures, and men’s health. No changes were made to the diagnostic schedule.

In December 2022, NHS England published an update of the Specialized Services Policy Pipeline (as of December 6, 2022). No new MedTech-related Clinical Commissioning Policies were added to the work program, and three new policies were published in the period from September 6, 2022, to December 6, 2022. The status of ongoing policies was updated as well.

On December 1, 2022, the Swiss Federal Office of Public Health published the changes that will occur to the Services Ordinance (KLV/OPre), which determines coverage of medical services in Switzerland. The updates will enter into force on January 1, 2023, and they relate to the list of explicitly evaluated services (Annex 1 of KLV/OPre), outpatient-before-hospital services (Annex 1a), List of Tools and Appliances(Annex 2), and List of Analyses (Annex 3).

In November 2022, NHS Digital published a final summary of core changes from OPCS-4.9 to OPCS-4.10 to be introduced from April 01, 2023. OPCS-4 is a statistical classification for clinical coding of interventions and procedures undertaken within the NHS. It is updated every three years. A total of 236 new four-character codes will be implemented in OPCS-4.10. Key changes concern cardiovascular, gastrointestinal, endoscopy, ENT, nephrology and urology, neurology and neurosurgery, obstetrics and gynecology, orthopedic, and breast surgery fields.

The HTA body of the Tuscany Regional Healthcare issues three types of documents: full HTA reports, rapid HTA reports, and motivational forms. With regional decree 21738 of November 4, 2022, Tuscany Regional Healthcare has published assessments of three medical devices in the orthopedics, surgical procedures, and peripheral vascular areas.

On October 27, 2022, the BfArM (Federal Institute for Drugs and Medical Devices) published the final version of the 2023 OPS procedure coding classification. The OPS, together with the ICD-10-GM (International Statistical Classification of Diseases and Related Health Problems, 10th revision, German Modification), forms the basis for the reimbursement systems in outpatient and inpatient care in Germany.

The French National Authority for Health released new recommendations about add-on reimbursement of medical devices and medical aids from the meetings of the National Commission for Evaluation of Medical Devices and Health Technologies in October 2022. Fourteen recommendations were published in relation to the registration, modification of registration conditions, and renewal of registration for devices in the List of reimbursable products and services. Opinions concern cardiovascular, neurovascular, orthopedic, and ENT devices, as well as medical aids.

In late September – early October 2022, three more health apps were introduced in the Directory of digital health applications (DiGAs) at the Federal Office for Drugs and Medical Devices (BfArM) and thus became reimbursable. These apps can be prescribed by physicians and psychotherapists and will be reimbursed by sickness funds.

On September 22, 2022, the Austrian version of the DRG system (LKF) 2023 model with the relevant supplementary documents was published in Austria. The document "Changes and innovations in the 2023 LKF model" summarizes the most significant changes and innovations in the LKF model for inpatient and outpatient care. The newly added procedure codes mainly concern cardiovascular, extracorporeal treatments, and peripheral vascular fields.