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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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Seventeen new procedure and sixteen diagnostics codes added to private reimbursement schedule in England

The Clinical Coding and Schedule Development (CCSD) group develops and maintains procedural and diagnostics nomenclature for private payers in England. New procedure codes concern scar revision, robotic-assisted thymectomy, prophylactic oophorectomy/ hysterectomy, percutaneous electrical nerve stimulation, delivery of fraction of proton beam therapy for non-ocular adult tumors and diagnostic codes for myriad breast and ovarian cancer panel 101 test, clinical exome sequencing MPLA test, and others. The codes are introduced with a recommended adoption date being the 1st of February 2020. The documents also contain a list of textual changes in codes and inactivated codes.

The CCSD Group has approved the following procedure codes for publication to the CCSD Schedule in September 2019 with a recommended adoption date being the 1st of February 2020:

  • Scar revision up to 5cm – head & neck (S6040)
  • Scar revision up to 5cm – trunk & limbs (S6041)
  • Scar revision over 5cm – head & neck (S6042)
  • Scar revision over 5cm – trunk & limbs (S6043)
  • Robotic-assisted thymectomy for myasthenia gravis/thymoma (B1801)
  • Chimeric Antigen Receptors Cell Therapy (CAR-T) (U0160)
  • Prophylactic oophorectomy (including bilateral) (Q2234)
  • Prophylactic hysterectomy (+/- oophorectomy) (Q0792)
  • Percutaneous electrical nerve stimulation (PENS) (A7070)
  • Planning and preparation for the delivery of Proton Beam Therapy (PBT) for non-ocular paediatric tumours (X6017)
  • Delivery of fraction of Proton Beam Therapy (PBT) for non-ocular paediatric tumours (X7017)
  • Delivery of fraction of Proton Beam Therapy (PBT) for non-ocular adult tumours (X7018)
  • Planning and preparation for the delivery of Proton Beam Therapy (PBT) for non-ocular adult tumours (X6018)
  • Removal of neurostimulator from spinal cord (A4841)
  • Removal of neurostimulator from peripheral nerve (A4842)
  • Transcatheter aortic valve implantation (TAVI) with percutaneous insertion of a cerebral protection device (K3581)
  • Sutureless aortic valve replacement for aortic stenosis (K2601)

See full details here.

The CCSD Group has approved the following diagnostic codes for publication to the CCSD Schedule in September 2019 with a recommended adoption date being the 1st of February 2020:

  • Exercise-induced laryngeal obstruction (EILO) test (RE013)
  • Myriad Breast and Ovarian Cancer Panel 101 (3019G)
  • Clinical Exom Sequencing MPLA (6006G)
  • TH1:TH2 Intracellular Cytokine Ratio with IVIg (0020B)
  • BH5 PRE COMPOUNDING TEST (0025B)
  • BH4 PRE COMPOUNDING TEST (0024B)
  • BH3 PRE COMPOUNDING TEST (0023B)
  • BH2 PRE COMPOUNDING TEST (0022B)
  • BH1 PRE COMPOUNDING TEST (0021B)
  • Alpha Subunits for LH (0018B)
  • Alpha Subunits for FSH (0019B)
  • Beta Catenin Mutation (0019G)
  • MAI Complex RNA (0636G)
  • CCND1 T(11:14) (0020G)
  • Mdm2 gene amplification (0021G)
  • HIV Integrase Drug Resistance (3020G)

See the full details here.

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