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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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Sixteen new procedure and two diagnostics codes added to private reimbursement schedule in England

The Clinical Coding and Schedule Development (CCSD) group develop and maintains procedural and diagnostics nomenclature for private payers in England. New procedure codes concern cytoreductive surgery for colorectal peritoneal carcinomatosis, cytoreductive surgery for ovarian malignancies, therapeutic sialendoscopy, intra corporeal salivary gland lithotripsy, bronchial thermoplasty and others and diagnostic codes for tests for common and rare mutations. The codes are introduced with a recommended adoption date being the 1st of August 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 procedure codes for publication to the CCSD Schedule in April 2019 with a recommended adoption date being the 1st of August 2019:

  • Therapeutic sialendoscopy (including stone retrieval +/- dilation) (F4831)
  • Intracorporeal salivary gland lithotripsy (F4832)
  • Combined open and endoscopic removal of submandibular gland stone (F5121)
  • Combined open and endoscopic removal of parotid gland stone (F5611)
  • Minimally invasive endoscopic repair of atrial septal defects (ASD) via mini-thoracotomy (K0960)
  • Transabdominal cerclage for cervical incompetence in gravid uterus (R1230)
  • Laparoscopic cerclage for cervical incompetence in gravid uterus (R1240)
  • Bronchial thermoplasty (including bronchoscopy) for severe asthma (E6710)
  • Harvesting and injection of bone marrow aspirate concentrate (BMAC) (W7180)
  • Cytoreductive surgery (Sugarbaker technique) for Pseudomyxoma Peritonei with intraperitoneal chemotherapy (J9901)
  • Cytoreductive surgery for Colorectal Peritoneal Carcinomatosis (2-3 distinct procedures) with intraperitoneal chemotherapy (J9902)
  • Cytoreductive surgery for Colorectal Peritoneal Carcinomatosis (4-6 distinct procedures) with intraperitoneal chemotherapy (J9903)
  • Cytoreductive surgery for Colorectal Peritoneal Carcinomatosis (7-8 distinct procedures) with intraperitoneal chemotherapy (J9904)
  • Repeat Cytoreductive surgery for Pseudomyxoma Peritonei or Colorectal Peritoneal Carcinomatosis with intraperitoneal chemotherapy (J9905)
  • Heated intraperitoneal chemotherapy for Colorectal Peritoneal Carcinomatosis (J9906)
  • Cytoreductive surgery for Ovarian Malignancies excluding intraperitoneal chemotherapy (J9907)

See full details here.

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

  • 5FU Common mutations (DPD) (0633G)
  • 5FU Rare mutations (DPD) (0634G)

See full details here.

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