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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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SwissDRG COVID19-related announcements

03 Apr 2020

On March 13, 2020, the entity managing the Swiss DRG system, SwissDRG, announced that in order to ensure that the growing number of acute hospital treatments, due to infection with the new coronavirus, can be uniformly coded and remunerated across Switzerland using case-based lump-sums, SwissDRG has developed a recommendation for the appropriate representation of these cases in version 9.0 of the SwissDRG tariff structure. The Federal Office for Public Health (FOPH) supports this recommendation, which allows for a uniform procedure throughout Switzerland for the remuneration of hospital care for patients affected by COVID19:

According to the communication among the World Health Organization, the German Institute for Medical Documentation and Information (DIMDI), and the Federal Statistics Office, COVID-19 can now be specifically coded with the ICD code U07.1.

To allow a correct representation of the COVID19 cases in the DRG system, the CHOP code 93.59.5 (“Complex treatment in case of colonization or infection with resistant multi-drug pathogens, depending on the number of days of treatment”) can be coded with immediate effect also for the complex treatment in the case of colonization or infection ascertained with the pathogen COVID19, provided that the other minimum characteristics of this CHOP code are met. Until now, this code could have only been used for multi-drug pathogens of the ICD codes U80 - U82.

At the same time, SwissDRG released an explanation regarding the additional reimbursement for special isolation stations. The billing of the ZE-2020-155 "special isolation" reimbursement requires certain structural and operational conditions. These include active autonomous ventilation systems with active negative pressure stages, particulate filters for exhaust air and special decontamination measures, as well as strict barrier nursing. In addition, according to the "Billing restrictions" mentioned in the SwissDRG 9.0 / 2020 catalog, the pathogens to be treated apply for this additional remuneration. Sars-CoV-2 coronavirus is not one of these pathogens.

Furthermore, due to the dynamic spread of SARS-CoV-2 and the associated disease COVID-19, the expected number of seriously ill patients with respiratory and multiorgan failure is pushing the resources available for critical care to the limit. Thus, an expansion of critical care capacity is already accelerating in different areas, for example, for the intensive care units, and the recovery rooms. SwissDRG is currently working with its partners to allow adequate compensation for ICU cases, even for those staying in uncertified premises / units.

See the full news in Italian (change to German or French in the top-right corner) here and here.

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