Percutaneous coronary interventions

Procedure coding

Typically, procedure coding for PCI is well-established in European countries.

In some countries, the coding might be complex, with existence of multiple codes depending on the number of treated coronary vessels or type and number of coronary stents. For example, in Germany, the combination of OPS codes for percutaneous coronary balloon angioplasty, insertion of a coronary stent, and multiple supplementary codes to specify the type (non-drug eluting stent, drug-eluting stent, bioresorbable stent, etc.) and number of inserted stents (from one to six) and treated coronary vessels (single or multiple coronary vessels), is used to describe the procedure. 

In other countries, the number of procedure codes for PCI is limited. For example, in France, the procedure is described via a single CCAM code for percutaneous coronary balloon angioplasty without stenting (code DDAF010) or with stenting depending on the number of treated vessels (code DDAF006 for stent insertion in one vessel, code DDAF004 – in two vessels, code DDAF003 – in three or more vessels) and do not specify the type of stents in their description. 

Policy considerations

Due to high medical and social importance, PCI in acute myocardial infarction can be subject to specific policies from payers or national decision-makers in the countries where such frameworks exist. 

For example, in England, the national payer, NHS England, developed so-called Service Specifications for primary PCI in ST-elevation myocardial infarction (STEMI), in which NHS England outlined patient pathways, eligible hospitals, responsibilities of different stakeholders, etc. 

In some countries, national decision-makers can restrict reimbursement of certain types of PCI. For example, PCI with a drug-coated balloon in Belgium is reimbursed only in case of re-stenosis.

Clinical guidelines and recommendations remain influential factors affecting the utilization of PCI.

Future challenges 

PCI with or without stent insertion has established reimbursement and funding in most European countries. New health technology assessments are unlikely to be relevant. 

Coronary stents, which can fit the established generic categories, are unlikely to benefit from the innovative payment schemes. 

Novel coronary stents and balloons with unique designs or properties or different cost profiles might need to develop specific procedure codes and adjust payment mechanisms to leverage their unique technology or cost profile fully. 

An important topic is the improvement of access and increasing number of simultaneous use of invasive and noninvasive coronary diagnostics (FFR, IVUS) and PCI, which impacts the treatment outcomes and changes the number of patients and eligibility criteria for different PCI options.