Coronary imaging and diagnostic procedures

Series
Coronary interventions
Status
Published
Date
Number of report
020

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The report presents a summary of reimbursement situation for a number of coronary imaging methods.

Sample pages are provided for an older version of the report. Before delivery to the client, the report is updated to the current state (e.g., 2022 coding, tariffs, and policy considerations). 

Procedures, covered in the report include:

  • Intravascular ultrasound (IVUS)
  • Coronary fractional flow reserve measurement (FFR)
  • Instantaneous wave-free ratio (iFR)
  • Cardiac computed tomography
  • Optical coherence tomography (OCT)

An analysis is provided for three indications: stable angina, unstable angina, and acute myocardial infarction.

Reimbursement analysis is provided only for admitted care settings for stand-alone imaging procedures and for imaging procedures performed in adjunction to percutaneous coronary intervention with and without stenting.

The report includes essential information about reimbursement and national funding, including:

  • Brief overview of reimbursement system for medical devices
  • Procedure coding for technology
  • Diagnosis coding
  • Payment mechanism for technology
  • Reimbursement tariffs for technology
  • Restrictions in indications or scenarios for use of technology
  • Policy considerations by payers and policy-makers about technology

Reimbursement information is provided for the following geographies:

  • Austria
  • Belgium
  • Denmark
  • England (UK)
  • France
  • Germany
  • Italy
  • Netherlands
  • Norway
  • Sweden
  • Switzerland

It is also possible to add analysis in Czech Republic, Finland, Hungary, Romania, Russia and Turkey.

Manufacturers of devices for coronary imaging system include:

  • Abbott (OPTIS™)
  • Acist (RXi Rapid Exchange FFR)
  • Arineta 
  • Asahi Intecc
  • Avinger (WildCat)
  • Axsun Technologies
  • Boston Scientific (OPTICROSS™, iLab™, Ultra ICE™, Polaris, COMET™)
  • Canon (Aquilion)
  • CathWorks
  • FUJIFILM (Speedia)
  • GE (Innova®, Revolution FrontierTM, Discovery™)
  • Hitachi (SCENARIA)
  • InfraReDx (LipiScan IVUS, Makoto™ Intravascular Imaging System)
  • Opsens Inc. (OptoWire and OptoMonitor FFR)
  • Philips/ Volcano (Eagle Eye Platinum, Verrata)
  • Samsung/NeuroLogica (BodyTom®)
  • Shimadzu (NeuViz)
  • Siemens (IVUSmap)
  • Silicon Valley Medical Instruments (HD IVUS)
  • SinoVision Technologies (Insitum)
  • St. Jude Medical (PRESSUREWIRE™ X GUIDEWIRE)
  • Terumo (Lunawave)

Table of content

1.    Introduction and summary
2.    Executive summary table
3.    Contents
4.    Methodology
5.    Reimbursement analysis in Austria

5.1.    Overview of the reimbursement system
5.2.    Reimbursement for coronary imaging and diagnostic procedures
5.2.1.    Procedure coding
5.2.2.    Diagnosis coding
5.2.3.    Payment mechanism and reimbursement tariffs
5.2.4.    Health technology assessments by LBI-HTA
6.    Reimbursement analysis in Belgium
6.1.    Overview of the reimbursement system
6.2.    Reimbursement for coronary imaging and diagnostic procedures
6.2.1.    Procedure coding
6.2.2.    Diagnosis coding
6.2.3.    Payment mechanism and reimbursement tariffs
6.2.4.    Policy considerations by the INAMI/RIZIV
6.2.5.    Health technology assessments by KCE
7.    Reimbursement analysis in Denmark
7.1.    Overview of the reimbursement system
7.2.    Reimbursement for coronary imaging and diagnostic procedures
7.2.1.    Procedure coding 
7.2.2.    Diagnosis coding
7.2.3.    Payment mechanism and reimbursement tariffs
7.2.4.    Policy considerations
8.    Reimbursement analysis in England
8.1.    Overview of the reimbursement system
8.2.    Reimbursement for coronary imaging and diagnostic procedures
8.2.1.    Procedure coding 
8.2.2.    Diagnosis coding
8.2.3.    Payment mechanism and reimbursement tariffs
8.2.4.    Policy considerations 
8.2.4.1.    Specifics of commissioning of the procedure
8.2.4.2.    Health technology assessments by NICE
9.    Reimbursement analysis in France
9.1.    Overview of the reimbursement system
9.2.    Reimbursement for coronary imaging and diagnostic procedures
9.2.1.    Procedure coding 
9.2.2.    Diagnosis coding
9.2.3.    Payment mechanism and reimbursement tariffs
9.2.4.    Policy considerations by HAS
10.    Reimbursement analysis in Germany
10.1.    Overview of the reimbursement system
10.2.    Reimbursement for coronary imaging and diagnostic procedures
10.2.1.    Procedure coding 
10.2.2.    Diagnosis coding
10.2.3.    Payment mechanism and reimbursement tariffs
10.2.4.    Policy considerations by G-BA
11.    Reimbursement analysis in Italy
11.1.    Overview of the reimbursement system
11.2.    Reimbursement for coronary imaging and diagnostic procedures
11.2.1.    Procedure coding at national level
11.2.2.    Procedure coding at regional level (Emilia-Romagna, Lombardy, Veneto regions)
11.2.3.    Diagnosis coding
11.2.4.    Payment mechanism and reimbursement tariffs at national level
11.2.5.    Payment mechanism and reimbursement tariffs at regional level
11.2.6.    Policy considerations
12.    Reimbursement analysis in the Netherlands
12.1.    Overview of the reimbursement system
12.2.    Reimbursement for coronary imaging and diagnostic procedures
12.2.1.    Procedure coding 
12.2.2.    Diagnosis coding
12.2.3.    Payment mechanism and reimbursement tariffs
13.    Reimbursement analysis in Norway
13.1.    Overview of the reimbursement system
13.2.    Reimbursement for coronary imaging and diagnostic procedures
13.2.1.    Procedure coding 
13.2.2.    Diagnosis coding
13.2.3.    Payment mechanism and reimbursement tariffs
13.2.4.    Policy considerations 
14.    Reimbursement analysis in Sweden
14.1.    Overview of the reimbursement system
14.2.    Reimbursement for coronary imaging and diagnostic procedures
14.2.1.    Procedure coding 
14.2.2.    Diagnosis coding
14.2.3.    Payment mechanism and reimbursement tariffs
14.2.4.    Policy considerations
15.    Reimbursement analysis in Switzerland
15.1.    Overview of the reimbursement system
15.2.    Reimbursement for coronary imaging and diagnostic procedures
15.2.1.    Procedure coding 
15.2.2.    Diagnosis coding
15.2.3.    Payment mechanism and reimbursement tariffs
15.2.4.    Policy considerations
16.    Disclaimer

22

Nov 2022

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.

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11

Oct 2022

In September 2022, the National Institute for Health and Care Research (NIHR) in England released one MedTech-related report in its Health Technology Assessment (HTA) Journal, which concerned early computed tomography coronary angiography in acute coronary syndrome. HTA Journal publishes research reports on the effectiveness, costs, and broader impact of health technologies for those who use, manage, and provide care in the NHS and informs National Institute for Health and Care Excellence (NICE) guidance.

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07

Oct 2022

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.

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18

Aug 2022

On July 15, 2022, the Austrian Institute for HTA (AIHTA) published five decision support documents, which provide recommendations regarding the inclusion of new medical interventions in the catalog of individual medical services of the performance-oriented hospital financing (Leistungsorientierten Krankenanstaltenfinanzierung, LKF) model, as well as four updates to previous decision support documents. The decisions relate mainly to cardiovascular and gastrointestinal technology groups.

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18

Jul 2022

On June 22, 2022, the document "Changes and innovations in the 2022 LKF model" (Änderungen und Neuerungen in den LKF-Modellen 2023) was published. The document 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.

Read more
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