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. 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

15

Oct 2021

The Scottish Health Technologies Group (SHTG) is a national health technology assessment (HTA) agency providing advice to NHSScotland on the use of new and existing health technologies, likely to have a significant impact on healthcare. In the third quarter of 2021, SHTG published only one report in relation to HeartFlow fractional flow reserve computerized tomography (FFRCT). Currently, the SHTG is working on assessments of technologies in the field of diabetes, digital health, surgical procedures, and other topics.

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Sep 2021

At the beginning of September 2021, the Government of the Russian Federation released the preliminary version of the Program of State Guarantees for the period of 2022-2024. Major changes concerned the High-End Medical Care (HEMC) list I, where two new procedures in the cardiovascular and neurovascular field were added. The HEMC list II was expanded with the procedures in the field of radiotherapy, neurology, and neurosurgery, surgical procedures. The final version is expected at the beginning of 2022.

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21

Sep 2021

In August 2021, the mini-HTA evaluation of the robot-assisted percutaneous coronary intervention was released. The method was described as safe and effective. After the introduction into the clinical practice, the method should be followed up for two years with a sufficient number of procedures to understand the real benefit. All procedures are to be registered in the Norwegian Registry for Invasive Cardiology.

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28

Jun 2021

In mid-June 2021, the document "Changes and innovations in the 2022 LKF model" (Änderungen und Neuerungen in den LKF-Modellen 2022) 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 concern mainly the cardiovascular, e-Health, and gastrointestinal area.

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22

Jun 2021

In late May 2021, the Clinical Coding and Schedule Development (CCSD) working group, which develops and maintains procedural and diagnostics nomenclature for private payers in England, has published Bulletins 0177 and 0074 with changes to be implemented not later than August 01, 2021. Five new procedure codes related to diagnostic imaging, ENT, breast reconstruction, and gynecology, and nine new diagnostic codes were introduced.

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