Diagnostic endoscopic procedures on the lower gastrointestinal tract

In November 2020, the Clinical Coding and Schedule Development (CCSD) group, which develops and maintains procedural and diagnostics nomenclature for private payers in England, has published Bulletins 0173 and 0070 with changes to be implemented not later than February 01, 2021. Three new procedure codes were introduced, related to robotic laparoscopy in gynecology, brachytherapy in prostate tumor, and autologous bone marrow aspirate concentrate (BMAC) for osteochondral defects of the knee. Also, four codes for diagnostic tests were added.

In Sensible Care projects, the Dutch Healthcare Institute, together with other parties, is investigating the possibilities for improving care pathways for patients. As of early November 2020, there are 30 ongoing projects, including two projects for assessing knee and hip osteoarthritis treatment and medicines for castration-refractory prostate carcinoma at the final evaluation phase.

In late September 2020, the Austrian version of the DRG system (LKF) 2021 model with the relevant supplementary documents was published in Austria. For 2021, the main changes include the addition of sixteen new procedure codes and the introduction of two new procedure codes for billing in the day-case settings, update of cases flat rates, and adjustments of the cases daily component calculation.

In mid-August 2020, the German Federal Institute for Drugs and Medical Devices (BfArM) published the preliminary 2021 version of OPS procedure coding nomenclature. Numerous content updates and new procedure codes inclusion concern the chapters 1 “Diagnostic measures,” 5 “Operations,” and 8 “Non-operative therapeutic measures.” The list of new endoscopy-related procedure codes added under the respective OPS sub-chapters of chapters 1 and 5 is provided below:

The Institute for Quality and Efficiency in Health Care (IQWiG) investigated the extent to which evidence is available for the benefit and harm of non-invasive computed tomography angiography (CTA) and stress diagnostics using magnetic resonance imaging (MRI) in people with suspected coronary heart disease (CAD) using evidence mapping.

On behalf of the Federal Joint Committee (G-BA), the Institute for Quality and Efficiency in Health Care (IQWiG) investigated whether (former) heavy smokers within statutory health insurance (SHI) should be offered lung cancer screening using low-dose computed tomography (LDCT).

The revised EBM (German Uniform Evaluation Standard) catalog came into force on July 1, 2020. MTRC has compiled the selection of the most significant changes.

The Corona warning app, developed on behalf of the German government, has been available for download in the Google and Apple stores since June 16, 2020. It is intended to help identify and break infection chains at an early stage. Users of the app receive a notification if they have been for a long time in the vicinity of a person who was later found to be infected with the coronavirus.

The reimbursement for PCR tests for the detection of SARS-CoV-2 will be reduced from €59.00 to €39.40 per test starting from July 1, 2020, and the billing of the examination will be limited to five times in the case of treatment. This decision was made by the extended evaluation committee on June 10, 2020.

According to the German Institute of Medical Documentation and Information (DIMDI) announcement, there will be a new ICD code for the coding of non-curative COVID-19 tests in symptom-free people implemented in ICD-10-GM on June 1, 2020. The implementation in the practice management systems is ongoing.

The German Society for Neurology (DGN) has published a new version of the S1 guideline "Syncope." It is valid until January 2025.

The German Society for Neurology (DGN) has released a new version of the S1 guideline "Diagnostics and therapy of neurogenic bladder disorders." It is valid until January 2025.

On May 7, 2020, the National Association of Statutory Health Insurance Physicians (KBV) announced that antibodies testing for COVID-19 will be reimbursement. The findings of the test must be communicated within 24 hours.

On the 1st of February, 2020, the National Association of Statutory Health Insurance Physicians (KBV) and the National Association of Statutory Health Insurance Funds (GKV-SV) have made the agreement for laboratory diagnostic clarification about the novel coronavirus. Afterwards, the statutory health insurance companies will cover the costs of the test for the novel coronavirus (2019-nCoV) if there are justified suspected cases.

The Clinical Coding and Schedule Development (CCSD) group develops and maintains procedural and diagnostics nomenclature for private payers in England. New procedure codes concern repair of femoral hernia requiring removal of previously inserted mesh, transurethral non-ablative radiofrequency of bladder, minimally invasive mitral valve repair, two-stage revision of total hip replacement for infection and others. The codes are introduced with a recommended adoption date being the 1st of May 2020. The document also contains a list of textual changes in codes, unacceptable combinations, and inactivated codes. There were no changes to the CCSD Schedule of Diagnostic Tests.

The Clinical Coding and Schedule Development (CCSD) group develops and maintains procedural and diagnostics nomenclature for private payers in England. New procedure codes concern removal of pectus bar, open surgical correction of pectus deformity of the chest wall, intradermal injection into the scalp, nerve and neurolytic root block with or without image guidance, facet joint injection with or without image guidance and diagnostic code for gustatory testing. The codes are introduced with a recommended adoption date being the 1st of May 2020. The documents also contain a list of textual changes in codes, unacceptable combinations, and inactivated codes.

In November 2019, the National Institute for Health and Care Excellence (NICE) published two new diagnostics guidance (for point-of-care creatinine devices and rapid tests for group A streptococcal infections), one new interventional procedure guidance (for irreversible electroporation for primary liver cancer) and two new MedTech innovation briefings (for Leukomed Sorbact for preventing surgical site infection and AmnioSense for unexplained vaginal wetness in pregnancy).

The Clinical Coding and Schedule Development (CCSD) group develops and maintains procedural and diagnostics nomenclature for private payers in England. New procedure codes concern injection eustachian tuboplasty, extracorporeal shockwave therapy for carpal tunnel syndrome, robotic-assisted laparoscopic excision of recto-vaginal endometriosis, and diagnostic codes for alpha-melanocyte stimulating hormone, NK cell inhibition panel, XR whole spine, and others. The codes are introduced with a recommended adoption date being the 1st of February 2020. The documents also contain a list of textual changes in codes, unacceptable combinations, and inactivated codes.

In October 2019, the National Institute for Health and Care Excellence (NICE) published one new interventional procedure guidance (for midcarpal hemiarthroplasty for wrist arthritis) and two new MedTech innovation briefings (for superDimension Navigation System to help diagnostic sampling of peripheral lung lesions and MR-proADM test for use with clinical deterioration scores in cases of suspected infection).

The Clinical Coding and Schedule Development (CCSD) group develops and maintains procedural and diagnostics nomenclature for private payers in England. New procedure codes concern scar revision, robotic-assisted thymectomy, prophylactic oophorectomy/ hysterectomy, percutaneous electrical nerve stimulation, delivery of fraction of proton beam therapy for non-ocular adult tumors and diagnostic codes for myriad breast and ovarian cancer panel 101 test, clinical exome sequencing MPLA test, and others. The codes are introduced with a recommended adoption date being the 1st of February 2020. The documents also contain a list of textual changes in codes and inactivated codes.

Reimbursement of optical coherence tomography (OCT) for diagnosis and therapy control in retinal diseases will be available from October 2019 via the EBM (Einheitlicher Bewertungsmaβstab, German Uniform Evaluation Standard).

In September 2019, Skåne Region released a report for ultrasound in symptoms of the acute scrotum that aimed to understand whether increased ultrasound use could improve the diagnostic of the studied condition. Although no studies investigating the direct benefit of ultrasound in patients with symptoms of acute scrotum were identified, its high precision, sensitivity, and specificity were outlined.

The report presents a summary of the reimbursement situation for a number of therapeutic endoscopic procedures on esophagus in Europe, including: endoscopic mucosal resection of lesion of esophagus; endoscopic submucosal resection of lesion of esophagus; endoscopic radiofrequency ablation of lesion of esophagus; endoscopic injection sclerotherapy to varices of esophagus; endoscopic balloon dilation of esophagus; endoscopic insertion of stent into esophagus. The analysis covers procedure coding, payment mechanism, reimbursement tariffs and policy restrictions in 11 EU countries including Austria, Belgium, Denmark, England, France, Germany, Italy, the Netherlands, Norway, Sweden and Switzerland. It is also possible to add analysis in the Czech Republic, Finland, Hungary, Romania, Russia and Turkey.

MTRC has developed three reports on the key market access topics, including innovation funding, health technology assessment and funding frameworks for medical devices. These reports help to understand the relevance of these frameworks to certain types of medical technologies, including endoscopy technologies. This post provides some key facts about the HTA, funding and innovation payment landscape for endoscopy devices in Europe.

MTRC has developed three reports on the key market access topics, including innovation funding, health technology assessment and funding frameworks for medical devices. These reports help to understand the relevance of these frameworks to certain types of medical technologies, including diagnostic imaging technologies. This post provides some key facts about the HTA, funding and innovation payment landscape for cardiovascular devices in Europe.

In Sweden, the Priority Council of Skåne Region prepares and presents suggestions for new methods, routines, and treatments, to be included in the healthcare system. In August 2019, the HTA report for endoscopic procedures in dysphagia was released. The analysis showed that fiberoptic endoscopic evaluation of swallowing and videofluoroscopy are clinically well-established procedures that have good and equal coherence between different assessors and in repeated assessments.

The Clinical Coding and Schedule Development (CCSD) group develop and maintains procedural and diagnostics nomenclature for private payers in England. New procedure codes concern hip replacement, endoscopic ablation, multiple arthroscopic operations on the ankle, collagen paste for closing an anal fistula and diagnostic codes for tests for next generations sequencing molecular intelligence, and others. The codes are introduced with a recommended adoption date being the 1st of November 2019. The documents also contain a list of textual changes in codes, inactivated codes, and an updated list of unacceptable combinations of codes.

In July 2019, the National Institute for Health and Care Excellence (NICE) published one new diagnostics guidance for therapeutic monitoring of TNF-alpha inhibitors in rheumatoid arthritis, two new interventional procedure guidance (for transurethral laser ablation for recurrent non-muscle-invasive bladder cancer and ultrasound-guided high-intensity transcutaneous focused ultrasound for symptomatic uterine fibroids), and one new MedTech innovation briefing for HemaClear for bloodless surgical field during limb surgery.

The Clinical Coding and Schedule Development (CCSD) group develop and maintains procedural and diagnostics nomenclature for private payers in England. New procedure codes concern mastectomy and immediate reconstruction of the breast, coronary intravascular lithotripsy, angioplasty, insertion of a stent, portal vein embolization, and others and diagnostic codes for tests for primary hyperoxaluria panel, myeloid panel, and hereditary angioedema. 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 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, and others and diagnostic codes for tests for common and rare mutations.

In April 2019, the National Institute for Health and Care Excellence published two new interventional procedure guidance for endoscopic ablation for an anal fistula and a pilonidal sinus, and two new MedTech innovation briefings for urine test for detecting bladder cancer in people with symptoms associated with malignancy and imaging software designed to help clinicians to diagnose and stage liver disease.

The report presents a summary of reimbursement situation for diagnostic endoscopic procedures on the lower gastrointestinal tract for benign and malignant diseases in outpatient settings. The following procedures will be considered: colonoscopy, rectoscopy, anoscopy. The analysis covers procedure coding, payment mechanism, reimbursement tariffs and policy restrictions in 11 EU countries including Austria, Belgium, Denmark, England, France, Germany, Italy, the Netherlands, Norway, Sweden and Switzerland.

The Clinical Coding and Schedule Development (CCSD) group develop and maintains procedural and diagnostics nomenclature for private payers in England. New diagnostic codes concern circulating tumor DNA profile for the different type of cancers, myriad Prolaris test, PET Scan with florbetapir, etc. and a procedure code for robotic-assisted radical hysterectomy and lymphadenectomy. The codes are introduced with a recommended adoption date being the 1st of May 2019. The documents also contain a list of textual changes in codes and an updated list of unacceptable combinations of codes.

Danish Health Authority published new codes for the Health Care Classification System in April 2019, including twelve surgical, nine medical codes and two codes for imaging diagnostics. New codes include endovascular occlusion of intracranial vessels, creation of AV fistula, number of embolization procedures and some other codes.

The report presents a summary of reimbursement situation for diagnostic endoscopic procedures on the upper gastrointestinal tract for benign and malignant diseases in outpatient settings. The following procedures will be considered: esophagoscopy, gastroscopy, duodenoscopy. The analysis covers procedure coding, payment mechanism, reimbursement tariffs and policy restrictions in 11 EU countries including Austria, Belgium, Denmark, England, France, Germany, Italy, the Netherlands, Norway, Sweden and Switzerland.

The 13 innovations joining the NHS Innovation Accelerator were announced on March 5, 2019, as part of an event to launch the fourth year of this award-winning national accelerator.

With a regional decree of March 7, 2019, Tuscany Regional Healthcare has published assessments of seventeen medical devices belonging to various therapeutic areas.

The report presents a summary of reimbursement situation for capsule endoscopy in ambulatory settings. Indications include gastrointestinal bleeding, Crohn's disease, malignant neoplasm of small intestine and celiac disease. The analysis covers procedure coding, payment mechanism, reimbursement tariffs and policy restrictions in 11 EU countries including Austria, Belgium, Denmark, England, France, Germany, Italy, the Netherlands, Norway, Sweden and Switzerland.

Federal Department of Home Affairs (FDHA) released changes in coverage of medical procedures, IVD tests and medical aids in Switzerland. They include extension of coverage for neonatal screening to severe congenital immunodeficiencies, extension of coverage under restrictions for TAVI, gene test for breast cancer, PET, PET / CT, local superficial hyperthermia during tumour treatment, external defibrillator and coverage for sub-urethral tapes for the treatment of stress urinary incontinence in women. Also, changes in the coverage for neonatal screening were introduced.

At the beginning of December 2018, the HTA entity of the Region of Tuscany has released a list of the upcoming assessments of the medical devices. Assessments include among others Impella ventricular assist device from Abiomed, Endocuff Vision colonoscope from Olympus, VascuFlex® Multi-LOC multiple stent delivery system from B Braun.

In mid-June 2018, the Spanish Network of Agencies for Assessing National Health System Technologies and Performance (REDETS) has published a report which analyzes transbronchial lung biopsy using cryoprobes in diffused lung diseases.

At the beginning of June 2018, the Federal Department of Home Affairs published an update of the Services Ordinance (Ordinanza sulle prestazioni, OPre). This update concerns many different fields, including the list of laboratory tests.

Starting with 19th of June, 2018, HIV self-test kits can be bought in pharmacies and druggists all over Switzerland.

Report includes analysis for the following procedures: radiofrequency ablation, endoscopic plication and suturing, injection of bulking agents and endoscopic augmentation of the lower esophageal sphincter using hydrogel implants. The analysis covers procedure coding, payment mechanism, reimbursement tariffs and policy restrictions in 11 EU countries including Austria, Belgium, Denmark, England, France, Germany, Italy, the Netherlands, Norway, Sweden and Switzerland.

In mid-May 2018, the Andalusian Agency for Health Technology Evaluation, AETSA, has published a structured summary on 18F-FDG PET in the early diagnosis of degenerative diseases of the central nervous system.

In late April 2018, AETSA, the Andalusian Agency for Health Technology Assessment, has published a report with the update of evidence regarding prognostic genomic tests in early breast cancer in Spain.

In mid-April 2018, the Basque HTA body (OSTEBA) has published recommendations of the clinical practice guidelines and use of the immunological faecal occult blood test for patients with symptoms compatible with colorectal cancer.

In November 2017, the Andalusian Agency for Health Technology Assessment (AETSA) published an evaluation report (assessed within literature review) on the utility of exome sequencing for diagnosed dysmorphic syndromes.

The Clinical Coding and Schedule Development Group develops and maintains procedural and diagnostics nomenclature for private payers in England. In November new codes for reconstruction of breast, open adnexectomy, transoral laser microsurgery and surgical correction of hallux valgus were added to the CCSD Schedule.

The Clinical Coding and Schedule Development Group develops and maintains procedural and diagnostics nomenclature for private payers in England. Several codes were added to both procedural and diagnostic Schedules, including procedures on spine and endoscopy procedure.

HAS published updated program that defines priority areas of work for 2017, including evidence review as part of developing new procedure codes for robotic surgery, endoscopic procedures, and technology assessments of remote monitoring, dialysis, coronary stents and others.

In second two weeks of May, National Institute for Health and Care Excellence has published two Medtech Innovation Briefings (collagen paste for anal fistulae and portable pulse‑echo ultrasound device to assist diagnosis of osteoporosis) one Interventional Procedure Guidance for endoscopic full thickness removal of non-lifting colonic polyps.

Changes will be made in nine chapters of Nomenclature. In relation to medical technologies and in-vitro diagnostics, the most important changes include changes in conditions for two ophthalmology and endoscopy codes, new conditions for reimbursement of photodynamic therapy in dermatology, introduction of two new codes for IVDs, and creating of requirements for reimbursement of number of IVD tests in pregnancy.

Three mini-HTAs were published since beginning of 2017: procalcitonin for diagnostic of bacterial infections, Per Oral Endoscopic Myotomy (POEM) for achalasia, and use of the Prosigna test (PAM50 ROR) for decisions on adjuvant treatment in breast cancer. These assessments can support introduction of methods at local hospital level in Norway.