Percutaneous procedures for deep vein thrombosis

Series
Peripheral vascular interventions
Status
Published
Date
Number of report
017

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Report presents summary of reimbursement situation for several procedures for treatment of deep vein thrombosis of lower extremities. Procedures, included into analysis include:

  • Mechanical thrombectomy
  • Systemic thrombolysis
  • Catheter-directed thrombolysis
  • Ultrasound-enhanced catheter-directed thrombolysis

The following clinical situations are considered:

  • Stand-alone procedure, performed as primary procedure due to admission due to deep vein thrombosis
  • Procedure, performed as secondary procedure for DVT, developed during hospital admission for coronary artery bypass grafting or hip replacement
    • Analysis is performed for CABG and hip replacement
      • With no complications
      • With DVT and no interventional treatment
      • With DVT and interventional treatment

Analysis is performed only for non-elective hospital admission with at least an overnight stay.

Report includes essential information about reimbursement and national funding of the percutaneous procedures, 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 percutaneous procedures for deep vein thrombosis include:

  • AngioDynamics (Uni-Fuse)
  • Argon Medical Devices (CLEANER 15 Rotational Thrombectomy System, CLEANER XT Rotational Thrombectomy System)
  • Boston Scientific (AngioJet Peripheral Thrombectomy Catheter - AngioJet ZelanteDVT)
  • BTG (EkoSonic Endovascular System)
  • Capture Vascular (MegaVac Mechanical Thrombectomy System)
  • DePuy Synthes (REVIVE PV Peripheral Vascular Thrombectomy Device)
  • Inari Medical (ClotTriever Thrombectomy System)
  • Penumbra (Indigo Mechanical Thrombectomy System)
  • Rex Medical (Cleaner Rotational Thrombectomy System)
  • Stentys (STENTYS AC Thrombectomy catheter)
  • Straub Medical (Aspirex S)

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 percutaneous procedures in deep vein thrombosis
5.2.1.    Procedure coding
5.2.1.1.    Procedure coding for mechanical thrombectomy
5.2.1.2.    Procedure coding for pharmacomechanical thrombectomy
5.2.1.3.    Procedure coding for catheter-directed thrombolysis
5.2.1.4.    Procedure coding for systemic pharmacological thrombolysis
5.2.1.5.    Procedure coding for surgical interventions
5.2.2.    Diagnosis coding
5.2.3.    Payment mechanism and reimbursement tariffs
5.2.3.1.    Reimbursement for mechanical thrombectomy in deep vein thrombosis 
5.2.3.2.    Reimbursement for pharmacomechanical thrombectomy in deep vein thrombosis 
5.2.3.3.    Reimbursement for catheter-directed thrombolysis in deep vein thrombosis
5.2.3.4.    Reimbursement for interventional treatment of deep vein thrombosis complicating coronary artery bypass grafting
5.2.3.5.    Reimbursement for interventional treatment of deep vein thrombosis complicating total hip replacement
6.    Reimbursement analysis in Belgium
6.1.    Overview of the reimbursement system
6.2.    Reimbursement for percutaneous procedures in deep vein thrombosis
6.2.1.    Procedure coding 
6.2.1.1.    Procedure coding for percutaneous procedures in deep vein thrombosis 
6.2.1.2.    Procedure coding for systemic pharmacological thrombolysis
6.2.2.    Payment mechanism and reimbursement tariffs
7.    Reimbursement analysis in Denmark
7.1.    Overview of the reimbursement system
7.2.    Reimbursement for percutaneous procedures in deep vein thrombosis
7.2.1.    Procedure coding 
7.2.1.1.    Procedure coding for percutaneous procedures in deep vein thrombosis 
7.2.1.2.    Procedure coding for systemic pharmacological thrombolysis
7.2.1.3.    Procedure coding for surgical interventions
7.2.1.4.    Additional coding 
7.2.2.    Diagnosis coding
7.2.3.    Payment mechanism and reimbursement tariffs
7.2.3.1.    Reimbursement for treatment of deep venous thrombosis without interventions
7.2.3.2.    Reimbursement for surgical thrombectomy in deep vein thrombosis
7.2.3.3.    Reimbursement for systemic pharmacological thrombolysis in deep vein thrombosis 
7.2.3.4.    Reimbursement for interventional treatment of deep vein thrombosis complicating coronary artery bypass grafting
7.2.3.5.    Reimbursement for interventional treatment of deep vein thrombosis complicating total hip replacement
8.    Reimbursement analysis in England
8.1.    Overview of the reimbursement system
8.2.    Reimbursement for percutaneous procedures in deep vein thrombosis
8.2.1.    Procedure coding 
8.2.1.1.    Procedure coding for mechanical thrombectomy
8.2.1.2.    Procedure coding for pharmacomechanical thrombectomy
8.2.1.3.    Procedure coding for catheter-directed thrombolysis
8.2.1.4.    Procedure coding for ultrasound-enhanced catheter-directed thrombolysis
8.2.1.5.    Procedure coding for systemic pharmacological thrombolysis
8.2.1.6.    Procedure coding for surgical interventions
8.2.1.7.    Additional coding 
8.2.2.    Diagnosis coding
8.2.3.    Payment mechanism and reimbursement tariffs
8.2.3.1.    Reimbursement for treatment of deep venous thrombosis without interventions
8.2.3.2.    Reimbursement for percutaneous interventions in deep vein thrombosis
8.2.3.3.    Reimbursement for systemic pharmacological thrombolysis in deep vein thrombosis 
8.2.3.4.    Reimbursement for interventional treatment of deep vein thrombosis complicating coronary artery bypass grafting
8.2.3.5.    Reimbursement for interventional treatment of deep vein thrombosis complicating total hip replacement
8.2.4.    Policy considerations 
8.2.4.1.    Health technology assessments by NICE
8.2.4.2.    Clinical guideline for diagnosis and management of deep vein thrombosis by NICE
8.2.4.3.    Commissioning of percutaneous procedures for deep vein thrombosis
9.    Reimbursement analysis in France
9.1.    Overview of the reimbursement system
9.2.    Reimbursement for percutaneous procedures in deep vein thrombosis
9.2.1.    Procedure coding 
9.2.1.1.    Procedure coding for percutaneous aspiration thrombectomy
9.2.1.2.    Procedure coding for pharmacomechanical thrombectomy
9.2.1.3.    Procedure coding for catheter-directed thrombolysis
9.2.1.4.    Procedure coding for systemic pharmacological thrombolysis
9.2.1.5.    Procedure coding for surgical interventions
9.2.2.    Diagnosis coding
9.2.3.    Payment mechanism and reimbursement tariffs
9.2.3.1.    Reimbursement for percutaneous interventions in deep vein thrombosis
9.2.3.2.    Reimbursement for systemic pharmacological thrombolysis in deep vein thrombosis 
9.2.3.3.    Reimbursement for interventional treatment of deep vein thrombosis complicating coronary artery bypass grafting
9.2.3.4.    Reimbursement for interventional treatment of deep vein thrombosis complicating total hip replacement
9.2.4.    Policy considerations
9.2.4.1.    Health technology assessment of total robot-assisted prostatectomy by HAS
9.2.4.2.    Coverage with evidence development
10.    Reimbursement analysis in Germany
10.1.    Overview of the reimbursement system
10.2.    Reimbursement for percutaneous procedures in deep vein thrombosis
10.2.1.    Procedure coding 
10.2.1.1.    Procedure coding for mechanical thrombectomy
10.2.1.2.    Procedure coding for pharmacomechanical thrombectomy
10.2.1.3.    Procedure coding for catheter-directed thrombolysis
10.2.1.4.    Procedure coding for ultrasound-enhanced catheter-directed thrombolysis
10.2.1.5.    Procedure coding for systemic pharmacological thrombolysis
10.2.1.6.    Procedure coding for surgical interventions
10.2.2.    Diagnosis coding
10.2.3.    Payment mechanism and reimbursement tariffs
10.2.3.1.    Reimbursement for percutaneous interventions in deep vein thrombosis
10.2.3.2.    Reimbursement for systemic pharmacological thrombolysis in deep vein thrombosis 
10.2.3.3.    Reimbursement for interventional treatment of deep vein thrombosis complicating coronary artery bypass grafting
10.2.3.4.    Reimbursement for interventional treatment of deep vein thrombosis complicating total hip replacement
11.    Reimbursement analysis in Italy
11.1.    Overview of the reimbursement system
11.2.    Reimbursement for percutaneous procedures in deep vein thrombosis
11.2.1.    Procedure coding 
11.2.1.1.    Procedure coding for percutaneous aspiration thrombectomy
11.2.1.2.    Procedure coding for pharmacomechanical thrombectomy
11.2.1.3.    Procedure coding for catheter-directed thrombolysis
11.2.1.4.    Procedure coding for systemic pharmacological thrombolysis
11.2.1.5.    Procedure coding for surgical interventions
11.2.2.    Diagnosis coding
11.2.3.    Payment mechanism and reimbursement tariffs at national level
11.2.3.1.    Reimbursement for mechanical thrombectomy in deep vein thrombosis 
11.2.3.2.    Reimbursement for aspirational thrombectomy and pharmacomechanical thrombectomy in deep vein thrombosis 
11.2.3.3.    Reimbursement for catheter-directed thrombolysis in deep vein thrombosis
11.2.3.4.    Reimbursement for interventional treatment of deep vein thrombosis complicating coronary artery bypass grafting
11.2.3.5.    Reimbursement for interventional treatment of deep vein thrombosis complicating total hip replacement
11.2.3.6.    Region-specific reimbursement tariffs 
12.    Analysis in the Netherlands
12.1.    Overview of the reimbursement system
12.2.    Reimbursement for percutaneous procedures in deep vein thrombosis
12.2.1.    Procedure coding 
12.2.1.1.    Procedure coding for percutaneous procedures in deep vein thrombosis 
12.2.1.2.    Procedure coding for systemic pharmacological thrombolysis 
12.2.1.3.    Procedure coding for surgical interventions
12.2.2.    Diagnosis coding
12.2.3.    Payment mechanism and reimbursement tariffs
12.2.3.1.    Payment mechanism and reimbursement tariffs for percutaneous interventions in deep vein thrombosis performed by a surgeon
12.2.3.2.    Payment mechanism and reimbursement tariffs for percutaneous interventions in deep vein thrombosis performed by a radiologist
12.2.3.3.    Reimbursement for systemic pharmacological thrombolysis in deep vein thrombosis 
12.2.3.4.    Reimbursement for interventional treatment of deep vein thrombosis complicating coronary artery bypass grafting
12.2.3.5.    Reimbursement for interventional treatment of deep vein thrombosis complicating total hip replacement
13.    Reimbursement analysis in Norway
13.1.    Overview of the reimbursement system
13.2.    Reimbursement for percutaneous procedures in deep vein thrombosis
13.2.1.    Procedure coding
13.2.1.1.    Procedure coding for percutaneous thrombectomy
13.2.1.2.    Procedure coding for catheter-directed thrombolysis
13.2.1.3.    Procedure coding for systemic pharmacological thrombolysis
13.2.1.4.    Procedure coding for surgical interventions
13.2.1.5.    Additional coding 
13.2.2.    Diagnosis coding
13.2.3.    Payment mechanism and reimbursement tariffs
13.2.3.1.    Reimbursement for treatment of deep venous thrombosis without interventions
13.2.3.2.    Reimbursement for mechanical thrombectomy in deep vein thrombosis 
13.2.3.3.    Reimbursement for pharmacomechanical thrombectomy in deep vein thrombosis 
13.2.3.4.    Reimbursement for catheter-directed and ultrasound-enhanced catheter-directed thrombolysis in deep vein thrombosis
13.2.3.5.    Reimbursement for interventional treatment of deep vein thrombosis complicating coronary artery bypass grafting
13.2.3.6.    Reimbursement for interventional treatment of deep vein thrombosis complicating total hip replacement
14.    Reimbursement analysis in Sweden
14.1.    Overview of the reimbursement system
14.2.    Reimbursement for percutaneous procedures in deep vein thrombosis
14.2.1.    Procedure coding 
14.2.1.1.    Procedure coding for percutaneous procedures in deep vein thrombosis 
14.2.1.2.    Procedure coding for systemic pharmacological thrombolysis 
14.2.1.3.    Procedure coding for surgical interventions
14.2.1.4.    Additional coding
14.2.2.    Diagnosis coding
14.2.3.    Payment mechanism and reimbursement tariffs
14.2.3.1.    Reimbursement for treatment of deep venous thrombosis without interventions
14.2.3.2.    Reimbursement for surgical thrombectomy in deep vein thrombosis
14.2.3.3.    Reimbursement for systemic pharmacological thrombolysis in deep vein thrombosis 
14.2.3.4.    Reimbursement for interventional treatment of deep vein thrombosis complicating coronary artery bypass grafting
14.2.3.5.    Reimbursement for interventional treatment of deep vein thrombosis complicating total hip replacement
15.    Reimbursement analysis in Switzerland
15.1.    Overview of the reimbursement system
15.2.    Reimbursement for percutaneous procedures in deep vein thrombosis
15.2.1.    Procedure coding 
15.2.1.1.    Procedure coding for mechanical thrombectomy
15.2.1.2.    Procedure coding for pharmacomechanical thrombectomy
15.2.1.3.    Procedure coding for catheter-directed thrombolysis
15.2.1.4.    Procedure coding for ultrasound-enhanced catheter-directed thrombolysis
15.2.1.5.    Procedure coding for systemic pharmacological thrombolysis
15.2.1.6.    Procedure coding for surgical interventions
15.2.2.    Diagnosis coding
15.2.3.    Payment mechanism and reimbursement tariffs
15.2.3.1.    Reimbursement for treatment of deep venous thrombosis without interventions
15.2.3.2.    Reimbursement for mechanical thrombectomy in deep vein thrombosis 
15.2.3.3.    Reimbursement for pharmacomechanical thrombectomy in deep vein thrombosis 
15.2.3.4.    Reimbursement for catheter-directed and ultrasound-enhanced catheter-directed thrombolysis in deep vein thrombosis
15.2.3.5.    Reimbursement for interventional treatment of deep vein thrombosis complicating coronary artery bypass grafting
15.2.3.6.    Reimbursement for interventional treatment of deep vein thrombosis complicating total hip replacement
15.2.4.    Policy considerations 
16.    Disclaimer

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