New procedure codes for peripherally inserted central catheter systems (PICC)

Client:

German Medical Device Association (BVMed)
Special Interest Group “Venous Access“
Reinhardtstr. 29 b
10117 Berlin

As a trade association, BVMed represents the interests of around 240 German and international manufacturers and suppliers in the medical device sector, as well as medical aid service providers and home care providers, in dealings with the government and the public.

Contact:
Isabel Knorr (Market Access and Reimbursement Officer, BVMed)
"It was a wonderful joint effort between inspiring-health, the industry and BVMed. The cooperation was fast, professional and smooth."

Project Objective:
Making PICCs visible / codable

Challenge:
Despite multiple requests, it has not yet been possible to introduce a specific OPS code for PICCs.

Solution:
1. Assessment of the previous OPS-applications and the current reimbursement in DRG and EBM
2. Evaluate the possibility of adjusting applications in light of DRGs and outpatient care.
3. Implementation via the proposal procedure

Benefit:
1. Consistent coding / coding system: the proposal developed included not only PICCs but all catheters in the affected chapter.
2. The new specific OPS code can be used to further develop the outpatient reimbursement catalogues and close a gap in care regarding inpatient/outpatient care of patients with PICC catheters.

inspiring-health
We support our customers in all application procedures of the German healthcare market that secure reimbursement until the final implementation in the reimbursement system. This also includes the application for an individual procedure code (OPS) at the BfArM. A technology only becomes identifiable, calculable and billable in the reimbursement systems when it is specifically named.

Initial situation

Despite several years of applications, it has not yet been possible to introduce a specific OPS code for peripherally inserted central venous catheters (PICCs). Within BVMed, the “Venous Access” Special Interest Group has questioned the extent to which a revised application would be useful in changing the situation.

At that time, the placement of PICCs was included in the code for central venous catheters = CVCs. However, compared to centrally placed CVCs, PICCs have the advantage that they can be placed for much longer periods of time. This provides an alternative treatment for the outpatient care of the patients concerned (for example, in antibiotic therapy, chemotherapy, parenteral nutrition and pain therapies).

However, due to the inclusion of PICCs in the OPS codes for CVCs, there is not only an equalization in coding, but also in billing. There is currently a care gap for patients with complex infusion therapy.

Procedure and performance

The project was carried out with the participation of the manufacturers in the interest group and was implemented as well as moderated by us in the role of external project management. Based on an initial analysis of the reimbursement situation, the evaluation of previous OPS applications and in light of the further development of outpatient reimbursement systems, a potential application strategy was developed and assessed, further developed and implemented in collaboration with the members of the group. The project group succeeded in securing the support of a total of three specialist societies as well as various university hospitals and key opinion leaders. Thus, a new OPS application could be submitted on time. The implementation was carried out by the BfArM as of 01.01.2023.

Benefit for the client

The spokespersons of BVMed's Special Interest Group “Venous Access“ (FBVZ) summarize the results as follows:

"The implementation of specific procedure codes for peripherally inserted central venous catheter systems was a long-standing process that has now been successfully completed thanks to the support of inspiring-health. The exchange of knowledge and the bundling of competences between inspiring-health, the industry and BVMed, with the support of the medical societies, finally brought us to our goal. The introduction into the outpatient sector has not yet been achieved, but this first step has created the basis for it. We look forward to future projects."