Abbott 2025 Coding Help Swiss DRG Peripheral Vascular Interventions

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Overview

PERIPHERAL VASCULAR INTERVENTION FOR PERIPHERAL ARTERIAL OCCLUSIVE DISEASE

The correct reimbursement of inpatient treatment cases in the SwissDRG systemA is dependent on the complete and correct coding of all relevant diagnoses and procedures based on the applicable diagnosis and procedure classifications and the coding manual. In particular, the following questions must be answered correctly:

• What is the main diagnosis of the case?
• Which secondary diagnoses may be coded according to the clinical documentation?
• How are the services provided coded completely and correctly in the CHOP classification system?

Main diagnosis (ICD-10)

The following main diagnoses can be considered in connection with peripheral arterial disease PAD in the ICD-10-GM 2024* catalogue:

Table 1 ICD-10-GM diagnosis codes for the coding of PAD

The differentiation of the basic ICD code I70.2 corresponds to the Fontaine stages, whereby stage IV is divided into two areas “with ulceration” and “with gangrene” for coding. This distinction is of particular importance since in many cases there is a differentiated grouping relevance between these two groups. The ICD-10-GM diagnosis classification provides the following information on the distinction between ulcers and gangrene:

• Ulceration (I70.24): Tissue defect limited to skin [cutis] and subcutaneous tissue [subcutis]
• Gangrene (I70.25): Dry gangrene, stage IVa according to Fontaine Moist gangrene, stage IVb according to Fontaine

Secondary diagnosis

The PCCL value plays a particularly important role in the DRG grouping of cases with peripheral vascular intervention. Particular attention must be paid to non-specialist diagnoses and complications during the stay. Heart disease, renal dysfunction and neurological comorbidities are just as important as wound healing disorders, coagulation disorders and other events. All these diagnoses may only be coded if the corresponding resources have been used, including the documentation required for verification in the patient file, as otherwise these ICD codes may be subsequently denied by the health insurance company as part of a possible case review, which would result in loss of revenue. A high PCCL value of at least severity level 4 regularly leads to significantly higher DRG flat rates if adequately documented.

PROCEDURES CODES (CHOP)

Another important aspect of the complete coding of treatment cases with PAD is the coding of all services and procedures performed. For this purpose, specific CHOP codes are available for balloon angioplasty or atherectomy, for stents placement and for a variety of other vascular interventions. Additional codes are used to specify the localization, the number of vessels treated, and the number of stents placed.

Coding of angioplasty or atherectomy

Table 2 CHOP code and CHOP text: Angioplasty and atherectomy

Additional important notes on coding 39.75.- Percutaneous transluminal vascular intervention of other vessels

When coding 39.75.-, please code the following:

• (Percutaneous) transluminal implantation of stents in blood vessels (39.B-)1
• Anatomical localization of certain percutaneous-transluminal catheter interventions [PTKI] (00.4B)2
• Number of treated vessels (00.40-00.43)2
• Injection or infusion of thrombolytic substance, by number of treatment days (99.10.-)
• Procedure at vascular bifurcation (00.44)2
• Microcatheter systems used in transluminal vascular interventions on spinal vessels, by number (00.4H.2-)
• Microcatheter systems used for transluminal vascular interventions in thoracic, abdominal and peripheral vessels, by number (00.4H.1-)
• Use of an embolic protection system (39.E1)

1. Details siehe Kodierung von Stent-Implantationen
2. Details siehe Kodierung von anderen vaskulären Interventionen

Coding of stent implantations

The coding of (percutaneous) transluminal stent implantations in blood vessels is done using 6-digit codes from category 39.B. For more precise differentiation or definition, the following explanations are given in the CHOP catalogue:

• A stent is an umbrella term for scissor-like, tubular endovascular prostheses that aim to keep a vessel open (preservation of the lumen).
• The stent graft, also known as a stent prosthesis, is a stent with a vascular prosthesis. It consists of an encapsulated mesh. Its purpose is, for example, to keep the vessel open (maintain lumen patency) and to take over the function of the vessel (bridge the lumen).
• A covered stent [stent graft] is a stent encapsulated, e.g., with polyester. For covered stents, the mechanical function is the primary focus. Encapsulated (covered) is not the same as coated.
• A “coated stent” is provided with a layer of another material or another substance. The effect of the coating (drug, antibody, bioactivity) is the main focus. A coated stent can be drug-eluting but does not have to be (e.g. antibody-coated or bioactive coating).

Stent types

The following stent types are differentiated via the 4th digit of code 39.B-:

Table 3 CHOP coding of stent types

* Large-lumen stents in adults: diameter > 16 mm and in children: diameter > 8 mm

Anatomical localization

Anatomical localization is distinguished via digits 5 and 6 of the codes 39.B-.–. The classification is shown below using the example of code 39.B1:

The localization is also coded in the same way for the other code groups 39.B-; however, not all localization positions are differentiated for the various stent types. Since a detailed list would go beyond the scope of this coding aid, reference is made to the complete procedure classification CHOP 2025.
It should be noted that codes with end digits 00 (N.E.C – nowhere else specified) should be avoided and a specific code should be used instead. Codes ending in 00 sometimes lead to lower-paying DRGs.

Information on the number, material properties, surface and coating as well as the length of the stents

In addition to codes 39.B, the following information on implanted stents must be coded:

Coding the number of stents implanted (percutaneous transluminal:

For codes from chapter 39.B- (Percutaneous) transluminal implantation of stents in blood vessels, each implanted stent is coded individually.
For example, if three non-drug eluting stents are implanted in femoral arteries and two non-drug eluting stents are implanted in tibial arteries, 39.B1.G1 is coded three times and 39.B1.H1 is coded twice.
The total amount of stents implanted during the stay is calculated and recorded with a code from chapter 39.C1.- “Number of implanted stents” on the date of the first day of intervention. In the previous example, five stents, 39.C1.15 “5 stents”.

Coding of other vascular interventions

Table 7 CHOP coding for other vascular interventions

Additional important notes on coding 39.75.- Percutaneous transluminal vascular intervention of other vessels

When coding 39.75.-, please code the following:

• (Percutaneous) transluminal implantation of stents in blood vessels (39.B-)1
• Anatomical localization of certain percutaneous-transluminal catheter interventions [PTKI] (00.4B)2
• Number of treated vessels (00.40-00.43)2
• Injection or infusion of thrombolytic substance, by number of treatment days (99.10.-)
• Procedure at vascular bifurcation (00.44)2
• Microcatheter systems used in transluminal vascular interventions on spinal vessels, by number (00.4H.2-)
• Microcatheter systems used for transluminal vascular interventions in anthoracic, abdominal and peripheral vessels, by number (00.4H.1-)
• Use of an embolic protection system (39.E1)

1. Details siehe Kodierung von Stent-Implantationen
2. Details siehe Kodierung von anderen vaskulären Interventionen

Table 8 CHOP coding for endarterectomy and endovenectomy

* An artificial vessel is a bypass, shunt or vascular replacement by means of an interposition device or vascular prosthesis [stent-graft]. The artificially created vessel can consist of artificial, biological and autologous material.

In addition to the codes for interventional procedures 39.50 (angioplasty or atherectomy) and 39.75 (percutaneous transluminal vascular interventions), the following codes are to be used:

Localization

* An artificial vessel is a bypass, shunt or vascular replacement using an interposition device or vascular prosthesis [stent-graft]. The artificial vessel can consist of artificial, biological and autologous material.

Number of vessels

Table 10 CHOP coding of the number of treated vessels

1. Excl.: (Aorto)coronary bypass (36.10.- – 36.1D.-)
2. Note: If applicable, this supplementary code must be recorded for each procedure.

The sum of the treated vessels per procedure must be shown.

DRG GROUPING

Peripheral interventions (PTA and stent implantation)

The DRG grouping of cases with PTA (39.75.17/.18/.1A/.1B) or stent implantation (39.B) depends on several factors:

• Number of balloons (only if drug-elution) and stents
• Stent type
• Length of the stent(s)
• Main or secondary diagnosis of PAD with ulcer or gangrene
• Number of treated vessels
• Age of patient
• Multiple/staged procedures
• Secondary diagnoses (PCCL ≥4)

All cases with peripheral balloon dilatation, stent implantation and most other endovascular interventions will continue to be grouped in the basic DRG F59.
The grouping logic is illustrated in Figure 1. The numbers on a grey background indicate the respective cost weight of the DRG.

Legend

• a.o. = and others
• o. interv. = other intervention
• B = intervention on both sides
• Multiple vessels = intervention on multiple vessels
• RD = renal denervation
• RT = Rotational thrombectomy
• ST = Stent and thrombectomy
• ST-2 = Selective thrombolysis
• ST-2-US = Ultrasound-guided selective thrombolysis

Remark

• And condition. From top to bottom, neighbouring rectangles correspond to “And” condition, e.g. F59F = PTA and diagnosis I70.24 / 25
• Or condition. From right to left, neighbouring rectangles correspond to the condition, e.g.
  F59B=PCCL>3 or Compl. Proz.
• Other intervention: “almost all” among the interventions that lead to F59E (certain procedures). These are upgraded.

Figure 1 Grouping structure for the most common cases

Note: Other special stent configurations can also trigger the F59F directly. The grouping logic for DRGs F59G to F59A is explained in detail below. This is done from a service-related perspective (which DRGs are triggered by a selected procedure under different conditions?). A DRG-related perspective (which case constellations all map to a selected DRG?) is shown in Figure 1.

Angioplasties with balloon or stent

Angioplasties with balloon dilatation only and stent implantations are included in DRGs F59G, F59F, F59E, F59C and F59B.
If only balloon dilatation is performed without stent implantation in a single vessel, the DRG F59G is assigned, regardless of the number of balloons, unless drug-eluting balloons (DEBs) are used. If the number of DEBs exceeds two, DRG F59F is assigned. Likewise, the implantation of up to two stents is assigned to DRG F59G, if the procedure is not performed bilaterally. This is independent of the type of stent, with two important exceptions: stents with a length of 15 cm or more and nitinol stents that are woven from individual wires (e.g., Supera™ Peripheral Stent System; exception: abdominal or pelvic arteries) are assigned to the higher-valued DRG F59F. The higher-valued DRG F59F is also assigned if the intervention involves more than one vessel or if the diagnosis includes gangrene or ulceration.
DRG F59G is also triggered by other procedures, outlined in the following chapter “Other endovascular procedures” including rotational and burr atherectomy. For patients up to 15 years of age, DRG F59E is assigned (as well as for certain procedures listed below). If an endovascular intervention is performed in multiple sessions (on two different days during the hospital stay with a break in between), DRG F59C is assigned. This applies to multiple balloon dilatations (balloon dilatations on two different days), multiple stent implantations (stents on two days) and selective thrombolysis (thrombolysis on two days). However, this does not apply to, for example, balloon dilatation on one day and stent implantation on another (which remains in DRG F59G) or selective thrombolysis on one day and balloon dilatation or stenting on another day (which, for certain procedures, leads to DRG F59E).

In the case of severe comorbidities, DRG F59B is assigned. This is also achieved with a complicating procedure. Complicating procedures are a global function of the SwissDRG system, whose grouping logic is extremely complex, and whose procedure tables are so extensive that they will not be described further here (see Definition Manual Volume 4, Global Functions).

Other endovascular procedures

See also Table 7.

DRG F59E is assigned, except for young patients (up to 15 years of age), in particular for the following procedures, regardless of accompanying angioplasties or stent implantations:

• Renal denervation by radiofrequency ablation (39.75.20)
• Renal denervation by circumferential ultrasound ablation (39.75.21)
• Rotational thrombectomy INCL. rotational and burr atherectomy (39.75.11)
• Stent and thrombectomy (39.75.17)
• Selective thrombolysis (39.75.15)

Ultrasound-guided selective thrombolysis (39.75.16) is assigned to DRG F59D. Selective thrombolysis and ultrasound-guided selective thrombolysis are assigned to DRG F59C in the case of multiple sessions, and to DRG F59A if extremely severe comorbidities (PCCL = 4) are also present. All other percutaneous-transluminal interventions (39.75) listed in Table 7 are assigned to DRG F59G.

Endarterectomy and endovenectomy

See also Table 8

Again, the use of non-specific codes (N.E.C.) should be avoided, as they lead to DRGs with a lower value than the specific codes and thus the service provided may not be adequately reimbursed.

For endarterectomies and endovenectomies, the anatomical localization is crucial for the grouping logic. Without extremely severe comorbidities, the following DRGs are used:

• Thoracic and abdominal arteries (38.14, 38.15, 38.16): F31F
• Lower extremity (38.18): F59D

Multiple OR procedures

DRG F59A is triggered by multiple complex OR procedures or vacuum treatments or by multiple selective thrombolyses with PCCL =4. The “complex OR procedures” are a global function of the SwissDRG system, which is described in the Definition Manual Volume 4, Global Functions. As the name suggests, these are complex and mostly, but not exclusively, surgical procedures that only loosely relate to the endovascular procedures covered in this overview. A detailed explanation is not provided here.

DRG F59 – Development of the cost weights 2024–2025

The following table shows the development of the cost weights of the basic DRG F59. The analysis from the SwissDRG data table (last column) shows the distribution of endovascular procedures in the base DRG F59 across the individual DRGs F59G – F59A, i.e. the relative frequency with which these DRGs are used.

Carotis stenting

The diagnosis I65.2 Occlusion and stenosis of the carotid artery together with a 6-digit procedure code from group 39.B (percutaneous) transluminal stenting of blood vessels with one of the localizations coded in digits 5 and 6 of the carotid artery (Table 4) leads to DRG B04C, with additional severe or extremely severe comorbidities to DRGs B04B or B04A.

Cave:

The same procedure with the diagnosis of atherosclerosis (e.g. I70.8 Atherosclerosis of other arteries) leads to the significantly lower rated DRG F59F (CW 0,941) or with extremely severe comorbidities to DRG F59B (CW 2,926).

VASCULAR OCCLUSION DEVICES WITH LARGE LUMEN

Diagnoses

The potential diagnoses that may determine the indication for the use of a large-lumen vascular occlusion device are extremly diverse, both in the literature and in clinical practice. These include, in particular, AV malformations such as fistulas and associated aneurysms, as well as steal phenomena, which may occur independently or as a result of a medical intervention. In addition, vessels can be occluded with plugs as part of trauma therapy, and elective vascular occlusion, for example, as part of of varicocele treatment or as a preparatory measure for procedures such as SIRT therapy, can also be performed using this technique. The entire spectrum of possible diagnoses cannot be presented exhaustively here; therefore, the following diagnoses are discussed as examples, considering their significance for grouping:

Table 11 Possible ICD-10-GM diagnosis codes for the use of a vascular plug

Procedures

The coding of the procedure for the implantation of one or more large-lumen vascular occlusion devices is always done using multiple codes. While an additional code from 00.4G Insertion of vascular occlusion devices (Table 13) codes the embolization with the occlusion device according to the number used, the embolization must also be specified by a CHOP code from the group 39.79.A- Selective embolization of other vessels with plugs based on anatomical location. When reviewing the additional reimbursement, it becomes clear that the mandatory combination is highly relevant for obtaining the supplementary payment.

Table 12 CHOP codes for vascular occlusion bodies (plugs), localization

Please also code:

For all the localizations except spinal vessels: Vascular plugs inserted into thoracic, abdominal and peripheral vessels, by number (00.4G.8-)

CHOP codes for vascular plugs, amount of plugs

Table 13 CHOP codes for vascular closure devices (plugs), number

DRG Grouping

The combination of codes described above for vascular embolization with plugs and for the number of plugs used will in most cases lead to DRG F31E, with additional extremely severe comorbidities resulting in F31C. Case constellations with additional complicating or multiple procedures or major vascular interventions can also be assigned to higher DRGs (see below).

Supplement Fee

The additional fee is scaled according to the quantitative CHOP code, whereby CHF 162,85 being reimbursed for each implanted (peripheral) plug.

Further information and coding helps can be found under: https://www.cardiovascular.abbott/de/de/hcp/reimbursement.html

Disclaimer: This material and the information contained herein is for general information purposes only and is not intended, and does not constitute legal, reimbursement, business, clinical, or other advice. Furthermore, it is not intended to and does not constitute a representation or guarantee of reimbursement, payment, or charge, or that reimbursement or other payment will be received. It is not intended to increase or maximize payment by any payer. Abbott makes no express or implied warranty or guarantee that the list of codes and narratives in this document is complete or error-free. Similarly, nothing in this document should be viewed as instructions for selecting any particular code, and Abbott does not advocate or warrant the appropriateness of the use of any particular code. The ultimate responsibility for coding and obtaining payment/reimbursement remains with the customer. This includes the responsibility for accuracy and veracity of all coding and claims submitted to third-party payers. In addition, the customer should note that laws, regulations, and coverage policies are complex and are updated frequently and is subject to change without notice. The customer should check with its local carriers or intermediaries often and should consult with legal counsel or a financial, coding, or reimbursement specialist for any questions related to coding, billing, reimbursement, or any related issues. This material reproduces information for reference purposes only. It is not provided or authorized for marketing use. Important Information: The information provided in this document was obtained from third-party sources (InEK etc.) and is passed through to you by Abbott only for your information and as coding suggestion. This information does not constitute legal or reimbursement advice and Abbott is not liable for the accuracy, completeness and the time of providing this information. Reimbursement laws, regulations rules and reimbursement policies of payers are complex and change permanently. The responsibility for coding and reimbursement applications remains with the care provider. Abbott therefore recommends that you contact your responsible payer, DRG-delegate and/or lawyer concerning coding, billing or other reimbursement issues.

Sources:

A) ICD 10 GM Version 2025 Systematisches Verzeichnis:
https://www.bfarm.de/DE/Kodiersysteme/Services/Downloads/_node.html#anker-ops-downloads
B) Bundesamt für Statistik BFS: Schweizerische Operationsklassifikation (CHOP), Version 2025:
https://www.bfs.admin.ch/bfs/de/home/statistiken/gesundheit/nomenklaturen/medkk/instrumente-medizinische-kodierung.assetdetail.32128591.html
C) SwissDRG AG: SwissDRGVersion 12.0, Abrechnungsversion (2025/2025):
https://www.swissdrg.org/de/akutsomatik/swissdrg-system-1402025/fallpauschalenkatalog

WE FOR YOU

DR. CHRISTOPH RATH
Manager DACH
Health Economics & Reimbursement
Mobile: +49 170 33 39 519

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Head of Health Economics &
Reimbursement DACH
Mobile: +49 151 46 14 62 63

CAUTION: This product is intended for use by or under the direction of a physician. Prior to use, reference the Instructions for Use, inside the product carton (when available) or at manuals.eifu.abbott for more detailed information on Indications, Contraindications, Warnings, Precautions and Adverse Events. This material is intended for use with healthcare professionals only. Supera™ Peripheral Stent System requires training prior to use according to the IFU. Information contained herein for DISTRIBUTION in Switzerland ONLY.

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FAQ

• Q: What is the importance of correct coding in the SwissDRG system?
  • A: Correct coding is crucial for ensuring proper reimbursement in the healthcare system and determining patient access to life-improving technologies.
• Q: How does the ICD-10-GM classification system help in coding PAD?
  • A: The ICD-10-GM system provides specific diagnosis codes that correspond to different stages of peripheral arterial disease, aiding in accurate coding and reimbursement.

Documents / Resources

Abbott 2025 Coding Help Swiss DRG Peripheral Vascular Interventions [pdf] Instruction Manual 2025 Coding Help Swiss DRG Peripheral Vascular Interventions, 2025, Coding Help Swiss DRG Peripheral Vascular Interventions, DRG Peripheral Vascular Interventions, Peripheral Vascular Interventions, Vascular Interventions

References

• User Manual