Supplementary fee (Zusatzentgelt - ZE): Thrombectomy aspiration catheters

Thrombectomy aspiration catheters: Change from national to hospital-specific supplemental fees.

Basics supplementary fee (Zusatzentgelt - ZE)

A supplementary fee (Zusatzentgelt - ZE) can be determined for predefined procedures that are performed in connection with various services in a hospital stay, and incur costs of a relevant amount.
ZEs are paid in addition to the aG-DRG flat fee per case on a procedure basis.
A distinction is made between priced and non-priced ZEs. Priced ZEs (like DGRs) are calculated annually by the Institut für das Entgeltsystem im Krankenhaus (InEK) and their €-value is set nationally. Unpriced procedures need to be calculated annually by the hospitals providing the services, requested in the budget negotiations, and agreed upon with the health insurers.

Supplementary fee (Zusatzentgelt - ZE) for aspiration catheters - changes in 2022

For historical reasons in the Catalog of Operation and Procedure Codes (OPS Catalog), aspiration catheters for thrombectomy were long coded as microwire retrievers (via an inclusive for microwire-assisted thrombectomy systems with continuous aspiration). In 2022, this coding was corrected, the code was deleted, and new procedure codes "thrombectomy aspiration catheter" were introduced for the use of one, two, and three or more catheters.

With the revision of the coding, the reimbursement of thrombectomy aspiration catheters was also adjusted. Until 2021, this was done via the priced supplemental fee ZE133. Starting in 2022, the new procedure codes will be assigned to a new non-priced ZE (ZE2022-197).

Impact of the change from priced to non-priced ZE

As a result, hospitals providing this service must calculate and request the new ZE for thrombectomy aspiration catheter for the 2022 budget year in terms of quantity and reimbursement level.

When preparing the cost calculation for the catalogue of demands, it should be noted that, in addition to the subdivision of the ZEs for the use of one, two, and three or more catheters, other cost factors may also be taken into account, for example, where catheters with a larger lumen also have a higher price. Ultimately, it seems reasonable to divide the ZE into nine categories: Use of 1, 2 as well as 3 or more catheters in conjunction with small, medium as well as large lumen (9 matrix).

Support by inspiring-health

As a rule, hospitals expect information material from manufacturers in preparation for the ZE negotiations, including a corresponding template for the cost calculation. inspiring-health supports you in this process and evaluates the reimbursement of your product in the current aG-DRG system for you in a first step, checks the possibility of additional financing via supplemental fees and assists in the preparation of the corresponding documents.