New procedure and IVD reimbursement codes in Belgian Nomenclature to come into effect from December 1, 2018

The Nomenclature of health benefits of the INAMI/RIZIV includes the benefits (with specific hospital and ambulatory codes) reimbursed by health care insurance, partially or totally. The Nomenclature and changes are published in the Belgian Official Gazette.

The changes of the following articles of the Nomenclature will come into force since December 1, 2018:

• Article 1 “General”
• Article 2 “Consultations, Visits and Opinions; Psychotherapies and other benefits”
• Article 3 “Medical Technical Services”
• Article 11 “General Special Benefits”
• Article 14 (e) “Thoracic Surgery”
• Article 14 (g) “Gynecology and obstetrics”
• Article 14 (h) “Ophthalmology”: new code for implantation of a lacrimal mucous plug in eye (245151-245162)
• Article 14 (i) “Otorhinolaryngology”: new code for laser treatment of the tonsils (256476-256480)
• Article 14 (k) “Orthopedic”
• Article 17 “Radiology”
• Article 18 “Radiotherapy and Nuclear Medicine”: new codes for determination of bone formation in blood (433355-433366) and urine (433370-433381)
• Article 22 “Physiotherapy”
• Article 24 “Clinical biology”
• Article 25 “In-Hospital Patient Monitoring”
• Article 32 “Anatomo-pathology”: new code and conditions of reimbursement for representative tumor tissue for a molecular biology examination in the prescription of tumor-specific medication in oncology patients (589875-589886)
• Article 33a “Genetic examinations”

Key changes in the article 17 “Radiology”

The following new codes have been introduced:

1. Computer controlled tomography (CT) without contrast of the upper and / or lower jaw (458953-458964)
2. Computer-controlled tomography of a level in the form of a vertebral body or an intervertebral space with or without contrast medium, minimum 6 cuts
   1. for two or more levels of thoracic spine (457855-457866)
   2. for two or more levels of lumbosacral spine (457870-457881)
   3. for an examination of the entire spine or for a combination of two cervical, thoracic or lumbosacral spine (  457892 457903)
3. MRI examination of thoracic spine, minimum 3 sequences, with or without contrast, with recording on support, optical or electromagnetic (457914-457925)
4. MRI examination of the lumbosacral spine, minimum 3 sequences, with or without contrast, with recording on support, either optical or electromagnetic (457936-457940)
5. MRI examination of whole spine or combination of two cervical, thoracic or lumbosacral spine MRI examinations, minimum 3 sequences, with or without contrast, with recording on support, either optical or electromagnetic (457951-457962)

There are the following conditions of reimbursement for computer controlled tomography (CT) without contrast of the upper and / or lower jaw (458953-458964):

• in preoperative planning in case of autotransplantation and in the framework for the placement of dental implants as described in the services 308512-308523, 308534-308545;
• in congenital dental anomaly;
• in case of presumption and / or follow-up of dentoalveolar traumatisms in the context of the interventions, described under the code 312756-312760;
• in case of presumption of an interrelation between the mandibular canal and a wisdom tooth as part of an extraction of wisdom tooth;
• in case of problems of eruption with impactions of elements definitive, supernumerary or additional;
• in the event of problematic articulation of the jaw linked to the bone;
• in case of diagnosis and / or therapeutic approach of tumors and benign cysts of jaw bone;
• during the preparation of a refundable maxillofacial surgery.

Key changes in the article 24 “Clinical biology”

The following new codes have been introduced:

• determination of bone formation in blood (542894-542905)
• determination of bone formation in urine (542916-542920)
• avidity detection of IgG antibodies against Toxoplasma gondii (552112-552123)
• leukocyte compatibility test preceding an organ transplant (556636-556640)
• investigation of anti-HLA cytotoxic antibodies (determination of the class of immunoglobulin or self-reactivity or HLA specificity) (556651-556662)
• identification of Class II Anti-HLA antibody in a candidate for organ transplantation (556673-556684)

Key changes in the article 33a “Genetic examinations”

The following new codes have been introduced:

• HLA A and / or B and / or Cw and / or DR and / or DQ and / or DP loci determination in a candidate for organ transplantation, using a molecular biology method by locus (555354-555365)
• Determination of HLA A and / or B and / or Cw and / or DR and / or DQ and / or DP loci in a living donor candidate, for organ transplantation, using a method of molecular biology (555413-555424)
• Determination of HLA A and / or B and / or Cw and / or DR and / or DQ and / or DP loci in a deceased donor, for organ transplantation, using a method of molecular biology (555435-555446)

See full details here.

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