Monaco Cardio-Thoracic Center - PACKAGE-PRICES 2011

PACKAGE-PRICES 2011

The package price covers all costs, including hospitalisation expenses and medical fees, all examinations carried out, even outside the Centre, and treatment of any post-operative complications connected with the operation.

The package price can only be fixed after the patient has been examined or precise and detailed information on his/her clinical case has been provided.

The "standard package" is subject to an additional charge of 20% for complex cases, 50% for complicated cases and 70% for a combination of complicated /complex cases and/or emergencies.

In intensive care, assisted ventilation, intra-aortic balloon pumping and renal dialysis are included (unless artificial life support equipment has to be maintained for more than 15 days due to the patient's previous [pre-intervention] state of health). Assisted circulation by ventricular prosthesis is not included.

The package price covers the patient's aftercare, by the Centre's doctors, for one month after hemodynamic investigations, for six months after interventional cardiology procedures and for one year after surgical operations, as well as, during that period of time*, and depending on the package price, redux-operations and hospitalisation connected with the procedure but not with the development of the causal pathology or of a previous or intercurrent pathology.
* with the exception of surgery for congenital cardiopathies and surgery performed on infants and new-born babies.

The procedures covered by the package price and the gravity of the pathology are listed in each section so that pre or post-interventional examinations can be carried out in a simple and objective way.

Emergency admission of a patient: pathological condition with risk of death within 48 hours if the appropriate medical treatment is not administered.

The following is a non-restrictive and non-exhaustive list of conditions constituting an emergency: myocardial infarction (within the first 48 hours or mechanical and/or rhythmic complications at any time), irreversible cardiac insufficiency, heart failure with acidosis, acute dysfunction of prosthesis, progressive infectious endocarditis, acute aortic dissection, fissured vascular aneurysm, unstable angina pectoris, etc.

- Hemodynamic investigations & interventional cardiology

A 10 - Ambulatory hemodynamic angiographic and ventricular investigations of the cardiac cavities and principal vessels.

A 11 - Hemodynamic investigations (special cases).

A 12 - Hemodynamic investigations.

Explorations prior to surgical procedures, during the same hospital stay, will be billed at the applicable rate.
Explorations prior to interventional cardiology procedures, realized on the same day, are included in this second package. Otherwise, a charge of 50% is applied to this package.
Approximate length of stay: 3 days.

	INTERNATIONAL CODIFICATION	PACKAGE PRICE (standard room) Euros	PRIVATE OPTION (Choice of practitioner) (private room) Euros
Right and/or left heart catheterisation with angiopneumography or aorto-arteriography. Coronary angiogram. Full electro-physiological investigation. Investigation, measurement of the cardiac structures (ventriculogram and auriculogram), of systolic and diastolic functions, with dynamic and graphic recording and/or analysis and measurement by magnetic resonance, of the contractility and viability of the ventricular wall. Coronary angiogram and parietography by magnetic resonance and/or multi-slice CT scan.	A1200 Standard	4 000	(+) 1 800
Catheterisation in infants, new-born babies or children under two. Complex electro-physiological investigation with endo-cavitary mapping. Catheterisation with right and / or left endo-cavitary heart biopsy.	A1220 Complex	4 800	(+) 1 800
All emergency hemodynamic investigations due to acute cardiac or coronary insufficiency. Coronary angiogram with or without thrombolysis in acute phase of myocardial infarction. Pulmonary embolism with respiratory distress. Circulatory arrest to treat arrhythmia. Intra-aortic balloon pumping or peripheral assisted circulation (prosthesis not included).	A1250 Complicated	6 000	(+) 1 800

A 21 - Interventional cardiology (prosthesis not included).

The six-month guarantee covers coronary controls and redux angioplasty on the same lesion.

	INTERNATIONAL CODIFICATION	PACKAGE PRICE (standard room) Euros	PRIVATE OPTION (Choice of practitioner) (private room) Euros
Coronary (and/or intra-thoracic vascular) transluminal angioplasty to treat one stenosis with or without stent. Percutaneous valvuloplasty. Percutaneous closure of patent ductus arteriosus or atrial septal defect and ostium secundum. Percutaneous vascular and intra-thoracic shunts closure. Extraction of a foreign body. Diagnostic or therapeutic pericardiocentesis under angiographic and/or transoesophagian echocardiographic control and/or by magnetic resonance. Closure of the arterial canal or septal defect by amplatzer or occluder.	A2100 Standard	8 000	(+) 3 000
Redux angioplasty (after 6 months) on the same territory. Angioplasty with temporary use of endoluminal devices (laser, atherectoma, rotablator, transcoronary echo, etc...). Treatment of atrial or ventricular arrhythmia by radiofrequency. Redux angioplasties to treat the same vessel or different vessels, during the same hospital stay, with or without stent.	A2120 Complex	9 600	(+) 3 000
Angioplasty for unstable angina or in acute phase of myocardial infarction and coronary thrombectomy. Valvuloplasty in new-born babies and infants suffering from cardiac insufficiency. Valvuloplasty in patients ≥80 years old. Emergency diagnostic or therapeutic pericardiocentesis under angiographic control and transoesophagian echocardiography or magnetic resonance. () Any other examinations within six months of the procedure are not included, as they are dependent upon the development of the infarcted area and other possible lesions.	A2150 Complicated	12 000	(+) 3 000

A 31 - Electro-systolic pacing (prosthesis not included).

A 32 - Change of pacemaker (prosthesis not included).

- Surgery

Cardio-thoracic and vascular surgery under extra-corporeal circulation

A 41 - Coronary surgery (vascular prosthesis not included).

A 51 - Valvular surgery (valvular prosthesis not included).

A 52 - Other cardiac surgery under extra-corporeal circulation (prosthesis not included).

A 61 - Congenital open heart surgery (valvular or vascular prosthesis not included).

The guarantee covers aftercare of new-born babies and infants for the first month after surgery but not the first year, because of the subsequent operations required for complex cardiopathies.

	INTERNATIONAL CODIFICATION	PACKAGE PRICE (standard room) Euros	PRIVATE OPTION (Choice of practitioner) (private room) Euros
Simple interventricular communication (with or without PAH). Interauricular communication. Partial atrioventricular canal. Other left-right shunts > 4 months. Partial APVR, triatrial heart, valvular plasty. Interventricular communication + pulmonary stenosis. Valve replacement surgery. Simple interventricular communication < 4 months. Pulmonary stenosis (whatever the level may be, except pulmonary bifurcation lesion). Regular Fallot. Aortic stenosis > 6 months requiring a simple resection, a commissurotomy or an aortic patch. Cavopulmonary derivation > 1 year (without disorder of the AV valves or of the ventricular function).	A6100 Standard	Mother-Child < 8 years old 25 000	(+) 12 000
Several associated malformations. Cardiopathy that has already been operated on or that is associated with another pathology. Congenital cardiopathy in adults (> 15 years -> old congenital cardiopathy) except for ostium secundum. Other left-right shunts < 4 months. Pulmonary atresia with intact septum > 6 months. Ebstein's disease. Aortic stenosis < 6 months requiring a simple resection, a commissurotomy or an aortic patch. Cavopulmonary derivation < 1 year (without disorder of the AV valves or of the ventricular function).	A6120 Complex	30 000	(+) 12 000
Emergencies in babies ≤ 1 month. Persistent decompensated cardiac insufficiency. Infectious endocarditis. Emergency (acute cyanosis). Video and robot-assisted surgery. Complete atrioventricular canal. Total APVR. Irregular Fallot or < 4 months. Pulmonary atresia + Interventricular communication. Pulmonary atresia with intact septum < 6 months. Vascular malposition + Interventricular communication. Anatomic repair of TGV (switch, REV). Common arterial trunk. Aortic stenosis requiring a Konno or Ross procedure. Aortic arch interruption (treatment/ECC). Total cavopulmonary derivation. Abnormal coronary artery.	A6150 Complicated A6170 Complex/Complicated or Emergency	37 500 42 500	(+) 12 000

Cardio-thoracic and vascular surgery without extra-corporeal circulation

A 62 - Closed heart congenital surgery.

A 71 - Cardio-thoracic surgery by thoracotomy or thoracoscopy and abdominal and thoracic aortic surgery without extra-corporeal circulation (prosthesis not included).

Beating heart aortic coronary by-pass surgery is classed under package price A41 on account of the partially-assisted circulation and/or recuperation circuit and disposable material.
Package price applicable whatever the approach.

	INTERNATIONAL CODIFICATION	PACKAGE PRICE (standard room) Euros	PRIVATE OPTION (Choice of practitioner) (private room) Euros
Pleural, pleuropulmonary or pulmonary ablation (partial or complete). Mediastinal tumour ablation. Intra-thoracic vascular surgery without E.C.C. Abdominal aortic surgery with or without endoprosthesis. Thoracic aorta surgery with or without endoprosthesis. Cardiac surgery without E.C.C. (closed heart commissurotomy, coarctation, patent ductus arterius, pericardectomy without ECC).	A7100 Standard	18 000	(+) 9 000
Redux surgery. Associated surgery (vascular, digestive, pleuropulmonary). Juxtarenal aneurysms. Aneurysms extended to hypogastric arteries.	A7120 Complex	21 600	(+) 9 000
Emergencies (chest trauma, arterial rupture and fissuring). Dissection with thoraco-abdominal expansion. Dissection extended to the thoracic arch. Respiratory, renal or cardiac insufficiency. Patients ≥ 80 years old. Insertion of a defibrillator by thoracotomy with control by circulatory arrest. Pleuro-pulmonary or mediastinal ablation involving the pericardium and principal vessels or cardiac structures. Procedure of aortic valvular replacement by transarterial approach or thoracotomy with cardiac surgery team and ECC in stand-by in hybrid angio-surgical room with interventional cardiology and vascular surgery together.(see a)	A7150 Complicated A7170 Complex/Complicated or Emergency	27 000 30 600	(+) 9 000 (+) 9 000
Package price A71, with an additional charge of 25% for: Mediastinoscopy. Diagnostic thoracoscopy.
Package price A71, with an additional charge of 50 % for: Diagnostic thoracotomy. Isolated parietal surgery. Pleuro-pulmonary-mediastinal biopsies. Pleural or pericardial drainage by thoracotomy.

a - Without use of ECC.

Peripheral vascular surgery

A 72 - Peripheral vascular surgery (prosthesis not included).

Other package prices.

External consultations
The consultations and the external examinations are realized by practitioners in free fees.

	INTERNATIONAL CODIFICATION	PACKAGE PRICE (standard room) Euros	PRIVATE OPTION (Choice of practitioner) (private room) Euros
Investigation of the cardiac or vascular structures by magnetic resonance with or without injection during a cardio-vascular check-up. Investigation of the cardiac or vascular structures by multi-slice CT scanner with or without injection. Angiography, angiopneumography, coronary angiogram. Thoracic and abdominal aortic angiography. Angiography of the peripheral vessels.	A1000 Standard	1 000
Special cases: cardiac investigation and coronary angiogram requiring magnetic resonance and multi-slice CT scan during the same session.	A1010 Standard	1 500

	INTERNATIONAL CODIFICATION	PACKAGE PRICE (standard room) Euros	PRIVATE OPTION (Choice of practitioner) (private room) Euros
Any peripheral arterial vascular surgery.	A7200 Standard	12 000	(+) 1 200 / day
Redux surgery on the same vessel. Several associated surgeries.	A7220 Complex	14 400	(+) 1 200 / day
Emergencies (trauma, arterial rupture and fissuring). Associated respiratory, renal or cardiac insufficiency. Patients ≥ 80 years old.	A7250 Complicated A7270 Complex/Complicated or Emergency	18 000 20 400	(+) 1 200 / day (+) 1 200 / day
Package price A72, with an additional charge of 50 % for: Saphenectomy

	INTERNATIONAL CODIFICATION	PACKAGE PRICE (standard room) Euros	PRIVATE OPTION (Choice of practitioner) (private room) Euros
Transesophageal, Dobutamine or stress echography in Day-Hospital.	A8300	750
Cardiac check-up (all procedures included except for hemodynamic and angio-ventricular investigations), vascular check-up, or pulmonary check-up, including ambulatory care or complete hospitalisation.	A8100	1 500 / day	(+) 1 200 / day
Myocardial infarction, supervision in a monitored unit, billed daily.	A8110	1 500 / day	(+) 1 200 / day
Myocardial infarction in acute phase, supervision in intensive care, billed daily.	A8200	2 500 / day
Package price: first 10 days of myocardial infarction in acute phase.	A8500	18 000
Package price: first 10 days of myocardial infarction + P.T.C.A.	A8510	20 000