2016 CODING. Reference Guide for Cardiac Rhythm and Heart Failure (CRHF) Procedures

Transcription

1 2016 HOSPITAL CODING Reference Guide for Cardiac Rhythm and Heart Failure (CRHF)

2

3 CONTENTS New in Pacemaker... 7 Implantable Defibrillator...13 Electrophysiology...19 Implantable Devices for Diagnostic...23 Medtronic CareLink Network...25 New in 2016 Pacemaker Implantable Defibrillator Electrophysiology Implantable Devices for Diagnostic Medtronic CareLink Network

4

5 This booklet includes the commonly billed hospital codes for cardiac rhythm and heart failure devices and procedures. This is not a comprehensive list of all available codes, and it is possible that there is a more appropriate code for any given procedure. These coding suggestions do not replace seeking coding advice from the payer and/or your own coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for interpretation of the appropriate codes to use for specific procedures. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third party payers as to the correct form of billing or the amount that will be paid to providers of service. For questions or for more information, please contact Medtronic at 1 (866) Cardiac Rhythm and Heart Failure reimbursement customer information is available at CPT copyright 2015 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein. Where reimbursement is requested for the use of a product that may be inconsistent or not expressly specified in the FDA cleared or approved labeling (e.g., instructions for use, operator s manual, or package insert), consult with your billing advisors or payers for advice on handling such billing issues. Some payers may have policies that make it inappropriate to submit claims for such items or related services of 27

6 HOSPITAL CODING SYSTEMS AND MEDICARE PAYMENT METHODOLOGIES Hospital Inpatient Coding and Reimbursement Hospitals will assign ICD-10-CM diagnosis and procedure codes for discharges that occur on or after October 1, Medicare inpatient hospital reimbursement is based on the Medicare-Severity Diagnosis Related Group (MS-DRG) system. For each discharge, the applicable diagnoses and procedure codes are categorized into one of many MS-DRGs. Only one MS-DRG is assigned regardless of the number of procedure and diagnosis codes. Each MS-DRG has a unique relative weight that is used to convert that episode of care into the payment amount Hospital Outpatient Coding and Reimbursement Similar to physicians, hospitals use ICD-10-CM codes for diagnoses and numeric CPT or HCPCS* (includes an alpha character) to report procedures performed in an outpatient setting. The Comprehensive Ambulatory Payment Classification (C-APC) methodology that began in CY 2015 will continue to exist for device-intensive procedures in CY The comprehensive payment policy will package payment for adjunctive and secondary items, services, and procedures into the most costly primary procedure at the claim level. 1 Changes to C-APC/APCs and CPT procedure codes are effective January 1st of each year. ICD-10-CM diagnosis codes will be implemented for service dates on or after October 1, The information in this document does not identify code pairs that may be subject to the Medicare National Correct Coding Initiatives (NCCI) edits. *HCPCS: Healthcare Common Procedure Coding System. Modifiers 2 : KX: Requirements specified in the medical policy have been met. Q0 (zero): Investigational clinical service provided in a clinical research study that is in an approved clinical research study. This modifier also denotes a primary prevention patient for Medicare implantable defibrillator device implants. -25: Significant, separately identifiable E/M service by the same physician or other qualified health care professional on the same day of the procedure or other service -52: Reduced services -58: Staged or related procedure or service by the same physician or other qualified health care professional during the post-operative period -73: Discontinued outpatient hospital procedure prior to administration of anesthesia -74: Discontinued outpatient hospital procedure after administration of anesthesia -76: Repeat procedure or service by same physician or other qualified health care professional -77: Repeat procedure by another physician or other qualified health care professional -78: Unplanned return to the OR/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the post-operative period -79: Unrelated procedure or service by the same physician during the post-operative period 2 of

7 NEW IN 2016 New in 2016 Hospital Coding and Reimbursement I. C-APC and APC reassignments effective January 1, CPT or Category III Codes Abbreviated 2016 CPT or Category III Description 2016 C-APC or APC Assignment 0387T Transcath insert/replace perm. leadless pacer, ventricular T Transcath removal of perm. leadless pacer, ventricular T 0391T Programming device eval. (in person), leadless pacemaker system Interrogation device eval. (in person), leadless pacemaker system Insert new/replace perm. pacer, w/transvenous lead; atrial Insert new/replace perm. pacer, w/transvenous lead; ventricle Insert new/replace perm. pacer, w/transvenous lead; atrial and ventricular Insert/replace temporary transvenous single chamber lead Insert/replace temporary transvenous dual chamber lead Insert pacer generator only; w/existing single lead Insert pacer generator only; w/existing dual leads Upgrade pacer system, convert single chamber to dual chamber Reposition previously implanted transvenous pacer or defibrillator lead Insert single transvenous pacer or defibrillator lead Insert 2 transvenous pacer or defibrillator leads Repair single transvenous pacer or defibrillator lead Repair 2 transvenous pacer or defibrillator leads Insert pacer generator only; w/existing multiple leads Relocate skin pocket for pacer relocate skin pocket for defibrillator Insert pacing lead, cardiac venous system, for left ventricular pacing, attach to previously placed pacer/defibrillator Reposition previously implanted cardiac venous system (left ventricular) lead Remove/replace pacer generator; single lead system Remove/replace pacer generator; multiple lead system Remove/replace pacer generator; multiple lead system Insert defibrillator generator only; w/existing dual leads Insert defibrillator generator only; w/existing multiple leads Remove pacer generator only Remove transvenous pacer lead; single lead system Remove transvenous pacer leads; dual lead system Insert defibrillator generator only; w/existing single lead Remove defibrillator generator only C-APC or APC Assignment of 27

8 New in 2016, continued CPT or Category III Codes Abbreviated 2016 CPT or Category III Description Remove single or dual chamber defibrillator leads; transvenously Insert new/replace perm. defibrillator system, w/ transvenous lead(s); single or dual chamber 2016 C-APC or APC Assignment Remove/replace defibrillator generator; single lead system Remove/replace defibrillator generator; dual lead system Remove/replace defibrillator generator; multiple lead system Insert new/replace perm. subcutaneous (subq.) defibrillator system, w/subq. lead Insert subq. defibrillator lead Remove subq. defibrillator lead Reposition previously implanted subq. defibrillator lead Implant cardiac-event recorder Remove cardiac-event recorder Cardioversion, electrical conversion of arrhythmia; external Cardioversion, electrical conversion of arrhythmia; internal External mobile cardiovascular telemetry Programming device eval. (in person), subq. lead defibrillator system Interrogation device eval. (in person), subq. lead defibrillator system Programming device eval. (in person); single lead pacer system Programming device eval. (in person); dual lead pacer system Programming device eval. (in person); multiple lead pacer system Programming device eval. (in person); single lead transvenous defibrillator system Programming device eval. (in person); dual lead transvenous defibrillator system Programming device eval. (in person); multiple lead transvenous defibrillator system Programming device eval. (in person); implantable loop recorder system Interrogation device eval. (in person); single, dual or multiple pacer system Interrogation device eval. (in person); single, dual, or multiple lead defibrillator system Interrogation device eval. (in person); implantable cardiovascular monitor system Interrogation device eval. (in person); implantable loop recorder system Interrogation device eval. (in person); wearable defibrillator system Transtelephonic rhythm strip eval(s) single, dual, or multiple lead pacer system, up to 90 days Interrogation device eval(s) (remote), up to 90 days; single, dual, or multiple lead pacer or defibrillator system C-APC or APC Assignment 4 of

9 New in 2016, continued CPT or Category III Codes Abbreviated 2016 CPT or Category III Description Interrogation device eval(s) (remote), up to 30 days; implantable cardiovascular monitor system or implantable loop recorder system 2016 C-APC or APC Assignment Transthoracic echo for congenital anomalies; complete Echo for congenital anomalies; follow-up or limited study Echo, complete, w/spectral Doppler and color flow Doppler Echo, complete, w/out spectral Doppler and color flow Doppler Echo; follow-up or limited study Bundle of His recording Intra-atrial recording Right ventricular recording Intra-atrial pacing Intraventricular pacing Esophageal recording of atrial electrogram Esophageal recording of atrial electrogram; with pacing Introduction of arrhythmia by electrical pacing Comprehensive electrophysiologic eval. w/o induction or attempted induction of arrhythmia Comprehensive electrophysiologic eval. w/induction or attempted induction of arrhythmia Electrophysiologic follow-up study w/pacing and recording to test effectiveness of therapy Electrophysiologic eval. of single or dual chamber transvenous pacing defibrillator Catheter ablation of atrioventricular node function Catheter ablation with treatment of supraventricular tachycardia (SVT) Catheter ablation with treatment of ventricular tachycardia (VT) Catheter ablation of atrial fibrillation by pulmonary vein isolation (PVI) Eval. of cardiovascular function with tilt table evaluation Electronic analysis of antitachycardia pacer system Initial set-up and programming of wearable defibrillator C-APC or APC Assignment New in 2016 Cardiac Rhythm and Heart Failure (CRHF) reimbursement customer information is available at Current Procedural Terminology (CPT) is copyright 2015 American Medical Association of 27

10 6 of

11 PACEMAKER PROCEDURES HOSPITAL INPATIENT: Pacemaker and Cardiac Resynchronization Pacemaker ICD-10-PCS (Procedure Coding System) Options are available at this web site address: 10-pm-proc-code pdf Possible DRG Assignments (MS-DRG: Medicare Severity Diagnosis Related Group) MS-DRG MCC: Major complication or comorbidity Brief MS-DRG Description Pacemaker implant w/mcc Pacemaker implant w/cc Pacemaker implant w/o CC/MCC Pacemaker revision w/mcc Pacemaker revision w/cc Pacemaker revision w/o CC/MCC Pacemaker device replacement w/mcc Pacemaker device replacement w/o MCC CC: Complication or comorbidity Pacemaker HOSPITAL OUTPATIENT CPT CODES: Pacemaker Insertion Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial ventricular atrial and ventricular Insertion of pacemaker pulse generator only; with existing single lead with existing dual leads with existing multiple leads Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator) Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator) Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for upgrade to dual chamber system) (List separately in addition to code for primary procedure) 0387T Transcatheter insertion or replacement of permanent leadless pacemaker, ventricular Insertion or Replacement of Temporary Pacemaker Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter (separate procedure) Insertion or replacement of temporary transvenous dual chamber pacing electrodes (separate procedure) Removal and Replacement Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system dual lead system multiple lead system Removal Removal of permanent pacemaker pulse generator only Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular dual lead system 0388T Transcatheter removal of permanent leadless pacemaker, ventricular of 27

12 Pacemaker, continued Repositioning, Repair, Relocation Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator Relocation of skin pocket for pacemaker Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator) Echocardiography Transthoracic echocardiography for congenital cardiac anomalies; complete follow-up or limited study Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study Doppler echocardiography, pulsed wave and/or continuous wave with spectral display; complete (List separately in addition to codes for echocardiographic imaging) (Use in conjunction with 93303, 93304, 93312, 93314, 93315, 93317, 93350, 93351) follow-up or limited study (List separately in addition to codes for echocardiographic imaging) (Use in conjunction with 93303, 93304, 93308, 93312, 93314, 93315, 93317, 93350, 93351) Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography) (Use in conjunction with 76825, 76826, 76827, 76828, 93303, 93304, 93308, 93312, 93314, 93315, 93317, 93350, 93351) 2 Cardiac Device Analysis, Interrogation, and Programming Evaluation Electronic analysis of antitachycardia pacemaker system (includes electrocardiographic recording, programming of device, induction and termination of tachycardia via implanted pacemaker, and interpretation of recordings) In Person Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead pacemaker system dual lead pacemaker system multiple lead pacemaker system Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors 0389T Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report, leadless pacemaker system 0391T Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording and disconnection per patient encounter, leadless pacemaker system Transtelephonic/Remote Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple lead pacemaker system, includes recording with and without magnet application with analysis, review and report(s) by a physician or other qualified health care professional, up to 90 days Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system or implantable cardioverter-defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system or implantable loop recorder system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results External External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; technical support for connection and patient instructions for use, attended surveillance, analysis and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional 8 of

13 Pacemaker, continued Peri-Procedural Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead pacemaker system 0390T Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure or test with analysis, review and report, leadless pacemaker system Frequency Guidelines: Medicare identifies the frequency guidelines for pacemaker clinic services in the Cardiac Pacemaker Evaluation Services Medicare National Coverage Determinations Manual (CMS Pub, ) Cardiac Pacemaker Evaluation Services (Rev. 173, Issued: ) CIM Contact your local payer to discuss this pacemaker evaluation National Coverage Determination and procedure code definitions. + Codes with a + symbol are add-on codes. These procedures are always performed in addition to the primary service/ procedure, and are never reported as stand-alone codes. Possible C-APC and APC Assignments Medicare Comprehensive Ambulatory Payment Classifications (C-APCs) include device-intensive procedures and are assigned a J1 status indicator. APC assignment may be applicable for other procedure codes. Pacemaker CPT Codes Abbreviated 2016 CPT Descriptions C-APC or APC Group C-APC/APC Description Relocation of skin pocket for pacemaker 5054 Level 4 Skin Reposition previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) 0388T Transcatheter removal of permanent leadless pacemaker, ventricular 5181 Level 1 Vascular 5182 Level 2 Vascular Reposition previously implanted left ventricular electrode 0387T Transcatheter insertion or replacement of permanent leadless pacemaker, ventricular Repair of single transvenous electrode, pacemaker or implantable defibrillator Repair of 2 transvenous electrodes, pacemaker or implantable defibrillator Remove transvenous pacemaker electrode; single lead system Remove transvenous pacemaker electrode(s); dual lead system Insert/replace temporary transvenous single chamber cardiac electrode 5193 Level 3 Endovascular 5221 Level 1 Pacemaker and Similar 5222 Level 2 Pacemaker and Similar Insert/replace temporary transvenous dual chamber pacing electrodes Insert pacemaker pulse generator only; with existing single lead Insert single transvenous electrode, pacemaker or implantable defibrillator Insert 2 transvenous electrodes, pacemaker or implantable defibrillator Remove and replace pacemaker generator; single lead system Remove pacemaker pulse generator only of 27

14 Pacemaker, continued CPT Codes Abbreviated 2016 CPT Descriptions C-APC or APC Group C-APC/APC Description Insert new or replacement pacemaker with transvenous electrode; atrial Insert new or replacement pacemaker with transvenous electrode; ventricular Insert new or replacement pacemaker with transvenous electrodes; atrial and ventricular 5223 Level 3 Pacemaker and Similar Insert pacemaker pulse generator only; with existing dual leads Upgrade pacemaker system, conversion of single chamber to dual chamber system Insert LV lead, with attachment to previously placed pacemaker or implantable defibrillator generator Remove and replace pacemaker generator; dual lead system Insert pacemaker pulse generator only; with existing multiple leads Remove and replace pacemaker generator; multiple lead system 5224 Level 4 Pacemaker and Similar Transthoracic echo, follow-up or limited study 5532 Level 2 Ultrasound and Related Services Transthoracic echo for congenital cardiac anomalies; follow-up or limited study Transthoracic echo, complete, with spectral and color flow Doppler Transthoracic echo, complete, without spectral and color flow Doppler Transthoracic echo for congenital cardiac anomalies; complete External mobile cardiovascular telemetry up to 30 days 0389T 0391T Programming device evaluation (in person), leadless pacemaker system Interrogation device evaluation (in person), leadless pacemaker system 5533 Level 3 Ultrasound and Related Services 5534 Level 4 Ultrasound and Related Services 5722 Level 2 Diagnostic Tests and Related Services 5741 Level 1 Electronic Analysis of Devices Programming device evaluation (in person), single lead pacemaker system Programming device evaluation (in person), dual lead pacemaker system Programming device evaluation (in person), multiple lead pacemaker system Interrogation device evaluation (in person); single, dual, or multiple lead pacemaker system Interrogation device evaluation (in person); implantable cardiovascular monitor (ICM) system Transtelephonic rhythm strip evaluation(s) single, dual, or multiple lead pacemaker system, up to 90 days Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker or implantable defibrillator system Interrogation device evaluation(s) (remote), up to 30 days; ICM or ILR Electronic analysis of antitachycardia pacemaker system 5743 Level 2 Electronic Analysis of Devices 10 of

15 Pacemaker, continued CPT Codes Abbreviated 2016 CPT Descriptions C-APC or APC Group C-APC/APC Description Insert LV lead, at time of insertion of pacemaker or implantable defibrillator generator Peri-procedural device evaluation, pacemaker system 0390T Peri-procedural device evaluation, leadless pacemaker system Doppler echo, complete Doppler echo, follow-up or limited study Doppler echo color flow velocity mapping Status C Inpatient Only* CPT Codes CPT Description Status N, Not separately payable "Items and Service Packaged into APC Rates" Insertion of epicardial electrode(s); open incision (e.g., thoracotomy, median sternotomy, subxiphoid approach) Pacemaker Insertion of epicardial electrode(s); endoscopic approach (e.g., thoracoscopy, pericardioscopy) Removal of permanent epicardial pacemaker and electrodes by thoracotomy; single lead system, atrial or ventricular Removal of permanent epicardial pacemaker and electrodes by thoracotomy; dual lead system Removal of permanent transvenous electrode(s) by thoracotomy * The Addendum E file includes the codes that are paid only as Inpatient procedures in CY Log on to: Regulations-and-Notices.html, then access, CMS-1633-FC; CMS-1607-F2, click on CY 2016 OPPS Final Rule Addenda and open Addendum E of 27

16 12 of

17 IMPLANTABLE DEFIBRILLATOR PROCEDURES HOSPITAL INPATIENT: Implantable Defibrillator and Cardiac Resynchronization Defibrillator ICD-10-PCS (Procedure Coding System) Options are available at this web site address: documents/icd-10-icd-proc-code pdf Possible DRG Assignments (MS-DRG: Medicare Severity Diagnosis Related Group) MS-DRG Brief MS-DRG Description Cardiac defibrillator implant w/cardiac cath w/principal dx of AMI, HF or Shock w/mcc Cardiac defibrillator implant w/cardiac cath w/principal dx of AMI, HF or Shock w/o MCC Cardiac defibrillator implant w/cardiac cath w/o principal dx of AMI, HF or Shock w/mcc Cardiac defibrillator implant w/cardiac cath w/o principal dx of AMI, HF or Shock w/o MCC Cardiac defibrillator implant w/o cardiac cath w/mcc Cardiac defibrillator implant w/o cardiac cath w/o MCC 245 AICD generator procedures 265 AICD lead procedures MCC: Major complication or comorbidity Implantable Defibrillator HOSPITAL OUTPATIENT CPT CODES: Implantable Defibrillator Insertion Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator) Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for upgrade to dual chamber system) (List separately in addition to code for primary procedure) Insertion of pacing cardioverter-defibrillator pulse generator only; with existing dual leads with existing multiple leads with existing single lead Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed Insertion of subcutaneous implantable defibrillator electrode Insertion or Replacement of Temporary Pacemaker (May be applicable to Implantable Defibrillator, verify with payers as deemed appropriate) Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter (separate procedure) Insertion or replacement of temporary transvenous dual chamber pacing electrodes (separate procedure) Removal and Replacement Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system dual lead system multiple lead system of 27

18 Implantable Defibrillator, continued Removal Removal of implantable defibrillator pulse generator only Removal of single or dual chamber implantable defibrillator electrode(s); by transvenous extraction Removal of subcutaneous implantable defibrillator electrode Repositioning, Repair, Relocation Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator Relocation of skin pocket for implantable defibrillator Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator) Repositioning of previously implanted subcutaneous implantable defibrillator electrode Intra-operative Device Testing Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator Follow-Up Device Testing Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters) Electrophysiologic evaluation of subcutaneous implantable defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters) Echocardiography Transthoracic echocardiography for congenital cardiac anomalies; complete follow-up or limited study Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study Doppler echocardiography, pulsed wave and/or continuous wave with spectral display; complete (List separately in addition to codes for echocardiographic imaging) (Use in conjunction with 93303, 93304, 93312, 93314, 93315, 93317, 93350, 93351) follow-up or limited study (List separately in addition to codes for echocardiographic imaging) (Use in conjunction with 93303, 93304, 93308, 93312, 93314, 93315, 93317, 93350, 93351) Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography) (Use in conjunction with 76825, 76826, 76827, 76828, 93303, 93304, 93308, 93312, 93314, 93315, 93317, 93350, 93351) 2 Cardiac Device Analysis, Interrogation, and Programming Evaluation In Person Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; implantable subcutaneous lead defibrillator system Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable subcutaneous lead defibrillator system Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead transvenous implantable defibrillator system dual lead transvenous implantable defibrillator system multiple lead transvenous implantable defibrillator system 14 of

19 Implantable Defibrillator, continued Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead transvenous implantable defibrillator system, including analysis of heart rhythm derived data elements Remote Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results External External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real-time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; technical support for connection and patient instructions for use, attended surveillance, analysis and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; wearable defibrillator system Initial set-up and programming by a physician or other qualified health care professional of wearable cardioverter-defibrillator includes initial programming of system, establishing baseline electronic ECG, transmission of data to data repository, patient instruction in wearing system and patient reporting of problems or events Peri-Procedural Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead implantable defibrillator system ICD/CRT-D Devices with OptiVol Technology Cardiac Device Analysis Interrogation In Person Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors Remote Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system or implantable loop recorder system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results + Codes with a + symbol are add-on codes. These procedures are always performed in addition to the primary service/ procedure, and are never reported as stand-alone codes. Implantable Defibrillator Possible C-APC and APC Assignments Medicare Comprehensive Ambulatory Payment Classifications (C-APCs) include device-intensive procedures and are assigned a J1 status indicator. APC assignment may be applicable for other procedure codes. CPT Codes Abbreviated 2016 CPT Descriptions C-APC or APC Group C-APC/APC Description Relocation of skin pocket for implantable defibrillator 5054 Level 4 Skin Reposition previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) Reposition previously implanted left ventricular electrode 5181 Level 1 Vascular 5182 Level 2 Vascular Electrophysiologic evaluation of single/dual chamber implantable defibrillator (not at initial implant or replacement) 5211 Level 1 Electrophysiologic of 27

20 Implantable Defibrillator, continued CPT Codes Abbreviated 2016 CPT Descriptions Repair of single transvenous electrode, pacemaker or implantable defibrillator Repair of 2 transvenous electrodes, pacemaker or implantable defibrillator Remove implantable defibrillator pulse generator only Remove single or dual chamber implantable defibrillator electrode(s), transvenous extraction Remove subcutaneous implantable defibrillator electrode Reposition previously implanted subcutaneous implantable defibrillator electrode Insert/replace temporary transvenous single chamber cardiac electrode Insert/replace temporary transvenous dual chamber pacing electrodes Insert single transvenous electrode, pacemaker or implantable defibrillator Insert 2 transvenous electrodes, pacemaker or implantable defibrillator Insert subcutaneous implantable defibrillator electrode Insert LV lead, with attachment to previously placed pacemaker or implantable defibrillator generator Insert implantable defibrillator generator only; with existing dual leads Insert implantable defibrillator generator only; with existing single lead Remove and replace implantable defibrillator generator; single lead system Remove and replace implantable defibrillator generator; dual lead system Insert implantable defibrillator generator only; with existing multiple leads C-APC or APC Group C-APC/APC Description 5221 Level 1 Pacemaker and Similar 5222 Level 2 Pacemaker and Similar 5223 Level 3 Pacemaker and Similar 5231 Level 1 ICD and Similar 5232 Level 2 ICD and Similar Insert or replace implantable defibrillator system, with transvenous lead(s), single or dual chamber Remove and replace implantable defibrillator generator; multiple lead system Insert or replace subcutaneous implantable defibrillator system Transthoracic echo, follow-up or limited study 5532 Level 2 Ultrasound and Related Services Transthoracic echo for congenital cardiac anomalies; follow-up or limited study 5533 Level 3 Ultrasound and Related Services Transthoracic echo, complete, with spectral and color flow Doppler Transthoracic echo, complete, without spectral and color flow Doppler Transthoracic echo for congenital cardiac anomalies; complete External mobile cardiovascular telemetry up to 30 days 5534 Level 4 Ultrasound and Related Services 5722 Level 2 Diagnostic Tests and Related Services 16 of

21 Implantable Defibrillator, continued CPT Codes Abbreviated 2016 CPT Descriptions Programming device evaluation (in person), implantable subcutaneous lead defibrillator system Interrogation device evaluation (in person), implantable subcutaneous lead defibrillator system Programming device evaluation (in person), single lead transvenous implantable defibrillator system Programming device evaluation (in person), dual lead transvenous implantable defibrillator system Programming device evaluation (in person), multiple lead transvenous implantable defibrillator system Interrogation device evaluation (in person); single, dual, or multiple lead transvenous implantable defibrillator system Interrogation device evaluation (in person); implantable cardiovascular monitor (ICM) system Interrogation device evaluation (in person); wearable defibrillator system Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker or implantable defibrillator system Interrogation device evaluation(s) (remote), up to 30 days; ICM or ILR Electronic analysis of antitachycardia pacemaker system Initial set-up and programming of wearable defibrillator Insert LV lead, at time of insertion of pacemaker or implantable defibrillator generator Peri-procedural device evaluation, implantable defibrillator system Doppler echo, complete Doppler echo, follow-up or limited study Doppler echo color flow velocity mapping Electrophysiologic evaluation of single/dual chamber implantable defibrillator leads at time of initial implant or replacement Electrophysiologic evaluation of single/dual chamber implantable defibrillator leads and generator at time of initial implant or replacement Electrophysiologic evaluation of subcutaneous implantable defibrillator (not at initial implant or replacement) C-APC or APC Group C-APC/APC Description 5741 Level 1 Electronic Analysis of Devices 5743 Level 2 Electronic Analysis of Devices Status N, Not separately payable "Items and Service Packaged into APC Rates" Implantable Defibrillator Status C Inpatient Only* CPT Codes CPT Description Insertion of epicardial electrode(s); open incision (e.g., thoracotomy, median sternotomy, subxiphoid approach) Insertion of epicardial electrode(s); endoscopic approach (e.g., thoracoscopy,pericardioscopy) Removal of single or dual chamber implantable defibrillator electrode(s); by thoracotomy * CMS-1613-FC-Addendum-E file that provides the codes that are paid only as Inpatient in CY 2015 is available at: Regulations-and-Notices.html; Click on CY2015 OPPS Addenda and then access for Addendum E of 27

22 18 of

23 ELECTROPHYSIOLOGY PROCEDURES HOSPITAL INPATIENT: Electrophysiology ICD-10-PCS (Procedure Coding System) Options are available at this web site address: Possible DRG Assignments (MS-DRG: Medicare Severity Diagnosis Related Group) MS-DRG Brief MS-DRG Description MCC: Major complication or comorbidity Other cardiothoracic procedures w/mcc Other cardiothoracic procedures w/cc Other cardiothoracic procedures w/o CC/MCC Percutaneous cardiovascular procedure w/o coronary artery stent w/mcc Percutaneous intracardiac procedures w/o MCC CC: Complication or comorbidity HOSPITAL OUTPATIENT CPT CODES: Recording, Mapping, and Pacing Bundle of His recording Intra-atrial recording Right ventricular recording Intraventricular and/or intra-atrial mapping of tachycardia site(s) with catheter manipulation to record from multiple sites to identify origin of tachycardia (List separately in addition to code for primary procedure) Intra-atrial pacing Intraventricular pacing Intracardiac electrophysiologic 3-dimensional mapping (List separately in addition to code for primary procedure) Esophageal recording of atrial electrogram with or without ventricular electrogram(s); with pacing Induction of arrhythmia by electrical pacing Electrophysiologic Evaluations Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording with left atrial pacing and recording from coronary sinus or left atrium (List separately in addition to code for primary procedure) with left ventricular pacing and recording (List separately in addition to code for primary procedure) Pharmacologic Assessment during EPS Programmed stimulation and pacing after intravenous drug infusion (List separately in addition to code for primary procedure) EP Follow-Up Study Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or attempted induction of arrhythmia Intra-Operative Cardiac Pacing and Mapping Intra-operative epicardial and endocardial pacing and mapping to localize the site of tachycardia or zone of slow conduction for surgical correction Intra-Operative Device Testing Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator Electrophysiology of 27

24 Electrophysiology, continued Follow-Up Device Testing Electrophysiologic evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters) Electrophysiologic evaluation of subcutaneous implantable defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters) Intracardiac Echocardiography Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (List separately in addition to code for primary procedure) External and Internal Cardioversion Cardioversion, elective, electrical conversion of arrhythmia; external internal (separate procedure) Catheter Ablation Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording (when necessary), and His bundle recording (when necessary) with intracardiac catheter ablation of arrhythmogenic focus; with treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathway, accessory atrioventricular connection, cavo-tricuspid isthmus or other single atrial focus or source of atrial re-entry with treatment of ventricular tachycardia or focus of ventricular ectopy including intracardiac electrophysiologic 3D mapping, when performed, and left ventricular pacing and recording, when performed Intracardiac catheter ablation of a discrete mechanism of arrhythmia which is distinct from the primary ablated mechanism, including repeat diagnostic maneuvers, to treat a spontaneous or induced arrhythmia (List separately in addition to code for primary procedure) Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia including left or right atrial pacing/recording when necessary, right ventricular pacing/recording when necessary, and His bundle recording when necessary with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (List separately in addition to code for primary procedure) Transseptal Puncture Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure) (Use in conjunction with 93452, 93453, , 93582, 93653, 93654) Tilt Table Testing Evaluation of cardiovascular function with tilt table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention Cardiac Device Analysis, Interrogation, and Programming Evaluation Electronic analysis of antitachycardia pacemaker system (includes electrocardiographic recording, programming of device, induction and termination of tachycardia via implanted pacemaker, and interpretation of recordings) + Codes with a + symbol are add-on codes. These procedures are always performed in addition to the primary service/ procedure, and are never reported as stand-alone codes. 20 of