2016 CODING AND REIMBURSEMENT. Cardiac Surgical Ablation & Left Atrial Appendage Management

2016 CODING AND REIMBURSEMENT Cardiac Surgical Ablation & Left Atrial Appendage Management

Introduction This information is for educational purposes and current as of January 2016. Healthcare providers are solely responsible for the accuracy of codes selected for the services rendered and reported in the patient s medical record. AtriCure does not assume responsibility for coding decisions, nor recommend codes for specific cases. Items and services that are billed to payers must be medically necessary and supported by appropriate documentation. AtriCure does not promote the off-label use of its devices. While a code may exist describing certain procedures and/or technologies, this does not guarantee payment by payers. Product Offerings: AtriCure product offering includes: Bipolar Radiofrequency (RF) and Cryoablation surgical ablation devices, the AtriClip Left Atrial Appendage Management System (LAAM), and cryoice Cryoanalgesia. These therapies are indicated as part of surgical treatment with either coronary artery bypass graft surgery (CABG), Mitral valve replacement (MVR), Aortic valve replacement (AVR), or in combination with an epicardial ablation procedure. Table 1. Physician Coding and Reimbursement Current Procedure Terminology (CPT is a registered trademark of the American Medical Association) are codes describing the procedure during the patient visit. CPT codes that may be appropriate for procedures used in conjunction with cardiac ablation surgery and LAAM include, but are not limited to: CPT * Description Cardiac Surgical Ablation 33250 Operative ablation of supraventricular arrhythmogenic focus or pathway without 33251 Operative ablation of supraventricular arrhythmogenic focus or pathway with 33254 Operative tissue ablation and reconstruction of atria, limited (e.g., modified Maze procedure) 33255 Operative tissue ablation and reconstruction of atria, extensive (e.g., Maze procedure); without 33256 Operative tissue ablation and reconstruction of atria, extensive (e.g., Maze procedure); with 33257 Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), limited (e.g., modified Maze procedure) 33258 Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), extensive (e.g., Maze procedure); without 33259 Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), extensive (e.g., Maze procedure), with 33261 Operative ablation of ventricular arrhythmogenic focus with 33265 Endoscopy, surgical; operative tissue ablation and reconstruction of atria, limited (e.g., modified Maze procedure), without 33266 Endoscopy, surgical; operative tissue ablation and reconstruction of atria, extensive (e.g., Maze procedure), without Total Facility Relative Value Units (RVUs) ** National Payment Rates 42.88 $1,536 47.25 $1,692 40.10 $1,436 47.12 $1,688 57.12 $2,046 17.00 $609 19.03 $682 24.60 $882 47.66 $1,707 39.53 $1,416 53.78 $1,926 Table 1. Physician Coding and Reimbursement continued on next page

Table 1. Physician Coding and Reimbursement continued Current Procedure Terminology (CPT is a registered trademark of the American Medical Association) are codes describing the procedure during the patient visit. CPT codes that may be appropriate for procedures used in conjunction with cardiac ablation surgery and LAAM include, but are not limited to: CPT * Description Total Facility Relative Value Units (RVUs) ** Mitral Valve Surgery 33418 Transcatheter mitral valve repair, percutaneous approach, including 52.30 $1,873 transseptal puncture when performed; initial prosthesis 33420 Valvotomy (Commissurotomy), mitral valve; closed heart 45.42 $1,627 48.81 $1,748 33422 Valvotomy (Commissurotomy), mitral valve; open heart, with National Payment Rates 33425 Valvuloplasty, mitral valve, with 79.67 $2,854 33426 Valvuloplasty, mitral valve, with ; with 69.34 $2,484 prosthetic ring 33427 Valvuloplasty, mitral valve, with ; radical 71.13 $2,548 reconstruction, with or without ring 33430 Replacement, mitral valve, with 81.56 $2,922 Aortic Valve Surgery 33400 Valvuloplasty, aortic valve; open, with 66.25 $2,373 33401 Valvuloplasty, aortic valve; open, with inflow occlusion 42.79 $1,533 33403 Valvuloplasty, aortic valve; using transventricular dilation, with 43.41 $1,555 33405 Replacement, aortic valve, with ; with 66.10 $2,368 prosthetic valve other than homograft or stentless valve 33411 Replacement, aortic valve; with aortic annulus enlargement, 97.77 $3,502 noncoronary sinus 33413 Replacement, aortic valve; by translocation of autologous 95.20 $3,410 pulmonary valve with allograft replacement of pulmonary valve (Ross procedure) CABG 33533 Coronary artery bypass, using arterial graft(s); single arterial graft 54.47 $1,951 33534 Coronary artery bypass, using arterial graft(s); 2 arterial grafts 63.99 $2,292 33535 Coronary artery bypass, using arterial graft(s); 3 arterial grafts 71.25 $2,552 33536 Coronary artery bypass, using arterial graft(s); 4 or more arterial grafts 76.72 $2,748

Table 1. Physician Coding and Reimbursement continued Current Procedure Terminology (CPT is a registered trademark of the American Medical Association) are codes describing the procedure during the patient visit. CPT codes that may be appropriate for procedures used in conjunction with cardiac ablation surgery and LAAM include, but are not limited to: CPT * Description Electrophysiology Cardiac Ablation 93631 Intra-operative epicardial and endocardial pacing and mapping to localize the site of tachycardia or zone of slow conduction for surgical conduction 93653 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), 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 93655 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 93656 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 93657 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 Total Facility Relative Value Units (RVUs) ** National Payment Rates 11.57 $414 24.64 $882 12.32 $441 32.83 $1,176 12.31 $441 *Source: American Medical Association. CPT 2016 Professional Edition. ** The facility payment is the physician s professional fee in a facility setting. Average national rates are unadjusted by Geography Practice Cost Index. Payment rates reflect a conversion factor of $35.82 (effective first quarter 2016).

Table 2. Inpatient Facility Coding and Reimbursement The site of service depends on the patient s chief complaint, clinical presentation and is solely determined by the admitting physician. The ICD-10-CM (Internal Classification of Disease, Tenth Revision, Clinical Modification) Diagnosis Code(s) and primary ICD-10-CM procedure code(s) determine the MS-DRG (Medicare Severity Diagnosis Related Group). MS-DRG * Description Inpatient National Standardized Prospective Payment CY 2015 Inpatient National Standardized Prospective Payment % Change, from 2015 to 2016 $ Change, from 2015 to 2016 Cardiac Surgical Ablation ** 228 Other cardiothoracic procedures $38,004 $39,427-3.6% -$1,423 with MCC 229 Other cardiothoracic procedures with CC $24,925 $24,054 3.6% $871 230 Other cardiothoracic procedures $23,519 $21,977 7.0% $1,542 w/o CC/MCC Aortic and Mitral Valves ** 216 Cardiac valve and other major $51,744 $51,358 0.7% $386 cardiothoracic procedures with cardiac 217 Cardiac valve and other major $34,212 $34,130 0.2% $82 cardiothoracic procedures with cardiac catheterization with CC 218 Cardiac valve and other major $29,969 $30,033 0.2% -$64 cardiothoracic procedures with cardiac catheterization without CC/MCC 219 Cardiac valve and other major $41,328 $41,559-0.5% -$231 cardiothoracic procedures w/o cardiac 220 Cardiac valve and other major $27,924 $28,072-0.5% -$148 cardiothoracic procedures w/o cardiac catheterization with CC 221 Cardiac valve and other major $24,825 $25,059-0.9% -$234 cardiothoracic procedures w/o cardiac catheterization w/o CC/MCC CABG ** 231 Coronary bypass with PTCA with MCC $42,442 $41,656 1.8% $786 232 Coronary bypass with PTCA w/o MCC $31,523 $30,186 4.4% $1,337 233 Coronary bypass with cardiac $40,006 $39,632 0.9% $374 234 Coronary bypass with cardiac $26,712 $26,324 1.4% $388 catheterization w/o MCCC 235 Coronary bypass w/o cardiac $31,619 $30,786 2.6% $833 236 Coronary bypass w/o cardiac catheterization w/o MCC $20,690 $20,466 1.0% $224 CC = comorbidity or complication, MCC = major complication or comorbidity, w/o = without, PTCA = percutaneous transluminal coronary angioplasty *Source: FY16 Medicare inpatient rates based upon Final Rule release. https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/ FY2016-IPPS-Final-Rule-Home-Page-Items/FY2016-IPPS-Final-Rule-Regulations.html **There are no separate MS-DRG payments for the use of the AtriClip LAAM in concomitant surgery, nor for the use of cryoice Cryoanalgesia.

Table 3. Outpatient Hospital and Ambulatory Surgery Center Reimbursement When a percutaneous ablation procedure is performed, the corresponding APC (ambulatory payment classification, similar to DRG for inpatient), and in hospital outpatient prospective payment system (HOPPS) may include: Procedure APC Medicare National Standardized Payment (HOPPS) New APC Title Percutaneous AF Ablation Electrophysiology evaluation time of implant 0084 $338 Level 1 EP Procedure Electrophysiology evaluation later date 0084 $281 Level 1 EP Procedure Ablate heart dysrhythm focus 5212 $4,697 Level 2 EP Procedure Comprehensive EP evaluation & ablate supraventricular arrhythmia 5213 $15,561 Level 3 EP Procedure Atrial fibrillation with EP study 5213 $15,561 Level 3 EP Procedure *Source: FY16 Medicare outpatient rates based upon Final Rule release. https://www.cms.gov/medicare/medicare-fee-for-service-payment/ HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1633-P.html Peer-Reviewed Evidence Clinical evidence in support of surgical cardiac ablation and left atrial appendage surgical exclusion, includes, but is not limited to the following peer-reviewed publications. Citations are available upon request. Cardiac surgical ablation with/without concomitant cardiac surgery (CABG, MVR, AVR) Ad et al. Surgical ablation of atrial fibrillation trends and outcomes in North America. J Thorac Cardiovasc Surg. (2012) 144(5):1051-60. Albåge et al. Long-Term Follow-Up of Cardiac Rhythm in 320 Patients After the Cox-Maze III Procedure for Atrial Fibrillation. Ann Thorac Surg. (2015) EPUB ahead of print. Calkins et al. HRS/EHRA/ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. (2007) 4(6):816-61. Geuzebroek et al. Totally thoracoscopic left atrial Maze: standardized, effective and safe. Interact Cardiovasc Thorac Surg. (2015) - EPUB ahead of print. Gillinov et al. Surgical ablation of atrial fibrillation during mitral-valve surgery. N Engl J Med. (2015) 372(15):1399-409. Philpott et al. The ABLATE Trial: Safety and Efficacy of Cox Maze-IV Using a Bipolar Radiofrequency Ablation System. Ann Thorac Surg. (2015) 100(5):1541-8 Concomitant cardiac surgery with either (CABG, MVR, AVR) and surgical left atrial appendage management Aryana et al. Association between incomplete surgical ligation of left atrial appendage and stroke and systemic embolization. Heart Rhythm. (2015) 12(7):1431-7 García-Fernández et al. Role of left atrial appendage obliteration in stroke reduction in patients with mitral valve prosthesis. JACC (2003) 42(7):1253-8. Onalan et al. Left atrial appendage exclusion for stroke prevention in patients with nonrheumatic atrial fibrillation. Stroke. (2007) 38(2 Suppl):624-30 Tsai et al. Surgical left atrial appendage occlusion during cardiac surgery for patients with atrial fibrillation: a meta-analysis. Eur J Cardiothorac Surg. (2015) 47(5):847-54 For further information please call AtriCure s Reimbursement Help Line @ 888-347-6403, extension 5338. ATRICURE, INC. 6217 Centre Park Drive West Chester, Ohio 45069 Customer Service: 1-866-349-2342 customerservice@atricure.com www.atricure.com ATRICURE EUROPE B.V. Schiphol Boulevard 127 1118 BG Schiphol The Netherlands Tel: +31 (0) 20-7005560 Fax: +31 (0) 20-7005561 customerserviceeurope@atricure.com MKT-1998A-G