2016 HOSPITAL CODING Reference Guide for Cardiac Rhythm and Heart Failure (CRHF)
CONTENTS New in 2016... 3 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
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) 877-4102. Cardiac Rhythm and Heart Failure reimbursement customer information is available at www.medtronic.com/crdmreimbursement. 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. 2016 1 of 27
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, 2015. 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 2016. 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, 2015. 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 27 2016
NEW IN 2016 New in 2016 Hospital Coding and Reimbursement I. C-APC and APC reassignments effective January 1, 2016 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 5193 0319 0388T Transcath removal of perm. leadless pacer, ventricular 5182 0622 0389T 0391T Programming device eval. (in person), leadless pacemaker system Interrogation device eval. (in person), leadless pacemaker system 33206 Insert new/replace perm. pacer, w/transvenous lead; atrial 5223 0089 33207 Insert new/replace perm. pacer, w/transvenous lead; ventricle 33208 Insert new/replace perm. pacer, w/transvenous lead; atrial and ventricular 5223 0089 5223 0089 33210 Insert/replace temporary transvenous single chamber lead 5222 0090 33211 Insert/replace temporary transvenous dual chamber lead 5222 0090 33212 Insert pacer generator only; w/existing single lead 5222 0090 33213 Insert pacer generator only; w/existing dual leads 5223 0089 33214 Upgrade pacer system, convert single chamber to dual chamber 33215 Reposition previously implanted transvenous pacer or defibrillator lead 5223 0089 5181 0103 33216 Insert single transvenous pacer or defibrillator lead 5222 0090 33217 Insert 2 transvenous pacer or defibrillator leads 5222 0090 33218 Repair single transvenous pacer or defibrillator lead 5221 0105 33220 Repair 2 transvenous pacer or defibrillator leads 5221 0105 33221 Insert pacer generator only; w/existing multiple leads 5224 0655 33222 Relocate skin pocket for pacer 5054 0328 33223 relocate skin pocket for defibrillator 5054 0328 33224 Insert pacing lead, cardiac venous system, for left ventricular pacing, attach to previously placed pacer/defibrillator 33226 Reposition previously implanted cardiac venous system (left ventricular) lead 5223 0089 5182 0103 33227 Remove/replace pacer generator; single lead system 5222 0090 33228 Remove/replace pacer generator; multiple lead system 5223 0089 33229 Remove/replace pacer generator; multiple lead system 5224 0655 33230 Insert defibrillator generator only; w/existing dual leads 5231 0107 33231 Insert defibrillator generator only; w/existing multiple leads 5232 0108 33233 Remove pacer generator only 5222 0090 33234 Remove transvenous pacer lead; single lead system 5221 0105 33235 Remove transvenous pacer leads; dual lead system 5221 0105 33240 Insert defibrillator generator only; w/existing single lead 5231 0107 33241 Remove defibrillator generator only 5221 0105 2015 C-APC or APC Assignment 2016 3 of 27
New in 2016, continued CPT or Category III Codes Abbreviated 2016 CPT or Category III Description 33244 Remove single or dual chamber defibrillator leads; transvenously 33249 Insert new/replace perm. defibrillator system, w/ transvenous lead(s); single or dual chamber 2016 C-APC or APC Assignment 5221 0105 5232 0108 33262 Remove/replace defibrillator generator; single lead system 5231 0107 33263 Remove/replace defibrillator generator; dual lead system 5231 0107 33264 Remove/replace defibrillator generator; multiple lead system 33270 Insert new/replace perm. subcutaneous (subq.) defibrillator system, w/subq. lead 5232 0108 5232 0108 33271 Insert subq. defibrillator lead 5222 0090 33272 Remove subq. defibrillator lead 5221 0105 33273 Reposition previously implanted subq. defibrillator lead 5221 0105 33282 Implant cardiac-event recorder 5222 0090 33284 Remove cardiac-event recorder 5073 0020 92960 Cardioversion, electrical conversion of arrhythmia; external 5781 0094 92961 Cardioversion, electrical conversion of arrhythmia; internal 5781 0094 93229 External mobile cardiovascular telemetry 5722 0213 93260 Programming device eval. (in person), subq. lead defibrillator system 93261 Interrogation device eval. (in person), subq. lead defibrillator system 93279 Programming device eval. (in person); single lead pacer system 93280 Programming device eval. (in person); dual lead pacer system 93281 Programming device eval. (in person); multiple lead pacer system 93282 Programming device eval. (in person); single lead transvenous defibrillator system 93283 Programming device eval. (in person); dual lead transvenous defibrillator system 93284 Programming device eval. (in person); multiple lead transvenous defibrillator system 93285 Programming device eval. (in person); implantable loop recorder system 93288 Interrogation device eval. (in person); single, dual or multiple pacer system 93289 Interrogation device eval. (in person); single, dual, or multiple lead defibrillator system 93290 Interrogation device eval. (in person); implantable cardiovascular monitor system 93291 Interrogation device eval. (in person); implantable loop recorder system 93292 Interrogation device eval. (in person); wearable defibrillator system 93293 Transtelephonic rhythm strip eval(s) single, dual, or multiple lead pacer system, up to 90 days 93296 Interrogation device eval(s) (remote), up to 90 days; single, dual, or multiple lead pacer or defibrillator system 5732 0450 2015 C-APC or APC Assignment 4 of 27 2016
New in 2016, continued CPT or Category III Codes Abbreviated 2016 CPT or Category III Description 93299 Interrogation device eval(s) (remote), up to 30 days; implantable cardiovascular monitor system or implantable loop recorder system 2016 C-APC or APC Assignment 93303 Transthoracic echo for congenital anomalies; complete 5534 0270 93304 Echo for congenital anomalies; follow-up or limited study 5533 0269 93306 Echo, complete, w/spectral Doppler and color flow Doppler 5533 0269 93307 Echo, complete, w/out spectral Doppler and color flow Doppler 5533 0269 93308 Echo; follow-up or limited study 5532 0267 93600 Bundle of His recording 5212 0085 93602 Intra-atrial recording 5212 0085 93603 Right ventricular recording 5211 0084 93610 Intra-atrial pacing 5212 0085 93612 Intraventricular pacing 5212 0085 93615 Esophageal recording of atrial electrogram 5211 0084 93616 Esophageal recording of atrial electrogram; with pacing 5211 0084 93618 Introduction of arrhythmia by electrical pacing 5211 0084 93619 Comprehensive electrophysiologic eval. w/o induction or attempted induction of arrhythmia 93620 Comprehensive electrophysiologic eval. w/induction or attempted induction of arrhythmia 93624 Electrophysiologic follow-up study w/pacing and recording to test effectiveness of therapy 93642 Electrophysiologic eval. of single or dual chamber transvenous pacing defibrillator 5212 0085 5212 0085 5212 0085 5211 0084 93650 Catheter ablation of atrioventricular node function 5212 0085 93653 Catheter ablation with treatment of supraventricular tachycardia (SVT) 93654 Catheter ablation with treatment of ventricular tachycardia (VT) 93656 Catheter ablation of atrial fibrillation by pulmonary vein isolation (PVI) 5213 0086 5213 0086 5213 0086 93660 Eval. of cardiovascular function with tilt table evaluation 5723 0096 93724 Electronic analysis of antitachycardia pacer system 5743 0691 93745 Initial set-up and programming of wearable defibrillator 5743 0691 2015 C-APC or APC Assignment New in 2016 Cardiac Rhythm and Heart Failure (CRHF) reimbursement customer information is available at www.medtronic.com/crdmreimbursement. Current Procedural Terminology (CPT) is copyright 2015 American Medical Association. 2016 5 of 27
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PACEMAKER PROCEDURES HOSPITAL INPATIENT: Pacemaker and Cardiac Resynchronization Pacemaker ICD-10-PCS (Procedure Coding System) Options are available at this web site address: http://www.medtronic.com/wcm/groups/mdtcom_sg/@mdt/@crdm/documents/documents/icd- 10-pm-proc-code-10-7-15.pdf Possible DRG Assignments (MS-DRG: Medicare Severity Diagnosis Related Group) MS-DRG 242 243 244 260 261 262 258 259 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 33206 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial 33207 ventricular 33208 atrial and ventricular 33212 Insertion of pacemaker pulse generator only; with existing single lead 33213 with existing dual leads 33221 with existing multiple leads 33214 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) 33216 Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator 33217 Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator 33224 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) +33225 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 33210 Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter (separate procedure) 33211 Insertion or replacement of temporary transvenous dual chamber pacing electrodes (separate procedure) Removal and Replacement 33227 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system 33228 dual lead system 33229 multiple lead system Removal 33233 Removal of permanent pacemaker pulse generator only 33234 Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular 33235 dual lead system 0388T Transcatheter removal of permanent leadless pacemaker, ventricular 2016 7 of 27
Pacemaker, continued Repositioning, Repair, Relocation 33215 Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode 33218 Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator 33220 Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator 33222 Relocation of skin pocket for pacemaker 33226 Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator) Echocardiography 93303 Transthoracic echocardiography for congenital cardiac anomalies; complete 93304 follow-up or limited study 93306 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 93307 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography 93308 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study +93320 Doppler echocardiography, pulsed wave and/or continuous wave with spectral display; complete (List separately in addition to codes for echocardiographic imaging) (Use 93320 in conjunction with 93303, 93304, 93312, 93314, 93315, 93317, 93350, 93351) 2 +93321 follow-up or limited study (List separately in addition to codes for echocardiographic imaging) (Use 93321 in conjunction with 93303, 93304, 93308, 93312, 93314, 93315, 93317, 93350, 93351) 2 +93325 Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography) (Use 93325 in conjunction with 76825, 76826, 76827, 76828, 93303, 93304, 93308, 93312, 93314, 93315, 93317, 93350, 93351) 2 Cardiac Device Analysis, Interrogation, and Programming Evaluation 93724 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 93279 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 93280 dual lead pacemaker system 93281 multiple lead pacemaker system 93288 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 93290 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 93293 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 93296 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 93299 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 93299 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 27 2016
Pacemaker, continued Peri-Procedural 93286 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, 100-03) 20.8.1 Cardiac Pacemaker Evaluation Services (Rev. 173, Issued: 09-04-14) CIM 50-1. 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 33222 Relocation of skin pocket for pacemaker 5054 Level 4 Skin 33215 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 33226 Reposition previously implanted left ventricular electrode 0387T Transcatheter insertion or replacement of permanent leadless pacemaker, ventricular 33218 Repair of single transvenous electrode, pacemaker or implantable defibrillator 33220 Repair of 2 transvenous electrodes, pacemaker or implantable defibrillator 33234 Remove transvenous pacemaker electrode; single lead system 33235 Remove transvenous pacemaker electrode(s); dual lead system 33210 Insert/replace temporary transvenous single chamber cardiac electrode 5193 Level 3 Endovascular 5221 Level 1 Pacemaker and Similar 5222 Level 2 Pacemaker and Similar 33211 Insert/replace temporary transvenous dual chamber pacing electrodes 33212 Insert pacemaker pulse generator only; with existing single lead 33216 Insert single transvenous electrode, pacemaker or implantable defibrillator 33217 Insert 2 transvenous electrodes, pacemaker or implantable defibrillator 33227 Remove and replace pacemaker generator; single lead system 33233 Remove pacemaker pulse generator only 2016 9 of 27
Pacemaker, continued CPT Codes Abbreviated 2016 CPT Descriptions C-APC or APC Group C-APC/APC Description 33206 Insert new or replacement pacemaker with transvenous electrode; atrial 33207 Insert new or replacement pacemaker with transvenous electrode; ventricular 33208 Insert new or replacement pacemaker with transvenous electrodes; atrial and ventricular 5223 Level 3 Pacemaker and Similar 33213 Insert pacemaker pulse generator only; with existing dual leads 33214 Upgrade pacemaker system, conversion of single chamber to dual chamber system 33224 Insert LV lead, with attachment to previously placed pacemaker or implantable defibrillator generator 33228 Remove and replace pacemaker generator; dual lead system 33221 Insert pacemaker pulse generator only; with existing multiple leads 33229 Remove and replace pacemaker generator; multiple lead system 5224 Level 4 Pacemaker and Similar 93308 Transthoracic echo, follow-up or limited study 5532 Level 2 Ultrasound and Related Services 93304 Transthoracic echo for congenital cardiac anomalies; follow-up or limited study 93306 Transthoracic echo, complete, with spectral and color flow Doppler 93307 Transthoracic echo, complete, without spectral and color flow Doppler 93303 Transthoracic echo for congenital cardiac anomalies; complete 93229 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 93279 Programming device evaluation (in person), single lead pacemaker system 93280 Programming device evaluation (in person), dual lead pacemaker system 93281 Programming device evaluation (in person), multiple lead pacemaker system 93288 Interrogation device evaluation (in person); single, dual, or multiple lead pacemaker system 93290 Interrogation device evaluation (in person); implantable cardiovascular monitor (ICM) system 93293 Transtelephonic rhythm strip evaluation(s) single, dual, or multiple lead pacemaker system, up to 90 days 93296 Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker or implantable defibrillator system 93299 Interrogation device evaluation(s) (remote), up to 30 days; ICM or ILR 93724 Electronic analysis of antitachycardia pacemaker system 5743 Level 2 Electronic Analysis of Devices 10 of 27 2016
Pacemaker, continued CPT Codes Abbreviated 2016 CPT Descriptions C-APC or APC Group C-APC/APC Description +33225 Insert LV lead, at time of insertion of pacemaker or implantable defibrillator generator 93286 Peri-procedural device evaluation, pacemaker system 0390T Peri-procedural device evaluation, leadless pacemaker system +93320 Doppler echo, complete +93321 Doppler echo, follow-up or limited study +93325 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" 33202 Insertion of epicardial electrode(s); open incision (e.g., thoracotomy, median sternotomy, subxiphoid approach) Pacemaker 33203 Insertion of epicardial electrode(s); endoscopic approach (e.g., thoracoscopy, pericardioscopy) 33236 Removal of permanent epicardial pacemaker and electrodes by thoracotomy; single lead system, atrial or ventricular 33237 Removal of permanent epicardial pacemaker and electrodes by thoracotomy; dual lead system 33238 Removal of permanent transvenous electrode(s) by thoracotomy * The Addendum E file includes the codes that are paid only as Inpatient procedures in CY 2016. Log on to: https://www.cms.gov/medicare/medicare-fee-for-service-payment/hospitaloutpatientpps/hospital-outpatient- Regulations-and-Notices.html, then access, CMS-1633-FC; CMS-1607-F2, click on CY 2016 OPPS Final Rule Addenda and open Addendum E. 2016 11 of 27
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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: http://www.medtronic.com/wcm/groups/mdtcom_sg/@mdt/@crdm/documents/ documents/icd-10-icd-proc-code-10-7-15.pdf Possible DRG Assignments (MS-DRG: Medicare Severity Diagnosis Related Group) MS-DRG 222 223 224 225 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 226 227 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 33216 Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator 33217 Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator 33224 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) +33225 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) 33230 Insertion of pacing cardioverter-defibrillator pulse generator only; with existing dual leads 33231 with existing multiple leads 33240 with existing single lead 33249 Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber 33270 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 33271 Insertion of subcutaneous implantable defibrillator electrode Insertion or Replacement of Temporary Pacemaker (May be applicable to Implantable Defibrillator, verify with payers as deemed appropriate) 33210 Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter (separate procedure) 33211 Insertion or replacement of temporary transvenous dual chamber pacing electrodes (separate procedure) Removal and Replacement 33262 Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system 33263 dual lead system 33264 multiple lead system 2016 13 of 27
Implantable Defibrillator, continued Removal 33241 Removal of implantable defibrillator pulse generator only 33244 Removal of single or dual chamber implantable defibrillator electrode(s); by transvenous extraction 33272 Removal of subcutaneous implantable defibrillator electrode Repositioning, Repair, Relocation 33215 Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode 33218 Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator 33220 Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator 33223 Relocation of skin pocket for implantable defibrillator 33226 Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator) 33273 Repositioning of previously implanted subcutaneous implantable defibrillator electrode Intra-operative Device Testing 93640 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; 93641 with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator Follow-Up Device Testing 93642 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) 93644 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 93303 Transthoracic echocardiography for congenital cardiac anomalies; complete 93304 follow-up or limited study 93306 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 93307 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography 93308 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study +93320 Doppler echocardiography, pulsed wave and/or continuous wave with spectral display; complete (List separately in addition to codes for echocardiographic imaging) (Use 93320 in conjunction with 93303, 93304, 93312, 93314, 93315, 93317, 93350, 93351) 2 +93321 follow-up or limited study (List separately in addition to codes for echocardiographic imaging) (Use 93321 in conjunction with 93303, 93304, 93308, 93312, 93314, 93315, 93317, 93350, 93351) 2 +93325 Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography) (Use 93325 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 93260 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 93261 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 93282 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 93283 dual lead transvenous implantable defibrillator system 93284 multiple lead transvenous implantable defibrillator system 14 of 27 2016
Implantable Defibrillator, continued 93289 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 93296 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 93229 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 93292 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 93745 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 93287 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 93290 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 93299 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 33223 Relocation of skin pocket for implantable defibrillator 5054 Level 4 Skin 33215 Reposition previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) 33226 Reposition previously implanted left ventricular electrode 5181 Level 1 Vascular 5182 Level 2 Vascular 93642 Electrophysiologic evaluation of single/dual chamber implantable defibrillator (not at initial implant or replacement) 5211 Level 1 Electrophysiologic 2016 15 of 27
Implantable Defibrillator, continued CPT Codes Abbreviated 2016 CPT Descriptions 33218 Repair of single transvenous electrode, pacemaker or implantable defibrillator 33220 Repair of 2 transvenous electrodes, pacemaker or implantable defibrillator 33241 Remove implantable defibrillator pulse generator only 33244 Remove single or dual chamber implantable defibrillator electrode(s), transvenous extraction 33272 Remove subcutaneous implantable defibrillator electrode 33273 Reposition previously implanted subcutaneous implantable defibrillator electrode 33210 Insert/replace temporary transvenous single chamber cardiac electrode 33211 Insert/replace temporary transvenous dual chamber pacing electrodes 33216 Insert single transvenous electrode, pacemaker or implantable defibrillator 33217 Insert 2 transvenous electrodes, pacemaker or implantable defibrillator 33271 Insert subcutaneous implantable defibrillator electrode 33224 Insert LV lead, with attachment to previously placed pacemaker or implantable defibrillator generator 33230 Insert implantable defibrillator generator only; with existing dual leads 33240 Insert implantable defibrillator generator only; with existing single lead 33262 Remove and replace implantable defibrillator generator; single lead system 33263 Remove and replace implantable defibrillator generator; dual lead system 33231 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 33249 Insert or replace implantable defibrillator system, with transvenous lead(s), single or dual chamber 33264 Remove and replace implantable defibrillator generator; multiple lead system 33270 Insert or replace subcutaneous implantable defibrillator system 93308 Transthoracic echo, follow-up or limited study 5532 Level 2 Ultrasound and Related Services 93304 Transthoracic echo for congenital cardiac anomalies; follow-up or limited study 5533 Level 3 Ultrasound and Related Services 93306 Transthoracic echo, complete, with spectral and color flow Doppler 93307 Transthoracic echo, complete, without spectral and color flow Doppler 93303 Transthoracic echo for congenital cardiac anomalies; complete 93229 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 27 2016
Implantable Defibrillator, continued CPT Codes Abbreviated 2016 CPT Descriptions 93260 Programming device evaluation (in person), implantable subcutaneous lead defibrillator system 93261 Interrogation device evaluation (in person), implantable subcutaneous lead defibrillator system 93282 Programming device evaluation (in person), single lead transvenous implantable defibrillator system 93283 Programming device evaluation (in person), dual lead transvenous implantable defibrillator system 93284 Programming device evaluation (in person), multiple lead transvenous implantable defibrillator system 93289 Interrogation device evaluation (in person); single, dual, or multiple lead transvenous implantable defibrillator system 93290 Interrogation device evaluation (in person); implantable cardiovascular monitor (ICM) system 93292 Interrogation device evaluation (in person); wearable defibrillator system 93296 Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker or implantable defibrillator system 93299 Interrogation device evaluation(s) (remote), up to 30 days; ICM or ILR 93724 Electronic analysis of antitachycardia pacemaker system 93745 Initial set-up and programming of wearable defibrillator +33225 Insert LV lead, at time of insertion of pacemaker or implantable defibrillator generator 93287 Peri-procedural device evaluation, implantable defibrillator system +93320 Doppler echo, complete +93321 Doppler echo, follow-up or limited study +93325 Doppler echo color flow velocity mapping 93640 Electrophysiologic evaluation of single/dual chamber implantable defibrillator leads at time of initial implant or replacement 93641 Electrophysiologic evaluation of single/dual chamber implantable defibrillator leads and generator at time of initial implant or replacement 93644 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 33202 Insertion of epicardial electrode(s); open incision (e.g., thoracotomy, median sternotomy, subxiphoid approach) 33203 Insertion of epicardial electrode(s); endoscopic approach (e.g., thoracoscopy,pericardioscopy) 33243 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: http://www.cms.gov/medicare/medicare-fee-for-service-payment/hospitaloutpatientpps/hospital-outpatient- Regulations-and-Notices.html; Click on CY2015 OPPS Addenda and then access for Addendum E. 2016 17 of 27
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ELECTROPHYSIOLOGY PROCEDURES HOSPITAL INPATIENT: Electrophysiology ICD-10-PCS (Procedure Coding System) Options are available at this web site address:http://www. medtronic.com/wcm/groups/mdtcom_sg/@mdt/@crdm/documents/documents/icd-10-ep-ablation-cod-10-7-15.pdf Possible DRG Assignments (MS-DRG: Medicare Severity Diagnosis Related Group) MS-DRG 228 229 230 273 274 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 93600 Bundle of His recording 93602 Intra-atrial recording 93603 Right ventricular recording +93609 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) 93610 Intra-atrial pacing 93612 Intraventricular pacing +93613 Intracardiac electrophysiologic 3-dimensional mapping (List separately in addition to code for primary procedure) 93615 Esophageal recording of atrial electrogram with or without ventricular electrogram(s); 93616 with pacing 93618 Induction of arrhythmia by electrical pacing Electrophysiologic Evaluations 93619 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 93620 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 +93621 with left atrial pacing and recording from coronary sinus or left atrium (List separately in addition to code for primary procedure) +93622 with left ventricular pacing and recording (List separately in addition to code for primary procedure) Pharmacologic Assessment during EPS +93623 Programmed stimulation and pacing after intravenous drug infusion (List separately in addition to code for primary procedure) EP Follow-Up Study 93624 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 93631 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 93640 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; 93641 with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator Electrophysiology 2016 19 of 27
Electrophysiology, continued Follow-Up Device Testing 93642 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) 93644 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 +93662 Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (List separately in addition to code for primary procedure) External and Internal Cardioversion 92960 Cardioversion, elective, electrical conversion of arrhythmia; external 92961 internal (separate procedure) Catheter Ablation 93650 Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement 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), 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 93654 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 +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 (List separately in addition to code for primary procedure) 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 (List separately in addition to code for primary procedure) Transseptal Puncture +93462 Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure) (Use 93462 in conjunction with 93452, 93453, 93458-93461, 93582, 93653, 93654) Tilt Table Testing 93660 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 93724 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 27 2016