• Have any questions?
  • info.zbook.org@gmail.com

FREQUENTLY ASKED QUESTIONS IMPLANT & MONITORING

2m ago
58 Views
0 Downloads
888.27 KB
31 Pages
Last View : Today
Last Download : n/a
Upload by : Melina Bettis
Share:
Transcription

FREQUENTLY ASKEDQUESTIONSIMPLANT &MONITORINGCore Devices:Pacemakers (PM)Implantable Cardioverter-Defibrillators (ICD)Cardiac Resynchronization Therapy (CRT)SEPTEMBER 2016

INTRODUCTIONAn implantable Pacemaker (PM) helps control abnormal heart rhythms, such as a slow heart rate. An implantablecardioverter-defibrillator (ICD) is implanted to treat tachyarrhythmias. A CRT device synchronizes the rhythm of the rightand left ventricles.This guide is intended to answer frequently asked questions regarding coding, coverage and payment for PMs,ICDs, and CRT devices and related procedures/services. This document is to be used as a guideline only.TABLE OF CONTENTSIMPLANT/EXPLANTCore Devices (Q1.IC- Q20.IC)Modifiers (Q20.IC)PAGES4-1111Pacemakers (Q21.IP- Q27.IP)Micra Transcatheter Pacing System (Q25.IP- Q27.IP)12-1313Implantable Cardioverter-Defibrillators (Q28.II- Q31.II)14TYRX Antibacterial Envelopes (Q31.IP- Q33.IP)15MONITORINGCore Devices (Q1.M- Q12.M)17-2190 Day Monitoring Period (Q7.M- Q12.M)20-21Heart Failure (Q13.M- Q13.M)21-22All Devices (Q17.M- Q23.M)Supervision (Q17.M- Q19.M)23-2423Professional and Technical Components (Q20.M- Q23.M)24Connected Care (Q24.M- Q27.M)25References26-27These coding suggestions do not replace seeking coding advice from the payer and/or your own coding staff. The ultimateresponsibility for correct coding lies with the provider of services. Please contact your local payer for interpretation ofthe appropriate codes to use for specific procedures. Medtronic makes no guarantee that the use of this information willprevent differences of opinion or disputes with Medicare or other third party payers as to the correct form of billing or theamount that will be paid to providers of service.For comprehensive coding references and recorded WebEx sessions, please visit the following websites:Medtronic Reimbursement website: www.Medtronic.com/crdmreimbursementMedtronic Academy: www.medtronicacademy.comCPT copyright 2015 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARSRestrictions 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 datacontained or not contained herein.September 2016 I References listed on page 26-272/31

Core DevicesPacemakers (PM)Implantable Cardioverter-Defibrillators (ICD)Cardiac Synchronization Therapy (CRT) devicesFREQUENTLY ASKEDQUESTIONSIMPLANT/EXPLANTSeptember 2016 I References listed on page 26-273/31

IMPLANT/EXPLANTCORE DEVICESQ1.IC: What is the correct CPT code to use for a system (generator and applicable lead(s)) transvenous implant of animplantable pacemaker (PM) or defibrillator (ICD)?A1.IC: The codes are listed in the table below.Insertion of Pacemaker or Implantable Defibrillator System1CPT CODEDESCRIPTION33206Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial33207Insertion of new or replacement of permanent pacemaker with transvenous electrode(s);ventricular33208Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrialand ventricular33249Insertion or replacement of permanent implantable defibrillator system, with transvenouslead(s), single or dual chamberQ2.IC: What is the correct CPT code to use for the insertion of an implantable pacemaker (PM) or defibrillator (ICD)generator when the patient has existing lead(s)?A2.IC: The codes are listed in the table below.Insertion of Pacemaker (Generator Only)1CPT CODEDESCRIPTION33212Insertion of pacemaker pulse generator only; with existing single lead33213Insertion of pacemaker pulse generator only; with existing dual leads33221Insertion of pacemaker pulse generator only; with existing multiple leadsInsertion of Implantable Defibrillator (Generator Only)1CPT CODEDESCRIPTION33240Insertion of defibrillator pulse generator only; with existing single lead33230Insertion of defibrillator pulse generator only; with existing dual leads33231Insertion of defibrillator pulse generator only; with existing multiple leadsSeptember 2016 I References listed on page 26-274/31

IMPLANT/EXPLANTCORE DEVICES continuedQ3.IC: How are implantable pacemaker (PM), or implantable defibrillator (ICD) generator replacements coded?A3.IC: Implantable PM and ICD generator replacements are coded using the PM or ICD remove and replace codes. Thecodes are used when the same type (PM or ICD) generator is removed and replaced with the same type generator; thenumber of chambers in the removed device has no impact on the code choice. The code is selected based on the numberof active leads attached to the new generator, including an existing or newly placed left ventricular (LV) lead.1Generator Remove and Replace Codes for Pacemakers1CPT CODEDESCRIPTION33227Removal of permanent pacemaker pulse generator with replacement of pacemaker pulsegenerator; single lead system33228Removal of permanent pacemaker pulse generator with replacement of pacemaker pulsegenerator; dual lead system33229Removal of permanent pacemaker pulse generator with replacement of pacemaker pulsegenerator; multiple lead systemGenerator Remove and Replace Codes for Implantable Defibrillators1CPT CODEDESCRIPTION33262Removal of implantable defibrillator pulse generator with replacement of implantabledefibrillator pulse generator; single lead system33263Removal of implantable defibrillator pulse generator with replacement of implantabledefibrillator pulse generator; dual lead system33264Removal of implantable defibrillator pulse generator with replacement of implantabledefibrillator pulse generator; multiple lead systemSeptember 2016 I References listed on page 26-275/31

IMPLANT/EXPLANTCORE DEVICES continuedQ4.IC: When are the codes used that describe removal of a generator only, and placement of a generator only, for bothimplantable pacemakers (PM) and defibrillators (ICD)?A4.IC: There are instances when the patient’s condition, such as an infected pocket may warrant removing only thegenerator. Another example is when a generator is changed from one type to another type, such as when an ICD systemis downgraded to a PM system.Example: The physician removes the ICD generator and inserts a new dual chamber PM generator. Thedefibrillator lead is deactivated and the right atrial (RA) and right ventricular (RV) pacing leads are connected tothe newly implanted PM generator.The table below lists the CPT codes which are appropriate to use when removing an implantable defibrillator (ICD)generator and inserting a dual chamber pacemaker (PM) generator.1Example: Removal of ICD Generator and Insertion of PM generator1CPT CODEDESCRIPTION33241Removal of implantable defibrillator pulse generator only33213Insertion of pacemaker pulse generator only; with existing dual leadsQ5.IC: What are the correct CPT codes to use when removing an implantable pacemaker (PM) or defibrillator (ICD)generator and then inserting a new generator and a right ventricular (RV) or right atrial (RA) lead. The physician did notremove any leads.Example: An ICD generator is removed, a replacement dual chamber ICD generator is inserted and the physicianconnects a new RV defibrillator lead to the replacement generator.A5.IC: The table below lists the CPT codes when removing an ICD generator, inserting a new RV defibrillator lead and areplacement dual chamber (ICD) generator. 1Example: Removal and Replacement of ICD Generator and Insertion of RV Lead1CPT CODEDESCRIPTION33241Removal of implantable defibrillator pulse generator only33249Insertion or replacement of permanent implantable defibrillator system with transvenouslead(s), single or dual chamberSeptember 2016 I References listed on page 26-276/31

IMPLANT/EXPLANTCORE DEVICES continuedQ6.IC: What are the CPT codes for the removal of a right atrial (RA) or right ventricular (RV) lead and the insertion of anew RA or RV lead into the existing implantable pacemaker (PM) or defibrillator (ICD)?A6.IC: The table below lists the CPT codes when removing a RA or RV lead and then inserting a new RA or RV lead into anexisting PM or ICD.1Removal and Replacement of a RA or RV Lead1CPT CODEDESCRIPTIONPacemaker Removal RA or RV Lead Code Options33234Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular33235Removal of transvenous pacemaker electrode(s); dual lead systemICD Removal RA or RV Lead Code33244Removal of single or dual chamber implantable defibrillator electrode(s); by transvenousextractionRA or RV Lead Replacement Code33216Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillatorQ7.IC: What is the appropriate CPT code to use when a lead is capped and not removed?A7.IC: There is no existing code for capping a lead. It is packaged into the procedure.1Q8.IC: What CPT code is added for the insertion of a left ventricular (LV) lead when implanting a bi-ventricularpacemaker (PM) or defibrillator (ICD) system, or upgrading a dual chamber PM or ICD system to a bi-ventricular PM or ICDsystem?A8.IC: The correct code is the add-on CPT code 33225: Insertion of pacing electrode, cardiac venous system, for leftventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator. This add-on code shouldbe listed separately in addition to the code for the primary procedure.1Q9.IC: What CPT code should be considered when the physician inserts the pacing electrode into the cardiac venoussystem for left ventricular pacing (LV lead) and then attaches this lead to an existing defibrillator (ICD) or pacemaker (PM)generator?Example: The patient was scheduled for a bi-ventricular ICD (CRT-D) implant about four months ago, and due tocomplications the physician was unable to place the LV lead. The patient now returns to have the LV lead placed.How is this coded?A9.IC: Use CPT code 33224: Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, withattachment to previously placed pacemaker or implantable defibrillator pulse generator (includes revision of pocket,removal, insertion, and/or replacement of existing generator).1September 2016 I References listed on page 26-277/31

IMPLANT/EXPLANTCORE DEVICES continuedQ10.IC: The physician attempts to place a left ventricular (LV) lead during an implant for a bi-ventricular pacemaker (PM)or defibrillator (ICD), and is unsuccessful. Should the physician or hospital bill for the attempted LV lead placement? Howshould this be coded?A10.IC: Yes, the service may be billed, provided there is documentation in the record that supports the efforts to implantthe LV lead and the decision to discontinue the procedure.For an outpatient procedure; The hospital would bill using modifier 74 (discontinued procedure after administration of anesthesia).1 The physician would bill using modifier 53 (discontinued service).1Q11.IC: The implanting physician wants to know if Medicare will reimburse for removing and replacing a pacemaker ordefibrillator generator because it “is at ERI”.A11.IC: There are two different terms that are used quite frequently:ERI: Elective Replacement IndicatorEOS: End Of ServiceMedicare will reimburse the procedure based on physician-documented medical necessity.2Q12IC: What CPT codes may be applicable when inserting or removing pacemaker (PM) or defibrillator (ICD) leads whenthe procedure is not performed transvenously?A12.IC: The table below lists the CPT codes for inserting or removing PM or ICD leads when the procedure is notperformed transvenously. These codes are defined by Medicare (CMS) as “inpatient only” procedures, and thereforecannot be reported on a hospital outpatient claim.1,3Insertion or Removal of PM or ICD Leads When Procedure is NOT Performed Transvenously1,3CPT CODEDESCRIPTION33202Insertion of epicardial electrode(s); open incision (e.g., thoracotomy, median sternotomy,subxiphoid approach33203Insertion of epicardial electrode(s); endoscopic approach (e.g., thoracoscopy, pericardioscopy)33236Removal of permanent epicardial pacemaker and electrodes by thoracotomy; single leadsystem, atrial or ventricular33237Removal of permanent epicardial pacemaker and electrodes by thoracotomy; dual lead system33238Removal of permanent transvenous electrode(s) by thoracotomy33243Removal of single or dual chamber implantable defibrillator electrode(s); by thoracotomyQ13.IC: What CPT code should be reported when a lead is repositioned?A13.IC: Consider reporting 33215: Repositioning of previously implanted transvenous pacemaker (PM) or implantabledefibrillator (ICD), (right atrial or right ventricular) electrode.1September 2016 I References listed on page 26-278/31

IMPLANT/EXPLANTCORE DEVICES continuedQ14.IC The description for CPT codes 33222 (PM) and 33223 (ICD) were revised from “skin pocket revision” to “skinpocket relocation”. What is the appropriate use of these codes?A14.IC: The following example and table below lists the appropriate CPT codes for this patient scenario.1Example: A patient with an infection required that the existing dual chamber ICD generator be removed.This procedure was performed over three months ago, the infection was properly treated, and thispast week the physician performed a skin pocket relocation and implanted the replacement generator.What procedure codes should be reported for this skin pocket relocation and the replacement dualchamber ICD generator insertion?Example: CPT Coding for ICD Generator Only Insertion and Skin Pocket Relocation1CPT CODEDESCRIPTION33230Insertion of pacing cardioverter-defibrillator pulse generator only; with existing dual leads33223Relocation of skin pocket for implantable defibrillatorQ15.IC: Since the descriptions for CPT code 33222 (Relocation of skin pocket for pacemaker (PM)) and 33223 fordefibrillator (ICD) were revised from “skin pocket revision” to “skin pocket relocation”, what codes should be used for care,such as debridement, related to an infected pocket?A15.IC: It is suggested that the provider consider the codes in the Integumentary System (skin) section of the CPT codebook.1Q16.IC:The hospital added a new device to their inventory and the supply chain manager has requested the HCPCS codefor the device. What is a HCPCS code and why is it needed?A16.IC: A HCPCS (Healthcare Common Procedure Coding System) is a code that identifies the device. HCPCS codes inthe cardiac device service line begin with the letter “C”. Most manufacturers refer to these HCPCS codes as “C-Codes”.For outpatient hospital procedures that are classified by Medicare as “device-intensive”, the hospital must include oneapplicable HCPCS when submitting their outpatient claim. A Physician practice should not report this type of a HCPCScode.4Q17.IC: For hospital inpatient procedure coding under ICD-10, is it necessary that the leads and generator are codedseparately?A17.IC: Yes. ICD-10 procedure codes (PCS) utilize specific rules to build codes including the components of a device.For more detail see our ICD-10 PCS coding documents.5September 2016 I References listed on page 26-279/31

IMPLANT/EXPLANTCORE DEVICES continuedQ18.IC: What is the appropriate coding for a situation where a patient has a single chamber pacemaker (PM) ordefibrillator (ICD) and now has a need for a bi-ventricular device to provide cardiac-resynchronization therapy (CRT)?Example: The patient has a dual chamber ICD, and due to worsening heart failure now requires a CRT-D device(bi-ventricular defibrillator). The existing ICD leads are retained.A18.IC: The coding rules require using device remove and replace codes when a generator is removed and replaced withthe same type of generator, AND there are no new right atrial or ventricular (RA or RV) leads placed. The placement ofthe left ventricular lead to accomplish the left ventricular (LV) pacing utilizes an add-on code and is coded separately. Theresulting system will have three leads. 1Example: Upgrade of Dual Chamber ICD to CRT-D1CPT CODEDESCRIPTION 33225Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time ofinsertion of implantable defibrillator or pacemaker pulse generator33264Removal of implantable defibrillator pulse generator with replacement of implantabledefibrillator pulse generator; multiple lead systemQ19.IC: How is the Medicare payment for outpatient hospital and physician services affected when more than oneprocedure is performed during the same episode of care?A19.IC: The payment for the outpatient hospital and physician is outlined below.Outpatient Hospital: The Medicare payment system currently reimburses device-intensive procedures performed in thehospital outpatient setting using Comprehensive Ambulatory Payment Classifications (C-APCs). Under C-APCs if two ormore procedures, designated by Medicare (CMS) as a C-APC, are performed concurrently, the procedure with the highestweighted C-APC will be paid to the hospital. C-APCs package all supplies and services during that episode into one singlepayment.4Example: If an intracardiac catheter ablation of the atrioventricular (AV) node function and a dual chamberdefibrillator (ICD) system implant are both performed: only one C-APC will be paid to the hospital. In this case, thedual chamber ICD system implant will be paid, as it is the higher weighted procedure. The cost of the intracardiaccatheter ablation of the AV node is included in this single payment.Physician: Medicare Physician payment is determined using the multiple procedure rule. For concurrent procedures, thephysician will be paid the full Physician Fee Schedule amount for the highest weighted procedure, and 50% of the PhysicianFee Schedule amount for additional procedures.6Example: For physician payment for an AV node ablation and a dual chamber ICD system implant, the dualchamber ICD system implant will be receive 100% payment and the AV node ablation will be paid at 50%.6September 2016 I References listed on page 26-2710/31

IMPLANT/EXPLANTCORE DEVICES continuedModifiersQ20.IC: All of the pacemaker (PM) and defibrillator (ICD) procedure codes (lead insertions, lead removals, systemimplants, device replacements, etc.) have a 90 day global surgical period. What modifiers might be applicable when thesame physician performs a subsequent, additional procedure during the 90 day global surgical period?A20.IC: The following table lists modifiers which may be used to describe subsequent, additional procedures. An exampleof appropriate use is provided for each modifier.1MODIFIERDESCRIPTIONStaged or Related Procedure or Service by the Same Physician or Other Qualified Health CareProfessional During the Postoperative Period.58Example: During a bi-ventricular defibrillator (CRT-D) implant, the physician isunsuccessful in implanting the left bi-ventricular ( LV lead). The next day the patient isbrought back to the EP lab and the LV lead is successfully implanted. The LV leadimplantation should be reported with 33224-58.Unplanned Return to the Operating/Procedure Room by the Same Physician or Other QualifiedHealth Care Professional Following Initial Procedure for a Related Procedure During thePostoperative Period.78Example: A patient has a dual chamber implantable pacemaker inserted and 6 weeks laterthe right ventricular lead becomes dislodged. The physician repositions the lead and thiswould be considered an unplanned return to the operating/procedure room. Therepositioning should be reported with 33215-78.Unrelated Procedure or Service by the Same Physician or Other Qualified Health CareProfessional During the Postoperative Period.79Example: A patient has a dual chamber defibrillator inserted and 6 weeks later breaks herwrist and

IMPLANT/EXPLANT Q1.IC: What is the correct CPT code to use for a system (generator and applicable lead(s)) transvenous implant of an implantable pacemaker (PM) or defibrillator (ICD)? A1.IC: The codes are listed in the table below. Q2.IC: What is the correct CPT code to use for the insert