2017 Cardiology Reimbursement Coding Fact Sheet

1 2017 Cardiology Reimbursement Coding fact Sheet1 of 6 The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Cordis Corporation concerning levels of Reimbursement , payment, or charge. Similarly, all CPT, ICD-10 and HCPCS codes are supplied for informational purposes only and represent no statement, promise, or guarantee by Cordis that these codes will be appropriate to specific circumstances or products or services provided or that Reimbursement will be made. Providers are ultimately responsible for exercising their independent clinical judgment to determine medical necessity for individual patients and the appropriate billing process according to the applicable payer s current policy.

2 CPT codes and descriptions are copyright 2016 American Medical Association. ICD-10 codes and descriptions are copyright 2016 World Health Organization; revised for use in the United States by the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention s (CDC) National Center for Health Statistics (NCHS) as ICD-10-CM / ICD-10-PCS. Healthcare Common Procedure Coding System (HCPCS) Level II codes and descriptions are maintained by the CMS HCPCS Workgroup. The information contained in this document is taken from various publicly available documents, is current at the date of publication and is subject to change at any Codes and Physician ReimbursementMedicare Part B pays for physician services based upon the Medicare Physician Fee Schedule (MPFS).

3 Fee schedule amounts are calculated according to the Resource-Based Relative Value Scale (RBRVS), which is updated each year. Procedures are reported using CPT codes. The 2017 CPT Professional Edition Manual also provides specific instructions for reporting particular families of codes. Individual payers may also have guidelines and coverage policies regarding certain services. The following table lists the most commonly used codes for coronary Codes and Physician Reimbursement for Coronary ProceduresCPT CodeDescription2017 Work RVUs2017 Medicare Base Payment Rate2 Non-FacilityFacilityDiagnostic Procedures and Imaging93451 Right heart $737$13693452 Left heart catheterization $839$24893453 Right and left heart $1,089$33293454 Coronary $851$25293455 Coronary angiography with bypass $995$29393456 Coronary angiography with right heart $1,076$32793457 Coronary angiography and bypass grafts, with right heart $1,220$36893458 Coronary angiography with left heart $1,025$31093459 Coronary angiography and bypass grafts, with left heart $1.

4 137$35293460 Coronary angiography with right and left heart $1,225$39493461 Coronary angiography with bypass grafts, right and left heart $1,402$435+93462 Left heart access via transseptal or transapical $219$219+93463 Pharmacological agent administration with hemodynamic $101$101+93464 Physiologic exercise study with hemodynamic $259$8993503 Placement of flow directed catheter (eg, Swan-Ganz) for $0$13293505 Endomyocardial $712$2281 2017 Current Procedural Terminology (CPT ), 2016 American Medical Association. CPT is a registered trademark of the American Medical The MPFS payment amounts are based upon data elements published by the Centers for Medicare and Medicaid Services (CMS)

5 In the Final Rule [CMS-1654-F] on November 2, 2016, and published in the Federal Register on November 15, 2016, with a conversion factor of $ CMS may make adjustments to any or all of the data inputs from time to Cardiology Reimbursement Coding fact Sheet2 of 6 Procedure Codes and Physician Reimbursement for Coronary ProceduresCPT CodeDescription2017 Work RVUs2017 Medicare Base Payment Rate2 Non-FacilityFacility93530 Right heart catheterization for congenital cardiac $0$21693531 Combined right & retrograde left heart cath for congenital cardiac $0$44693532 Combined right & transseptal left heart cath through intact septum for congenital cardiac $0$55693533 Combined right & transseptal left heart cath through existing septum opening for congenital cardiac $0$37193561 Indicator dilution

6 Study with cardiac output (separate procedure) $0$1393562 Indicator dilution study; subsequent measurement of cardiac $0$1+93563 Injection/imaging for coronary angiography with cath for congenital $61$61+93564 Injection/imaging for bypass graft angiography with cath for congenital $64$64+93565 Injection/imaging for left heart angiography with cath for congenital $47$47+93566 Injection/imaging for right heart angiography with cath for congenital $164$48+93567 Injection/imaging procedure for supravalvular $139$55+93568 Injection/imaging procedure for pulmonary $147$50+93571 Intravascular coronary flow reserve measurement, initial $0$100+93572 Intravascular coronary flow reserve measurement.

7 Each additional $0$80+92978 Coronary vessel or graft imaging with IVUS or OCT, initial $0$100+92979 Coronary vessel or graft imaging with IVUS or OCT, each additional $0$80 Therapeutic / Interventional Procedures92920 Angioplasty, single vessel $0$556+92921 Angioplasty, additional branch $0$092924 Atherectomy, single vessel $0$664+92925 Atherectomy, additional branch $0$092928 Stent, single vessel $0$619+92929 Stent, additional branch $0$092933 Atherectomy + stent, single vessel $0$694+92934 Atherectomy + stent, additional branch $0$092937 PCI of or through bypass, any method(s) $0$618+92938 PCI of or through bypass, additional branch $0$092941 PCI of acute MI, all interventions, single vessel $0$69692943 PCI of chronic total occlusion, any method(s)

8 $0$695+92944 PCI of chronic total occlusion, additional branch $0$0+92973 Percutaneous coronary thrombectomy, $0$1852017 Cardiology Reimbursement Coding fact Sheet3 of 6 Procedure Codes and Physician Reimbursement for Coronary ProceduresCPT CodeDescription2017 Work RVUs2017 Medicare Base Payment Rate2 Non-FacilityFacilityOther Supportive Therapies92975 Thrombolysis, coronary, by intracoronary $0$39492977 Thrombolysis, coronary, by intravenous $70$033967 Insertion of intra-aortic balloon assist device, $0$27133968 Removal of intra-aortic balloon assist device, $0$3533990 Insert ventricular assist device (VAD), percutaneous, arterial access $0$44533991 Insert VAD, percutaneous, arterial & venous access, $0$65233992 Remove ventricular assist device, at separate session from $0$21033993 Reposition ventricular assist device, with imaging, at separate $0$183G0269 Placement of occlusive device into vascular access $0$0 Note: Procedures with a zero value in the non-facility column are carrier priced outside a facility setting, and may not be approved.

9 Additional branch interventions and placement of occlusive device are packaged into the primary Surgery Center (ASC) ReimbursementIn general, the ASC payment rate for services is set at approximately 65% of the payment rate for the same service under the HOPPS, with some For example, for device-intensive services (where device costs account for more than 50 percent of the total cost of the service), ASCs receive the same payment rate for the device cost as under the HOPPS, with payment for the service portion of the ASC rate calculated at the usual percentage rate of the corresponding OPPS service payment. ASCs will not typically bill separately for these CMS has assigned APC-based payment rates in an Ambulatory Surgery Center only to surgical procedure codes CPT codes in the range 10000 69999, plus a few Category III codes, C-codes, and G-codes and does not include cardiac catheterization codes.

10 Intra-aortic balloon and ventricular assist devices are designated Hospital Outpatient ReimbursementOutpatient facility claims also report CPT and HCPCS6 codes, which map to Ambulatory Payment Classifications (APCs), which assign a Medicare hospital outpatient payment rate for the service. Depending upon the services provided, hospitals may receive payment for more than one APC per patient encounter. If a claim contains services that result in an APC payment but also contains packaged services, no separate payment for the packaged services will be provided, as these are included in the APC. However, charges related to the packaged services are used for outlier and Transitional Corridor Payments (TOPs) as well as for future rate setting.