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2017 HOSPITAL CODING - Medtronic

2 017 H O S P I TA L CODINGR eference Guide for Cardiac Rhythm and Heart Failure (CRHF) ProceduresNew in 2017 ..3 Pacemaker Procedures ..5 Implantable Defibrillator Procedures ..11 Electrophysiology Procedures ..17 Implantable Devices for Diagnostic Procedures ..21 Medtronic CareLink Network Procedures ..23 CONTENTSP acemaker ProceduresElectrophysiology ProceduresImplantable Defibrillator ProceduresImplantable Devices for Diagnostic ProceduresMedtronicCareLink Network ProceduresNew in 20172017 1 of 25 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 CODING suggestions do not replace seeking CODING advice from the payer and/or your own CODING staff.

2 of 25 2017 HOSPITAL CODING SYSTEMS AND MEDICARE PAYMENT METHODOLOGIES Hospital Inpatient Coding and Reimbursement Hospitals will continue to assign ICD-10 diagnosis and procedure codes as …

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Transcription of 2017 HOSPITAL CODING - Medtronic

1 2 017 H O S P I TA L CODINGR eference Guide for Cardiac Rhythm and Heart Failure (CRHF) ProceduresNew in 2017 ..3 Pacemaker Procedures ..5 Implantable Defibrillator Procedures ..11 Electrophysiology Procedures ..17 Implantable Devices for Diagnostic Procedures ..21 Medtronic CareLink Network Procedures ..23 CONTENTSP acemaker ProceduresElectrophysiology ProceduresImplantable Defibrillator ProceduresImplantable Devices for Diagnostic ProceduresMedtronicCareLink Network ProceduresNew in 20172017 1 of 25 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 CODING suggestions do not replace seeking CODING advice from the payer and/or your own CODING staff.

2 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 questions or for more information, please contact Medtronic at 1 (866) Rhythm and Heart Failure reimbursement customer information is available at copyright 2016 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use.

3 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 reimbursement is requested for the use of a product that may be inconsistentor not expressly specified in the FDA cleared or approved labeling ( , instructions foruse, operator s manual, or package insert), consult with your billing advisors or payersfor advice on handling such billing issues. Some payers may have policies that make itinappropriate to submit claims for such items or related of 25 2017 HOSPITAL CODING SYSTEMS AND MEDICARE PAYMENT METHODOLOGIESH ospital Inpatient CODING and ReimbursementHospitals will continue to assign ICD-10 diagnosis and procedure codes as this CODING methodology was implemented for discharges occurring on and after October 1, 2015.

4 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 amountHospital Outpatient CODING and ReimbursementSimilar 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 2017 .

5 The comprehensive payment policy will package payment for adjunctive and secondary items, services, and procedures into the most costly primary procedure at the claim Changes to C-APC/APCs and CPT procedure codes are effective January 1st of each diagnosis codes were implemented for service dates on and 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 :KX: Requirements specified in the medical policy have been met. PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospitalPO: Excepted service provided at an off-campus, outpatient, provider-based department of a hospitalQ0 (zero): Investigational clinical service provided in a clinical research study that is in an approved clinical research study.

6 This modifier also denotes a primary prevention patient for Medicare implantable defibrillator device implants. SC: Medically necessary service or supply-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.

7 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 2017 3 of 25 NEW IN 2017 HOSPITAL CODING and ReimbursementI. C-APC and APC reassignments effective January 1, 20171 CPT or Category III CodesAbbreviated 2017 CPT or Category III Description2017 C-APC or APC Assignment2016 C-APC or APC Assignment0387 TTranscath insert/replace perm. leadless pacer, ventricular5194519333215 Reposition previously implanted transvenous pacer or defibrillator lead5182518133284 Remove cardiac-event recorder5071507393229 External mobile cardiovascular telemetry5733572293303 Transthoracic echo for congenital anomalies; complete5524553493304 Echo for congenital anomalies; follow-up or limited study5524553393306 Echo, complete, w/spectral Doppler and color flow Doppler5524553393307 Echo, complete, w/out spectral Doppler and color flow Doppler5524553393308 Echo.

8 Follow-up or limited study55235532 Cardiac Rhythm and Heart Failure (CRHF) reimbursement customer information is available at Procedural Terminology (CPT) is copyright 2016 American Medical in 20174 of 25 20172017 5 of 25 PACEMAKER PROCEDURESHOSPITAL INPATIENT:An example of ICD-10 Inpatient HOSPITAL CODING for a dual chamber pacemaker system implant and a cardiac resynchronization therapy pacemaker implant is available at this website address: DRG Assignments (MS-DRG: Medicare Severity Diagnosis Related Group)MS-DRG Brief MS-DRG Description242243244 Pacemaker implant w/MCCP acemaker implant w/CCPacemaker implant w/o CC/MCC260261262 Pacemaker revision w/MCCP acemaker revision w/CCPacemaker revision w/o CC/MCC258259 Pacemaker device replacement w/MCCP acemaker device replacement w/o MCCMCC: Major complication or comorbidity CC: Complication or comorbidityHOSPITAL OUTPATIENT CPT CODES:Pacemaker ProceduresInsertion33206 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial33207 ventricular33208 atrial and ventricular33212 Insertion of pacemaker pulse generator only.

9 With existing single lead33213 with existing dual leads33221 with existing multiple leads33214 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 defibrillator33217 Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator33224 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)

10 +33225 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator ( , 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 Pacemaker33210 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 Replacement33227 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system33228 dual lead system33229 multiple lead systemPacemaker Procedures6 of 25 2017 Removal33233 Removal of permanent pacemaker pulse generator only33234 Removal of transvenous pacemaker electrode(s).


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