2021 Coding & Payment Quick Reference - Boston Scientific

1 Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, Coding or site of service Coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate Coding following codes are thought to be relevant to Biliary procedures and are referenced throughout this guide. All rates shown are 2021 Medicare national averages; actual rates will vary geographically and/or by individual Physician, Hospital Outpatient, and ASC payments It is important to remember that surgical endoscopy always includes a diagnostic endoscopy (CPT Code 43260). Therefore, when a diagnostic endoscopy is performed during the same session as a surgical endoscopy, the diagnostic endoscopy code is not separately reported. (CPT Assistant, October 2001)1 Select Biliary Procedures2021 Coding & Payment Quick ReferenceCPT Code1 Code DescriptionWorkTotal OfficeTotal FacilityIn-OfficeIn-FacilityHospital OutpatientASCD iagnostic 43260 Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) $327$3,081 $1,381 Therapeutic43261 Endoscopic retrograde cholangiopancreatography (ERCP); with biopsy, single or $343$3,081 $1,38143262 Endoscopic retrograde cholangiopancreatography (ERCP); with $363$3,081 $1,38143263 Endoscopic retrograde cholangiopancreatography (ERCP); with pressure measurement of sphincter of $363$3,081 $1,38143264 Endoscopic retrograde cholangiopancreatography (ERCP); with removal of calculi/debris from biliary/pancreatic duct(s) $370$3,081 $1,38143265 Endoscopic retrograde cholangiopancreatography (ERCP).

2 With destruction of calculi, any method (eg, mechanical, electrohydraulic, lithotripsy) $440$5,029 $2,05843277 Endoscopic retrograde cholangiopancreatography (ERCP); with trans-endoscopic balloon dilation of biliary/pancreatic duct(s) or of ampulla (sphincteroplasty), including sphincterotomy, when performed, each duct $384$3,081 $1,38143278 Endoscopic retrograde cholangiopancreatography (ERCP); with ablation of tumor(s), polyp(s), or other lesion(s), including pre- and post-dilation and guide wire passage, when performed $439$3,081 $1,381 Effective: 1 JAN2021 Expires: 31 DEC2021MS-DRG Rates Expire: 30 SEP2021 ENDO-47409-AJ See important notes on the uses and limitations of this information on page copyright 2020 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical ,2 Facility32021 Medicare National Average Payment2 Effective: 1 JAN2021 Expires: 31 DEC2021MS-DRG Rates Expire: 30 SEP2021 ENDO-47409-AJ CPT Code1 Code DescriptionWorkTotal OfficeTotal FacilityIn-OfficeIn-FacilityHospital OutpatientASCS tenting43274 Endoscopic retrograde cholangiopancreatography (ERCP); with placement of endoscopic stent into biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent $470$5,029 $2,05843275 Endoscopic retrograde cholangiopancreatography (ERCP); with removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s) $382$3,081 $1,38143276 Endoscopic retrograde cholangiopancreatography (ERCP).

3 With removal and exchange of stent(s), biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent exchanged $489$5,029 $2,058 CPT Code1 Code DescriptionWorkTotal OfficeTotal FacilityIn-OfficeIn-FacilityHospital OutpatientASCF luoroscopy74328-26 Endoscopic catheterization of the biliary ductal system, radiological supervision and $29No additional Payment **No additional Payment **74329-26 Endoscopic catheterization of the pancreatic ductal system, radiological supervision and $29No additional Payment **No additional Payment **74330-26 Combined endoscopic catheterization of the biliary and pancreatic ductal systems, radiological supervision and $37No additional Payment **No additional Payment **Fluoroscopy is often performed in conjunction with ERCP procedures. Possible CPT Codes include:RVUsPhysician ,2 Facility32021 Medicare National Average PaymentRVUsPhysician ,2 Facility32021 Medicare National Average PaymentSee important notes on the uses and limitations of this information on page copyright 2020 American Medical Association.

4 All rights reserved. CPT is a registered trademark of the American Medical : 1 JAN2021 Expires: 31 DEC2021MS-DRG Rates Expire: 30 SEP2021 ENDO-47409-AJ See important notes on the uses and limitations of this information on page copyright 2020 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical C-Code Information For all C-Code information, please Reference the C-code Finder: IndicatorLong DescriptorC1748H*Endoscope, single-use ( , disposable), upper GI, imaging/illumination device (insertable)Medicare Transitional Pass-Through (TPT) Payment Category Applicable to EXALT Model D Single Use DuodenoscopeThe Centers for Medicare & Medicaid Services (CMS) has approved Boston Scientific s application for a transitional pass-through (TPT) Payment category to describe single-use endoscopes, such as the EXALT Model D Single-Use Duodenoscope. Effective July 1, 2020, the new device pass-through code (C1748) may be used to bill for EXALT Model D when used in the treatment of Medicare patients in the hospital outpatient setting.

5 This device specific Payment is in addition to the endoscopic retrograde cholangiopancreatography (ERCP) procedure Payment and is intended to cover the cost of the device. TRANSITIONAL PASS-THROUGH CODEThe following HCPCS code must be reported on the claim for a hospital to be eligible for TPT Coding : Appropriate ERCP CPT code(s) plusDevice HCPCS code: C1748 Device Revenue Code: EXALT Model D is a single use sterile device and may be reported using revenue code 278 - Medical/surgical supplies and devices; other additional Coding and reimbursement information, contact your local Endoscopy Reimbursement Manager or the Endoscopy Reimbursement Help Desk at or (508) CMS guidance on the new device transitional pass-through category is available at: (See Section 7 and Tables 8 & 9).*C1748 has a Medicare status indicator of H and therefore is not subject to copayment Medicare patients treated in the outpatient setting will not incur any additional costs for the utilization of EXALT Model D during an ERCP FOR PROCEDURE AND DEVICE ON A CLAIMWhen physicians perform an ERCP procedure on a Medicare patient in the hospital outpatient setting with EXALT Model D, hospitals, if appropriate, may bill:4 Hospital Inpatient Coding Select ProceduresSee important notes on the uses and limitations of this information on page copyright 2020 American Medical Association.

6 All rights reserved. CPT is a registered trademark of the American Medical 10 PCSCodeICD 10 PCS Description0F558 ZZDestruction of Right Hepatic Duct, Via Natural or Artificial Opening Endoscopic0F568 ZZDestruction of Left Hepatic Duct, Via Natural or Artificial Opening Endoscopic0F578 ZZDestruction of Common Hepatic Duct, Via Natural or Artificial Opening Endoscopic0F588 ZZDestruction of Cystic Duct, Via Natural or Artificial Opening Endoscopic0F598 ZZDestruction of Common Bile Duct, Endoscopic0F5C8 ZZDestruction of Ampulla of Vater, Endoscopic0F5D8 ZZDestruction of Pancreatic Duct, Endoscopic0F5F8 ZZDestruction of Accessory Pancreatic Duct, Via Natural or Artificial Opening Endoscopic0F758 DZDilation of Right Hepatic Duct with Intraluminal Device, Via Natural or Artificial Opening Endoscopic0F758 ZZDilation of Right Hepatic Duct , Via Natural or Artificial Opening Endoscopic0F768 DZDilation of Left Hepatic Duct with Intraluminal Device.

7 Endoscopic0F768 ZZDilation of Left Hepatic Duct, Endoscopic0F778 DZDilation of Common Hepatic Duct with Intraluminal Device, Via Natural or Artificial Opening Endoscopic0F778 ZZDilation of Common Hepatic Duct, Via Natural or Artificial Opening Endoscopic0F788 DZDilation of Cystic Duct with Intraluminal Device, Via Natural or Artificial Opening Endoscopic0F788 ZZDilation of Cystic Duct, Endoscopic0F798 DZDilation of Common Bile Duct with Intraluminal Device, Endoscopic0F798 ZZDilation of Common Bile Duct, Endoscopic0F7C8 DZDilation of Ampulla of Vater with Intraluminal Device, Endoscopic0F7C8 ZZDilation of Ampulla of Vater, Endoscopic0F7D8 DZDilation of Pancreatic Duct with Intraluminal Device, Via Natural or Artificial Opening Endoscopic0F7D8 ZZDilation of Pancreatic Duct, Endoscopic0F7F8 DZDilation of Accessory Pancreatic Duct with Intraluminal Device, Endoscopic0F7F8 ZZDilation of Accessory Pancreatic Duct, Endoscopic0FB98 ZXExcision of Common Bile Duct, Endoscopic, Diagnostic0 FBC8 ZXExcision of Ampulla of Vater, Endoscopic, Diagnostic0 FBD8 ZXExcision of Pancreatic Duct, Endoscopic, Diagnostic0 FBF8 ZXExcision of Accessory Pancreatic Duct, Via Natural or Artificial Opening Endoscopic, Diagnostic 0FC58 ZZExtirpation of Matter from Right Hepatic Duct, Via Natural or Artificial Opening Endoscopic0FC68 ZZExtirpation of Matter from Left Hepatic Duct, Via Natural or Artificial Opening Endoscopic0FC78 ZZExtirpation of Matter from Common Hepatic Duct, Via Natural or Artificial Opening Endoscopic0FC98 ZZExtirpation of Matter from Common Bile Duct, Endoscopic0 FCD8 ZZExtirpation of Matter from Pancreatic Duct, Via Natural or Artificial Opening Endoscopic0 FCF8 ZZExtirpation of Matter from Accessory Pancreatic Duct, Via Natural or Artificial Opening Endoscopic0FF58 ZZFragmentation in Right Hepatic Duct.

8 Endoscopic0FF68 ZZFragmentation in Left Hepatic Duct, Endoscopic0FF78 ZZFragmentation in Common Hepatic Duct, Via Natural or Artificial Opening Endoscopic0FF88 ZZFragmentation in Cystic Duct, Via Natural or Artificial Opening Endoscopic0FF98 ZZFragmentation in Common Bile Duct, Endoscopic0 FFC8 ZZFragmentation in Ampulla of Vater, Endoscopic0 FFD8 ZZFragmentation in Pancreatic Duct, Endoscopic0 FFF8 ZZFragmentation in Accessory Pancreatic Duct, Via Natural or Artificial Opening Endoscopic0 FHB8 DZInsertion of Intraluminal Device into Hepatobiliary Duct, Via Natural or Artificial Opening Endoscopic0 FHD8 DZInsertion of Intraluminal Device into Pancreatic Duct, Endoscopic0 FJB8 ZZInspection of Hepatobiliary Duct, Via Natural or Artificial Opening Endoscopic0 FJD8 ZZInspection of Pancreatic Duct, Endoscopic0 FPB80 ZRemoval of Drainage Device from Hepatobiliary Duct, Via Natural or Artificial Opening Endoscopic0 FPB8 DZRemoval of Intraluminal Device from Hepatobiliary Duct, Via Natural or Artificial Opening Endoscopic0 FPD80 ZRemoval of Drainage Device from Pancreatic Duct, Endoscopic0 FPD8 DZRemoval of Intraluminal Device from Pancreatic Duct, EndoscopicEffective: 1 JAN2021 Expires: 31 DEC2021MS-DRG Rates Expire: 30 SEP2021 ENDO-47409-AJ 5 Medicare Hospital Inpatient Payment Rates Effective October 1, 2020 - September 30, 2021 Medicare Severity Diagnosis Related Groups (MS-DRGs) assignment is based on a combination of diagnoses and procedure codes reported.

9 While MS-DRGs listed in this guide represent likely assignments, Boston Scientific cannot guarantee assignment to any one specific MS-DRG. MS-DRGs resulting from inpatient biliary procedures may include (but are not limited to):MS-DRGD escriptionHospital Inpatient Medicare National Average Payment5435 Malignancy of hepatobiliary system or pancreas with Major Complication or Comorbidity (MCC6)$11,266436 Malignancy of hepatobiliary system or pancreas with Complication or Comorbidity (CC6)$7,200437 Malignancy of hepatobiliary system or pancreas without CC/MCC$5,749438 Disorders of pancreas except malignancy with MCC6$10,260439 Disorders of pancreas except malignancy with CC6$5,427440 Disorders of pancreas except malignancy without CC/MCC$3,894441 Disorders of liver except malignancy, cirrhosis, alcoholic hepatitis with MCC6$12,108442 Disorders of liver except malignancy, cirrhosis, alcoholic hepatitis with CC6$5,988443 Disorders of liver except malignancy, cirrhosis, alcoholic hepatitis without CC/MCC$4,260444 Disorders of the biliary tract with MCC6$10,726445 Disorders of the biliary tract with CC6$6,921446 Disorders of the biliary tract without CC/MCC$5,246 See important notes on the uses and limitations of this information on page copyright 2020 American Medical Association.

10 All rights reserved. CPT is a registered trademark of the American Medical : 1 JAN2021 Expires: 31 DEC2021MS-DRG Rates Expire: 30 SEP2021 ENDO-47409-AJ Boston Scientific Corporation300 Boston Scientific Way Marlboro, MA 01752 2021 Boston Scientific Corporation or its affiliates. All rights : 1 JAN2021 Expires: 31 DEC2021MS-DRG Rates Expire: 30 SEP2021 ENDO-47409-AJ6 Please note: this Coding information may include codes for procedures for which Boston Scientific currently offers no cleared or approved products. In those instances, such codes have been included solely in the interest of providing users with comprehensive Coding information and are not intended to promote the use of any Boston Scientific products for which they are not cleared or approved. The Health Care Provider (HCP) is solely responsible for selecting the site of service and treatment modalities appropriate for the patient based on medically appropriate needs of that patient and the independent medical judgement of the HCP.