CATHETER ABLATION REIMBURSEMENT GUIDE - …

1 Updated January 1, 2016 CATHETER ABLATION REIMBURSEMENT GUIDEJ anuary 1, 20162 of 7TA B L E O F CONTENTSA blation Catheters ..3 CryoAblation Catheters Arctic Front Cardiac CryoAblation CATHETER , Arctic Front Advance Cardiac CryoAblation CATHETER , Arctic Front Advance ST Cardiac CryoAblation CATHETER , Freezor Cardiac CryoAblation CATHETER , Freezor MAX Cardiac CryoAblation CatheterConventional Radiofrequency (RF) ABLATION Catheters Marinr Conventional Radiofrequency (RF) ABLATION CATHETER , RF Conductr MC Conventional Radiofrequency (RF) ABLATION CATHETER , and RF Contactr Conventional Radiofrequency (RF) ABLATION CATHETER , Enhancr Conventional Radiofrequency (RF) ABLATION CatheterCoverage for CATHETER ABLATION Procedures ..4 MedicareOther PayersPhysician Services Coding ..4 CATHETER AblationDiagnostic Electrophysiologic Study (EPS)Inpatient Hospital Coding.

2 5 ICD-9-CM1 crosswalk to ICD-10-PCS2 Procedure CodesMedicare Severity Diagnosis Related Group (MS-DRG) AssignmentsOutpatient Hospital Coding ..6 Comprehensive Ambulatory Payment Classification (C-APCs):Medicare Hospital Outpatient CATHETER ABLATION C-Code ListingDiagnosis Codes ..7 ICD-9-CM crosswalk to ICD-10-CM3 Diagnosis CodesFor questions or for more information, please contact Medtronic at 1 (866) coding suggestions and coding guidelines in this GUIDE 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 specif ic 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 REIMBURSEMENT is requested for the use of a product that may be inconsistent or not expressly specif ied in the FDA cleared or approved labeling ( , instructions for use, operator s manual, or package insert), consult with your billing advisors or payers for advice on handling such billing issues.

3 Some payers may have policies that make it inappropriate to submit claims for such items or related 1, 2016A B L AT I O N CATHETERSA rctic Front , Arctic Front Advance , and Arctic Front Advance ST Cardiac CryoAblation CathetersCatheterIndicationArctic Front , Arctic Front Advance , and Arctic Front Advance ST Cardiac CryoAblation CathetersTreatment of drug refractory recurrent symptomatic Paroxysmal Atrial Fibrillation (PAF)The Arctic Front , Arctic Front Advance , and Arctic Front Advance ST Cardiac CryoAblation catheters deliver refrigerant (via the CryoConsole) through an inflatable balloon to remove heat from tissue, freezing and disabling unwanted electrical circuits in the pulmonary veins that may contribute to PAF. The Cryoballoon s shape achieves contact over a broad area to create the barriers that prevent these electrical currents from entering the heart s atria.

4 The FlexCath and the FlexCath Advance Steerable Sheaths position the Arctic Front , Arctic Front Advance , and Arctic Front Advance ST Cardiac Cryoballoon in the Cardiac CryoAblation CathetersCatheterIndication and UseFreezor Cardiac CryoAblation CatheterTreatment of Atrioventricular Nodal Re-entry Tachycardia (AVNRT).Freezor MAX Cardiac CryoAblation CatheterTreatment of PAF. Used in conjunction with the Arctic Front Advance Cryoballoon to: Provide touch-up cryoablation and complete the Pulmonary Vein Isolation (PVI) process as needed Cryoablate focal trigger sites Create the ABLATION line between the inferior vena cava and the tricuspid valveThe Freezor and Freezor MAX Cardiac CryoAblation Catheters are deflectable, single-use, electrophysiology catheters designed to ablate cardiac tissue using cryothermal energy. Refrigerant is directed via the CryoConsole through these devices, creating precise, focal lesions.

5 Conventional Radiofrequency (RF) ABLATION CathetersCatheterIndicationRF Marinr MC Multi-Curve Steerable ABLATION CatheterRF catheters are indicated for use with the Medtronic RF generator to deliver RF energy for intracardiac ABLATION of accessory atrioventricular (AV) conduction pathways associated with tachycardia for the treatment of AV nodal re-entrant tachycardia (AVNRT) and for creation of complete AV block in patients with a difficult to control ventricular response to an atrial Marinr SC Single-Curve Steerable ABLATION CatheterRF Conductr MC Multi-Curve Bidirectional ABLATION CatheterRF Contactr Dual-Curve ABLATION CatheterRF Enhancr II Single-Curve ABLATION CatheterConventional RF ABLATION Catheters are used in conjunction with a Medtronic RF power generator to produce therapeutic, heat-based energy at a targeted area of cardiac tissue. RF energy, delivered via the CATHETER , destroys tissue integral to the onset and maintenance of most atrial of 7 January 1, 2016 COVERAGE FOR CATHETER ABLATION PROCEDURES Medicare:Medicare has not issued national or local coverage determinations for CATHETER ABLATION services.

6 The Social Security Act allows coverage and payment for only those services that are considered to be medically reasonable and The medical necessity for services provided must be documented in the medical record. Other Payers:We recommend that you contact the patient s insurance company for guidance on what specific CPT codes are required for CATHETER ABLATION procedures as part of your request for a prior authorization or a pre-determination. PHYSICIAN SERVICES CODINGS ignificant changes were made to the CPT codes for CATHETER ABLATION procedures for services performed on and after January 1, 2013. Both the CATHETER ABLATION and electrophysiological study (EPS) aspects of the procedure are reflected in these CATHETER ABLATION codes. In some instances, the CATHETER ABLATION and EPS procedures are no longer considered distinct procedures and therefore not reportable with separate codes.

7 Some of the CPT5 codes used to describe EP diagnostic and cardiac CATHETER ABLATION procedures, as well as mapping procedures, which may sometimes be concurrently performed at physician s discretion, are listed ABLATION :CPT5 CodeCPT5 Code Description93650 Intracardiac CATHETER ABLATION of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement93653 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 (Do not report 93653 in conjunction with 93600-3, 93610, 93612, 93618-20, 93642, 93654, 93656) treatment of ventricular tachycardia or focus of ventricular ectopy including intracardiac electrophysiologic 3D mapping, when performed, and left ventricular pacing and recording, when performed (Do not report 93654 in conjunction with 93279-84, 93286-9, 93600-3, 93609-10, 93612-3, 93618-20, 93622, 93642, 93653, 93656)

8 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 f ibrillation by pulmonary vein isolation (Do not report 93656 in conjunction with 93279-84, 93286-9, 93462, 93600, 93602-3, 93610, 93612, 93618-21, 93653-4)The ABLATION procedure codes 93653, 93654 and 93656 are distinct primary procedure codes and may not be reported codes +93655 and +93657 may be applicable when intracardiac CATHETER ABLATION of a discrete arrhythmia is performed after the treatment of the primary ablated mechanism.+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 (Use 93655 in conjunction with 93653-4, 93656)+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 (Use 93657 in conjunction with 93656)+93462 Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (Use 93462 in conjunction with 33477, 93452-3, 93458-93461, 93582, 93653-4) (Do not report 93462 in conjunction with 93656) (Do not report 93462 in conjunction with 0345T unless transapical puncture is performed) When reporting ABLATION therapy codes (93653 93657)

9 , comprehensive EP studies may not be separately of 7 January 1, 2016 Diagnostic Electrophysiologic Study (EPS):Coding information to be used when a physician performs a diagnostic Electrophysiologic Study (EPS) prior to a CATHETER CodeCPT5 Code Description93619 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 (Do not report 93619 in conjunction with 93600, 93602-3, 93610, 93612, 93618, 93620-2, 93653-7)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 (Do not report 93620 in conjunction with 93600, 93602-3, 93610, 93612, 93618-9, 93653-7)+ left atrial pacing and recording from coronary sinus or left atrium (Use 93621 in conjunction with 93620, 93653-4) (Do not report 93621 in conjunction with 93656)+ left ventricular pacing and recording (Use 93622 in conjunction with 93620, 93653, 93656) (Do not report 93622 in conjunction with 93654)+93623 Programmed stimulation and pacing after intravenous drug infusion (Use 93623 in conjunction with 93610, 93612, 93619-20, 93653-4, 93656)

10 +93662 Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (Use 93662 in conjunction with 92987, 93453, 93460-2, 93532, 93580-1, 93620-2, 93653-4, 93656 as appropriate) (Do not report 92961 in addition to 93662)93624 Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or attempted induction of arrhythmiaMapping is considered a distinct procedure performed in addition to a diagnostic EP study or ABLATION procedure+93609 Intraventricular and/or intra-atrial mapping of tachycardia site(s) with CATHETER manipulation to record from multiple sites to identify origin of tachycardia (Use 93609 in conjunction with 93620, 93653, 93656) (Do not report 93609 in conjunction with 93613, 93654)+93613 Intracardiac electrophysiologic 3-dimensional mapping (Use 93613 in conjunction with 93620, 93653, 93656) (Do not report 93613 in conjunction with 93609, 93654)5 of 7 INPATIENT HOSPITAL CODINGICD-9-CM1 crosswalk to ICD-10-PCS2 Procedure Codes for discharges after September 30, 2015 Please note that there is not always a direct crosswalk from ICD-9-CM to ICD-10-PCS.