MEDICARE HOSPITAL OUTPATIENT CHANGES - Medtronic

1 MEDICARE HOSPITAL OUTPATIENT CHANGES EFFECTIVE JANUARY 1, 2017 (CY 2017 )CRHF Economics & Health PolicyNovember 30, 2016 DISCLAIMER This presentation is intended only for educational use. Any duplication is prohibited without written consent of the authors. This information does not replace seeking coding advice from the payer and/or your coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for their interpretation of the appropriate codes to use for specific procedures.

2 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 service. CPT 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. 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.

3 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 herein. Note: CPT code descriptions may be abbreviated and not listed in their entirety in all cases in this presentation. For full descriptions, please refer to your 2017 CPT code ECONOMICS & HEALTH POLICYCONTINUING EDUCATION UNITS This program has prior approval of the American Academy ofProfessional Coders (AAPC) for one continuing education hour. Granting of this prior approval in no way constitutes endorsement by AAPC of the program content or the program AAPC requires attendees to participate in the entire Web-Ex presentation in order to qualify for the CEU certificate.

4 This program has prior approval of the American Health Information Management Association (AHIMA) for one continuing education unit. Granting of this prior approval in no way constitutes endorsement by AHIMA of the program content or the program sponsor. Registered attendees that qualify will receive an email that includes the AAPC and the AHIMA CEU certificates within a couple of ECONOMICS & HEALTH POLICYAGENDA CY 2017 Updates APC/C-APC Assignment CHANGES OPPS Payment Rate Comparisons CY 2017 OPPS Regulations Device Intensive Procedures Site Neutral Payment.

5 Provider-Based Designation MEDICARE Coverage Policies Appendix Q&A4 CRHF ECONOMICS & HEALTH POLICYCY 2017 Updates5 CRHF ECONOMICS & HEALTH POLICYUPDATES OPPS payment rates are increasing by The rural adjustment to OPPS payments for Sole Community Hospitals will continue for CY 2017 . Twenty-five New Comprehensive Ambulatory Payment Classifications (C-APCs) added for CY 2017 . Hospitals that do not meet the OUTPATIENT quality reporting requirements will see a 2% payment rate reduction. The CY 2020 payment year and subsequent years will include 2 claims based measures and 5 OUTPATIENT Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey-based measures.

6 The Comprehensive observation services (C-APC 8011) will remain not applicable when associated with a surgical procedure. CMS Fact Sheet and Press Release dated November 1, 2016; Pages 79569, 79583-79585, 79755 of the Federal Register dated November 14, 2016. See Appendix for the ECONOMICS & HEALTH POLICYINPATIENT VERSUS OUTPATIENT PERCENTAGES112015 MEDICARE Physician Part B claims data file (Physician/Supplier Procedure Summary Master File). ECONOMICS & HEALTH POLICYCPT CodeBrief DescriptionInpatient % OUTPATIENT %(includes ASC)

7 33206-33208 Pacemaker system implants59%41%33228 Dual chamber Pacemaker generator replacement14%86%33249 ICD system implants39%61%33263 Dual chamber ICD generator replacement11%89%33282 ILR implant25%75%93656 PVI catheter ablation18%72%APC/C-APC Assignment Changes8 CRHF ECONOMICS & HEALTH POLICYAPC / C-APC ASSIGNMENT CHANGES for CRHF RELATED PROCEDURE/SERVICES for CY 2017 CPT Code /HCPCSB rief CPT Code / HCPCS DescriptionCY 2017 APC/ C-APC Assignment/National Payment1CY 2016 APC/ C-APC Assignment/National Payment1 Leadless Pacemaker Implant0387 TTranscather insert/replace permanent.

8 Leadless pacer, ventricular 5194$14,776(No CMS coverage yet)5193$14,612(No CMS coverage yet)Transvenous lead repositioning33215 Reposition previously implanted transvenous pacer or defibrillator lead5181$2,3605182$2,247 Removal of an implantable, patient-activated cardiac event recorder33284 Remove implanted cardiac event recorder - if this is the only procedure performed5071$5395073$942 External mobile cardiovascular telemetry with electrocardiographic recording93229Up to 30 days technical support. connection and instructions5733$555722$2201 HOSPITAL OUTPATIENT Regulations and Notices and then CMS-1656 for CY 2017 and CMS-1633 for CY ECONOMICS & HEALTH POLICYAPC / C-APC ASSIGNMENT CHANGES for CRHF RELATED PROCEDURE/SERVICES for CY 2017 - continuedCPT CodeBrief CPT Code DescriptionCY 2017 APC/ C-APC Assignment/National Payment1CY 2016 APC/ C-APC Assignment/National Payment1 Echocardiography93303 Transthoracic echo for congenital anomalies; complete5524$4495534$69993304 Echo for congenital anomalies.

9 Follow-up or limited study5533$41793306 Echo, complete, w/spectral Doppler and color flow Doppler5533$41793307 Echo, complete, w/out spectral Doppler and color flow Doppler5533$41793308 Echo; follow-up or limited study5523$2265532$15410 CRHF ECONOMICS & HEALTH POLICY1 HOSPITAL OUTPATIENT Regulations and Notices and then CMS-1656 for CY 2017 and CMS-1633 for CY PAYMENT RATE COMPARISONS 11 CRHF ECONOMICS & HEALTH POLICYN ational MEDICARE HOSPITAL OUTPATIENT Payment Rates forSignificant Medtronic Therapies1 Therapy and Applicable CPT CodesCY2013 APCCY2014 APCCY 2015C-APCsCY 2016C-APCsCY2017C-APCs% change13-17 ICDs (33249)$30,680composite$32,145composite$ 30,818$30,490$30,514( )CRT-Ds(33249 and +33225)

10 $30,680composite$32,145composite$30,818$ 30,490$30,514( )Pacemakers (33208)$10,187$10,588$9,493$9,273$9,410( )CRT-Ps(33208 and +33225)$15,280$15,883$16,407$16,914$16, Ablations (93656)$11,146composite$13,115composite$ 14,362$15,561$16, HOSPITAL APC / C-APC PAYMENTS 2013- 2017 SHOW VARIABILITY1 MEDICARE national payment rates indicated are based on information included in the CMS Federal Registersfor CY 2013 2017 available at: ~ APC: Ambulatory Payment Classification; C-APC: Comprehensive Ambulatory Payment ClassificationAPC / C-APC payment rates reflect CHANGES based on the Affordable Care ECONOMICS & HEALTH POLICYOPPS MEDICARE PAYMENT COMPARISONS - PACEMAKERS:CY 2015 CY 2017 Comprehensive APCsMedicare CY 2015-CY 2017 OPPS final rule National Payments from Addendum B, see Appendix for links.