Solitaire Revascularization Device Coding and ...

1 Solitaire Revascularization DEVICECODING ANDREIMBURSEMENTGUIDE1 The Solitaire Revascularization Device is a self-expanding Device designed to restore blood fl ow in patients experiencing acute ischemic stroke due to large intracranial vessel occlusion. The Device is designed for use in the neurovasculature, such as the internal carot-id artery, M1 and M2 segments of the middle cerebral artery, anterior cerebral artery, basilar and the vertebral arteries. The Solitaire Revascularization Device is com-prised of a scaff olding design made of nitinol and a pushwire attached to the nitinol scaf-folding. It is supplied pre-loaded into an intro-ducer sheath. The Solitaire Device is designed to be delivered through a microcatheter, deployed across the clot and removed along with the clot to enable Revascularization of the occluded intracranial vessel. The revascular-ization procedure employs a widely accepted mode of delivery where the arterial system is accessed through the femoral artery in the groin.

2 The Device is then navigated to the brain using standard endovascular Revascularization Device2 DIAGNOSIS CODINGICD-10-CM DIAGNOSIS CODES1 eff ective October 1, 2017 ICD-10-CM diagnosis codes are used by both physicians and hospitals to report the indication for the infarction due to thrombosis of unspecifi ed precerebral infarction due to thrombosis of right vertebral infarction due to thrombosis of left vertebral infarction due to thrombosis of bilateral vertebral infarction due to thrombosis of unspecifi ed vertebral infarction due to thrombosis of basilar infarction due to thrombosis of right carotid infarction due to thrombosis of left carotid infarction due to thrombosis of bilateral carotid infarction due to thrombosis of unspecifi ed carotid infarction due to thrombosis of other precerebral infarction due to embolism of unspecifi ed precerebral infarction due to embolism of right vertebral arteryCODE2 ischemic stroke .

3 PRECEREBRAL ARTERIES CODE DESCRIPTIONM edtronic provides this information for your convenience only. It does not constitute legal advice or a recommendation regarding clinical practice. Information provided is gathered from third-party sources and is subject to change without notice due to frequently changing laws, rules and regulations. Medtronic makes no guarantee that the use of this information will prevent diff erences of opinion or disputes with Medicare or other payers as to the correct form of billing or the amount that will be paid to providers of service. Please contact your Medicare contractor, other payers, reimbursement specialists and/or legal counsel for interpretation of Coding , coverage and payment policies. This document provides assistance for FDA cleared indications. Where reimbursement is sought for use of a product that may be inconsistent with, or not expressly specifi ed in, the FDA cleared labeling (eg, instructions for use, operator s manual or package insert), consult with your billing advisors or payers on handling such billing issues.

4 Some payers may have policies that make it inappropriate to submit claims for such items or related following information is calculated per the footnotes included and does not take into eff ect Medicare payment reductions resulting from sequestration associated with the Budget Control Act of 2011. Sequestration reductions went into eff ect on April 1, questions please contact us at infarction due to embolism of left vertebral infarction due to embolism of bilateral vertebral infarction due to embolism of unspecifi ed vertebral infarction due to embolism of basilar infarction due to embolism of right carotid infarction due to embolism of left carotid infarction due to embolism of bilateral carotid infarction due to embolism of unspecifi ed carotid infarction due to embolism of other precerebral infarction due to unspecifi ed occlusion or stenosis of unspecifi ed precerebral infarction due to unspecifi ed occlusion or stenosis of right vertebral infarction due to unspecifi ed occlusion or stenosis of left vertebral infarction due to unspecifi ed occlusion or stenosis of bilateral vertebral infarction due to unspecifi ed occlusion or stenosis of unspecifi ed vertebral infarction due to

5 Unspecifi ed occlusion or stenosis of basilar infarction due to unspecifi ed occlusion or stenosis of right carotid infarction due to unspecifi ed occlusion or stenosis of left carotid infarction due to unspecifi ed occlusion or stenosis of bilateral carotid infarction due to unspecifi ed occlusion or stenosis of unspecifi ed carotid infarction due to unspecifi ed occlusion or stenosis of other precerebral arteriesCODE2 ischemic stroke : PRECEREBRAL ARTERIES CODE DESCRIPTIONDIAGNOSIS OF IV t-PA3 Status post-administration of IV t-PA (rtPA) in a diff erent facility within the last 24 hours prior to admission to current facility4 DIAGNOSIS CODINGICD-10-CM DIAGNOSIS CODES1 eff ective October 1, 2017 ICD-10-CM diagnosis codes are used by both physicians and hospitals to report the indication for the infarction due to thrombosis of unspecifi ed cerebral infarction due to thrombosis of right middle cerebral infarction due to thrombosis of left middle cerebral infarction due to thrombosis of bilateral middle cerebral infarction due to thrombosis of unspecifi ed middle cerebral infarction due to thrombosis of right anterior cerebral infarction due to thrombosis of left anterior cerebral infarction due to thrombosis of bilateral anterior cerebral infarction due to thrombosis of unspecifi ed anterior cerebral infarction due to thrombosis of right posterior cerebral infarction due to thrombosis of left posterior cerebral infarction due to thrombosis of bilateral posterior cerebral infarction due to thrombosis of unspecifi ed posterior cerebral

6 Infarction due to thrombosis of right cerebellar infarction due to thrombosis of left cerebellar infarction due to thrombosis of bilateral cerebellar infarction due to thrombosis of unspecifi ed cerebellar infarction due to thrombosis of other cerebral infarction due to embolism of unspecifi ed cerebral infarction due to embolism of right middle cerebral infarction due to embolism of left middle cerebral infarction due to embolism of bilateral middle cerebral infarction due to embolism of unspecifi ed middle cerebral infarction due to embolism of right anterior cerebral infarction due to embolism of left anterior cerebral infarction due to embolism of bilateral anterior cerebral infarction due to embolism of unspecifi ed anterior cerebral infarction due to embolism of right posterior cerebral arteryCODE2 ischemic stroke : CEREBRAL ARTERIES CODE infarction due to embolism of left posterior cerebral infarction due to embolism of bilateral posterior cerebral infarction due to embolism of unspecifi ed posterior cerebral infarction due to embolism of right cerebellar infarction due to embolism of left cerebellar infarction due to embolism of bilateral cerebellar infarction due to embolism of unspecifi ed cerebellar infarction due to embolism of other cerebral infarction due to unspecifi ed occlusion or stenosis of unspecifi ed cerebral infarction due to unspecifi ed occlusion or stenosis of right middle cerebral infarction due to unspecifi ed occlusion or stenosis of left middle cerebral infarction due to unspecifi ed occlusion or stenosis of bilateral middle cerebral infarction due to unspecifi ed occlusion or stenosis of unspecifi ed middle cerebral infarction

7 Due to unspecifi ed occlusion or stenosis of right anterior cerebral infarction due to unspecifi ed occlusion or stenosis of left anterior cerebral infarction due to unspecifi ed occlusion or stenosis of bilateral anterior cerebral infarction due to unspecifi ed occlusion or stenosis of unspecifi ed anterior cerebral infarction due to unspecifi ed occlusion or stenosis of right posterior cerebral infarction due to unspecifi ed occlusion or stenosis of left posterior cerebral infarction due to unspecifi ed occlusion or stenosis of bilateral posterior cerebral infarction due to unspecifi ed occlusion or stenosis of unspecifi ed posterior cerebral infarction due to unspecifi ed occlusion or stenosis of right cerebellar infarction due to unspecifi ed occlusion or stenosis of left cerebellar cerebral infarction due to unspecifi ed occlusion or stenosis of bilateral cerebellar infarction due to unspecifi ed occlusion or stenosis of unspecifi ed cerebellar infarction due to unspecifi ed occlusion or stenosis of other cerebral infarction due to cerebral venous thrombosis, cerebral infarction, unspecifi ed DIAGNOSIS CODINGCODE2 ischemic stroke .

8 CEREBRAL ARTERIES DESCRIPTION6 HOSPITAL INPATIENT PROCEDURE Coding AND DRG PAYMENTICD-10-PCS PROCEDURE CODES4 eff ective October 1, 2017 ICD-10-PCS procedure codes are used by hospitals to report surgeries and procedures performed in the inpatient of Matter from Right Internal Carotid Artery, Percutaneous Approach03CK3 ZZExtirpation of Matter from Intracranial Artery, Percutaneous ApproachFluoroscopy of Intracranial Arteries using Other Contrast6 Fluoroscopy of Intracranial Arteries using Low Osmolar ContrastIntroduction of Other Thrombolytic into Peripheral Vein, Percutaneous Approach03CG3 ZZB31 RYZZB31R1ZZ3E03317 CODEREMOVAL OF THROMBUS5 CEREBRAL ARTERIOGRAPHYUSE OF THROMBOLYTIC (IV t-PA)CODE DESCRIPTIONE xtirpation of Matter from Right Common Carotid Artery, Percutaneous Approach03CH3 ZZExtirpation of Matter from Left Common Carotid Artery, Percutaneous Approach03CJ3 ZZExtirpation of Matter from Left Internal Carotid Artery, Percutaneous Approach03CL3 ZZExtirpation of Matter from Right External Carotid Artery, Percutaneous Approach03CM3 ZZExtirpation of Matter from Left External Carotid Artery, Percutaneous Approach03CN3 ZZExtirpation of Matter from Right Vertebral Artery, Percutaneous Approach03CP3 ZZExtirpation of Matter from Left Vertebral Artery, Percutaneous Approach03CQ3ZZ7 HOSPITAL INPATIENT PROCEDURE Coding AND DRG PAYMENTI ntracranial Hemorrhage or Cerebral Infarction W MCC064 DRG ASSIGNMENT FY2018 eff ective October 1, 2017 Under Medicare s MS-DRG methodology for hospital inpatient payment.

9 Each inpatient stay is assigned to one of about 750 diagnosis-related groups, based on the ICD-10 codes assigned to the diagnoses and procedures. Each MS-DRG has a relative weight that is then converted to a fl at payment amount. Implanted devices are typically included in the fl at payment and are not paid separately. Only one MS-DRG is assigned for each inpatient stay, regardless of the number of procedures performed. MS-DRGs shown are those typically assigned to the following scenarios. MS-DRG7 ischemic stroke WITH REMOVAL OF THROMBUS ( Solitaire Device MECHINICAL THROMBECTOMY)11 ischemic stroke WITH ADMINISTRATION OF THROMBOLYTIC ONLYISCHEMIC stroke WITH MEDICAL MANAGEMENT ONLYC raniotomy with Major Device Implant/ acute Complex Central Nervous System Principal Diagnosis W MCC or Chemo Implant11023 acute ischemic stroke with Use of Thrombolytic Agent W MCC061 acute ischemic stroke with Use of Thrombolytic Agent W CC062 Intracranial Hemorrhage or Cerebral Infarction W CC or IV t-PA in 24 Hrs065 acute ischemic stroke with Use of Thrombolytic Agent WO CC/MCC063 Intracranial Hemorrhage or Cerebral Infarction WO CC/MCC066 Craniotomy with Major Device Implant/ acute Complex Central Nervous System Principal Diagnosis WO MCC11024FY 2018 SUBJECT TO PACT7,9 YesYesNoNoYesNoYesYesFY 2018 MEDICARE NATIONAL AVERAGE10$10,658$33,115 $16,861 $11,644 $6,214$9,744$4,499$23,090FY 2018 GEOMETRIC MEAN LENGTH OF RELATIVE TITLE7.

10 8 HCPCS Device CODESHCPCS Device codes are assigned by the entity that purchased and supplied the Device to the patient. In the case of Solitaire , that is the hospital. However, hospitals assign HCPCS Device codes only when the Device is provided in the hospital outpatient setting. HCPCS Device codes cannot be assigned or billed for procedures performed in the inpatient setting. If a hospital requires a HCPCS Device code for an inpatient case for internal purposes only, such as for tracking, please refer to the HCPCS addendum for references. 8 PHYSICIAN PROCEDURE Coding AND PAYMENTCPT CODES12 eff ective January 1, 2018CY 2018 RBRVS FACTORS13 eff ective January 1, 2018 CPT CODE CY2018 MEDICARE NATIONAL AVERAGE (FACILITY SETTING)15,16CY2018 MEDICARE RVUS (FACILITY SETTING)15 MULTIPLE PROCEDURE DISCOUNTING14 CODE DESCRIPTIONP ercutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis, intracranial, any method, including diagnostic angiography, fl uoroscopic guidance, catheter placement, and intraprocedural pharmacological thrombolytic injection(s) 61645$865 PHYSICIAN PROCEDURE Coding AND PAYMENT FOR Solitaire THROMBECTOMYP hysicians use CPT codes for all Medicare s Resource-Based Relative Value Scale (RBRVS) methodology for physician payment, each CPT code is assigned a point value, the relative value unit (RVU)