Venous Stenting Coding and Reimbursement Guide - …

1 Venous Stenting Coding & Reimbursement Guide 2021 Venous Stenting Coding & Reimbursement Guide 2 ICD-10-CM Diagnosis Codes .. 4 CPT Codes .. 6 ICD-10-PCS Procedure Codes .. 9 HCPCS II Device Codes .. 10 Physician Coding and Payment .. 12 Hospital Outpatient Coding and Payment .. 14 Hospital Inpatient Coding and Payment .. 17 Ambulatory Surgical Center Coding and Payment .. 18 References .. 20 TABLE OF CONTENTS Venous Stenting Coding & Reimbursement Guide 3 medtronic does not represent or guarantee that this information is complete, accurate, or applicable to any particular patient or third-party payer.

2 medtronic disclaims all liability for any consequence resulting from reliance on this document. The final decision of billing for any service must be made by the health care provider considering the medical necessity of the service furnished as well as the requirements of third-party payers and any local, state, or federal laws and regulations that apply. medtronic is providing this information in an educational capacity with the understanding that medtronic is not engaged in rendering accounting, or other professional services. Health care providers should consult with their own advisors regarding Coding , coverage, and payment.

3 Note: medtronic does not offer products with approved indications for all procedures listed. For questions or more information, please contact: medtronic Vascular Health Economics, Policy & Payment (866) 260-3987 CPT Copyright 2020 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.

4 The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Venous Stenting Coding & Reimbursement Guide 4 ICD-10-CM Diagnosis Codes ICD-10-CM diagnosis codes are used by both hospitals and physicians to document the indication for the procedure. Possible indications for Venous Stenting may include the codes listed below. Unspecified codes may also be available for the indications below, but their use should be avoided if possible, in favor of a more precise code for the specific anatomic sites.

5 Diagnosis ICD-10-CM Code Code Description Acute Embolism & Thrombosis Acute embolism and thrombosis of right femoral vein Acute embolism and thrombosis of left femoral vein Acute embolism and thrombosis of femoral vein, bilateral Acute embolism and thrombosis of right iliac vein Acute embolism and thrombosis of left iliac vein Acute embolism and thrombosis of iliac vein, bilateral Chronic Embolism & Thrombosis Chronic embolism and thrombosis of right femoral vein Chronic embolism and thrombosis of left femoral vein Chronic embolism and thrombosis of femoral vein, bilateral Chronic embolism and thrombosis of right iliac vein Chronic embolism and thrombosis of left iliac vein Chronic embolism and thrombosis of iliac vein.

6 Bilateral Postthrombotic Syndrome Postthrombotic syndrome without complications of right lower extremity Postthrombotic syndrome without complications of left lower extremity Postthrombotic syndrome without complications of bilateral lower extremity Postthrombotic syndrome with ulcer of right lower extremity Postthrombotic syndrome with ulcer of left lower extremity Postthrombotic syndrome with ulcer of bilateral lower extremity Continued on the next page Venous Stenting Coding & Reimbursement Guide 5 Diagnosis ICD-10-CM Code Code Description Postthrombotic Syndrome continued Postthrombotic syndrome with inflammation of right lower extremity Postthrombotic syndrome with inflammation of left lower extremity Postthrombotic syndrome with inflammation of bilateral lower extremity Postthrombotic syndrome with ulcer and inflammation of right lower extremity Postthrombotic syndrome with ulcer and inflammation of left lower extremity Postthrombotic syndrome with ulcer and inflammation of bilateral lower extremity Postthrombotic syndrome with

7 Other complications of right lower extremity Postthrombotic syndrome with other complications of left lower extremity Postthrombotic syndrome with other complications of bilateral lower extremity Nonthrombotic Obstruction of Vein *Compression of vein *Note is assigned for Venous stenosis or stricture as well as May-Thurner syndrome Venous Stenting Coding & Reimbursement Guide 6 CPT Codes CPT codes are used by physicians for all procedures as well as by Ambulatory Surgical Centers and hospitals for outpatient procedures.

8 The index procedure of Venous stent placement requires multiple CPT codes. Placement of Venous Stent CPT Code CPT Description 37238 Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; initial vein +37239 Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; each additional vein Coding Points : o The codes are defined by vessel, not by stent.

9 A single code is assigned when multiple stents are placed in the same vessel. o When a single lesion extends across two vessels but is opened with a single therapy , only one code is used. o When additional, different vessels are treated in the same session, the use of the add-on code (+37239) should be used as appropriate. o Angioplasty in the same vessel before and after stent deployment, including all pre-dilation and post-dilation, is integral and not coded separately. Treatment of a lesion outside of the segment that is stented but within the same vessel is also included and not coded separately.

10 O Angioplasty in a separate and distinct vessel may be reported separately o Catheterization is not included and is coded separately. o The codes include all radiological S&I, completion imaging, and closure. o Intravascular Ultrasound (IVUS) is coded separately when performed. Catheterization CPT Code CPT Description 36011 Selective catheter placement, Venous system, first order branch 36012 Selective catheter placement, Venous system; second order or more selective branch Coding Points : o From a contralateral access site: o stent placement in the common iliac vein - 36011 is most likely o stent placement in the external iliac vein or common femoral vein 36012 is most likely o The appropriate order must always be confirmed Venous Stenting Coding & Reimbursement Guide 7 Venography CPT Code CPT Description Extremity Venography 75820 Venography, extremity, unilateral, radiological supervision and interpretation 75822 Venography, extremity, bilateral, radiological supervision and interpretation Inferior Vena Cava Venography 75825 Venography, caval, inferior.