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. 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.

2 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. 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. The AMA does not directly or indirectly practice medicine or dispense medical services.

3 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. 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.

4 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 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.

5 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 . 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.

6 Treatment of a lesion outside of the segment that is stented but within the same vessel is also included and not coded separately. 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, with serialography, radiological supervision and interpretation Coding Points: o Venography may be performed during stent placement, as well as pre- Stenting and post- Stenting .

7 However, although performed, codes for venography may not always be assigned. o When diagnostic venography was previously performed and billed, it cannot be coded and billed again during the stent placement procedure because it is considered duplicative. o Diagnostic venography can be coded separately with Venous stent placement in certain scenarios: o No prior venography is available and the decision to intervene is based on the new diagnostic venography - OR o The patient's condition has changed since the previous venography - OR o There was inadequate visualization with the previous venography - OR o A clinical change occurred during the stent placement procedure which requires new evaluation outside the target area o If venography is coded separately with the Venous stent placement, modifier -59 for Distinct Procedural Service must be appended to the venography code to indicate that the venography was truly diagnostic and to override NCCI bundling edits.

8 O Catheterization is coded separately with diagnostic venography. When diagnostic venography is performed and coded separately with placement of Venous stent , the catheterization codes assigned for one suffice for the other. Depending on the extent of the diagnostic venography, the catheterization may be more extensive than that associated with placement of the Venous stent and multiple catheterization codes may be needed. o Physicians only: Physicians must append modifier -26, Professional Component, to codes 75820, 75822, and 75825 for venography performed in a facility. This indicates that the physician service is interpretation of results, with the facility supplying the equipment. Venous Stenting Coding & Reimbursement Guide 8 Other Potentially Applicable CPT Codes Other imaging may also be performed during the encounter for Venous stent placement. This may occur to meet the hospital standard of care, or as medically necessary at physician direction.

9 CPT Code CPT Description Intravascular Ultrasound (IVUS) +37252 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation, initial noncoronary vessel +37253 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel Ultrasound Guided Vessel Puncture for Access +76937 Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting Duplex Scan 93970 Duplex scan of extremity veins including responses to compression and other maneuvers, complete bilateral study 93971 Duplex scan of extremity veins including responses to compression and other maneuvers, unilateral or limited study Coding Points: o IVUS codes include all transducer manipulations and repositioning before, during and after the stent placement.

10 O If a single lesion extends across two vessels, only one IVUS code is used. o Catheterization for IVUS is subsumed into the catheterization codes assigned for the Venous stent placement. o To assign code +76937, all requirements in its definition must be met. In particular, the use of handheld ultrasound does not qualify. o *Physicians only: Physicians must append modifier -26, Professional Component, to code +76937 for ultrasound guidance and to 93970 or 93971 for a Duplex performed in a facility. This indicates that the physician service is interpretation of results, with the facility supplying the equipment. Venous Stenting Coding & Reimbursement Guide 9 ICD-10-PCS Procedure Codes ICD-10-PCS codes are used by hospitals for inpatient procedures. These codes are one of the key elements making up hospital inpatient DRG assignment and Medicare DRG Reimbursement . ICD-10-PCS codes are standardized. The following bullet points highlights what each character represents and those used in Venous Stenting .