2017 hospital coding - medtronic · 2 of 25 2017 hospital coding systems and medicare payment...

2017 HOSPITAL CODING

Reference Guide for Cardiac Rhythm and Heart Failure (CRHF) Procedures

New in 2017 ........................................................................................ 3

Pacemaker Procedures ................................................................... 5

Implantable Defibrillator Procedures .........................................11

Electrophysiology Procedures .....................................................17

Implantable Devices for Diagnostic Procedures ....................21

Medtronic CareLink™ Network Procedures .............................23

CONTENTS

Pacemaker

ProceduresElectrophysiology Procedures

Implantable

Defibrillator

Procedures

Implantable D

evices for D

iagnostic Procedures

Medtronic

CareLink

™ Netw

ork Procedures

New

in 2017

2017 1 of 25

This booklet includes the commonly billed hospital codes for cardiac rhythm and heart failure devices and procedures. This is not a comprehensive list of all available codes, and it is possible that there is a more appropriate code for any given procedure.

These coding suggestions 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 specific 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 service.

For questions or for more information, please contact Medtronic at 1 (866) 877-4102.

Cardiac Rhythm and Heart Failure reimbursement customer information is available at www.medtronic.com/crdmreimbursement.

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. 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.

Where reimbursement is requested for the use of a product that may be inconsistentor not expressly specified in the FDA cleared or approved labeling (e.g., instructions foruse, operator’s manual, or package insert), consult with your billing advisors or payersfor advice on handling such billing issues. Some payers may have policies that make itinappropriate to submit claims for such items or related services.

2 of 25 2017

HOSPITAL CODING SYSTEMS AND MEDICARE PAYMENT METHODOLOGIESHospital Inpatient Coding and ReimbursementHospitals will continue to assign ICD-10 diagnosis and procedure codes as this coding methodology was implemented for discharges occurring on and after October 1, 2015. Medicare inpatient hospital reimbursement is based on the Medicare-Severity Diagnosis Related Group (MS-DRG) system. For each discharge, the applicable diagnoses and procedure codes are categorized into one of many MS-DRGs. Only one MS-DRG is assigned regardless of the number of procedure and diagnosis codes. Each MS-DRG has a unique relative weight that is used to convert that episode of care into the payment amount

Hospital Outpatient Coding and ReimbursementSimilar to physicians, hospitals use ICD-10-CM codes for diagnoses and numeric CPT or HCPCS* (includes an alpha character) to report procedures performed in an outpatient setting. The Comprehensive Ambulatory Payment Classification (C-APC) methodology that began in CY 2015 will continue to exist for device-intensive procedures in CY 2017. The comprehensive payment policy will package payment for adjunctive and secondary items, services, and procedures into the most costly primary procedure at the claim level.1 Changes to C-APC/APCs and CPT procedure codes are effective January 1st of each year.

ICD-10-CM diagnosis codes were implemented for service dates on and after October 1, 2015.

The information in this document does not identify code pairs that may be subject to the Medicare National Correct Coding Initiatives (NCCI) edits.

*HCPCS: Healthcare Common Procedure Coding System.

Modifiers2:KX: Requirements specified in the medical policy have been met. PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospitalPO: Excepted service provided at an off-campus, outpatient, provider-based department of a hospitalQ0 (zero): Investigational clinical service provided in a clinical research study that is in an approved clinical research study. This modifier also denotes a primary prevention patient for Medicare implantable defibrillator device implants. SC: Medically necessary service or supply-25: Significant, separately identifiable E/M service by the same physician or other qualified health care professional on the

same day of the procedure or other service-52: Reduced services-58: Staged or related procedure or service by the same physician or other qualified health care professional during the

post-operative period-73: Discontinued outpatient hospital procedure prior to administration of anesthesia-74: Discontinued outpatient hospital procedure after administration of anesthesia-76: Repeat procedure or service by same physician or other qualified health care professional-77: Repeat procedure by another physician or other qualified health care professional-78: Unplanned return to the OR/procedure room by the same physician or other qualified health care professional

following initial procedure for a related procedure during the post-operative period-79: Unrelated procedure or service by the same physician during the post-operative period

2017 3 of 25

NEW IN 2017Hospital Coding and ReimbursementI. C-APC and APC reassignments effective January 1, 20171

CPT or Category III Codes Abbreviated 2017 CPT or Category III Description 2017 C-APC or

APC Assignment2016 C-APC or APC Assignment

0387T Transcath insert/replace perm. leadless pacer, ventricular 5194 5193

33215 Reposition previously implanted transvenous pacer or defibrillator lead

5182 5181

33284 Remove cardiac-event recorder 5071 5073

93229 External mobile cardiovascular telemetry 5733 5722

93303 Transthoracic echo for congenital anomalies; complete 5524 5534

93304 Echo for congenital anomalies; follow-up or limited study 5524 5533

93306 Echo, complete, w/spectral Doppler and color flow Doppler 5524 5533

93307 Echo, complete, w/out spectral Doppler and color flow Doppler

5524 5533

93308 Echo; follow-up or limited study 5523 5532

Cardiac Rhythm and Heart Failure (CRHF) reimbursement customer information is available at www.medtronic.com/crdmreimbursement.

Current Procedural Terminology (CPT) is copyright 2016 American Medical Association.

New

in 2017

4 of 25 2017

2017 5 of 25

PACEMAKER PROCEDURESHOSPITAL INPATIENT:An example of ICD-10 Inpatient Hospital coding for a dual chamber pacemaker system implant and a cardiac resynchronization therapy pacemaker implant is available at this website address: http://www.medtronic.com/content/dam/medtronic-com/01_crhf/PDF/icd-10-pcs-procedure-coding-examples-for-crhf.pdf

Possible DRG Assignments (MS-DRG: Medicare Severity Diagnosis Related Group)

MS-DRG Brief MS-DRG Description

242243244

Pacemaker implant w/MCCPacemaker implant w/CCPacemaker implant w/o CC/MCC

260261262

Pacemaker revision w/MCCPacemaker revision w/CCPacemaker revision w/o CC/MCC

258259

Pacemaker device replacement w/MCCPacemaker device replacement w/o MCC

MCC: Major complication or comorbidity CC: Complication or comorbidity

HOSPITAL OUTPATIENT CPT CODES:Pacemaker Procedures

Insertion33206 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial33207 ventricular33208 atrial and ventricular33212 Insertion of pacemaker pulse generator only; with existing single lead33213 with existing dual leads33221 with existing multiple leads33214 Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system

(includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator)

33216 Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator33217 Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator33224 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to

previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator)

+33225 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for upgrade to dual chamber system) (List separately in addition to code for primary procedure)

0387T Transcatheter insertion or replacement of permanent leadless pacemaker, ventricular

Insertion or Replacement of Temporary Pacemaker33210 Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker

catheter (separate procedure)33211 Insertion or replacement of temporary transvenous dual chamber pacing electrodes (separate

procedure)

Removal and Replacement33227 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator;

single lead system33228 dual lead system33229 multiple lead system

Pacemaker

Procedures

http://www.medtronic.com/content/dam/medtronic-com/01_crhf/PDF/icd-10-pcs-procedure-coding-examples-for-crhf.pdf



6 of 25 2017

Removal33233 Removal of permanent pacemaker pulse generator only33234 Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular33235 dual lead system0388T Transcatheter removal of permanent leadless pacemaker, ventricular

Repositioning, Repair, Relocation33215 Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or

right ventricular) electrode33218 Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator33220 Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator33222 Relocation of skin pocket for pacemaker33226 Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal,

insertion and/or replacement of existing generator)

Echocardiography93303 Transthoracic echocardiography for congenital cardiac anomalies; complete93304 follow-up or limited study93306 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording,

when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography

93307 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography

93308 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study

+93320 Doppler echocardiography, pulsed wave and/or continuous wave with spectral display; complete (List separately in addition to codes for echocardiographic imaging) (Use 93320 in conjunction with 93303, 93304, 93312, 93314, 93315, 93317, 93350, 93351)2

+93321 follow-up or limited study (List separately in addition to codes for echocardiographic imaging) (Use 93321 in conjunction with 93303, 93304, 93308, 93312, 93314, 93315, 93317, 93350, 93351)2

+93325 Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography) (Use 93325 in conjunction with 76825, 76826, 76827, 76828, 93303, 93304, 93308, 93312, 93314, 93315, 93317, 93350, 93351)2

Cardiac Device Analysis, Interrogation, and Programming Evaluation93724 Electronic analysis of antitachycardia pacemaker system (includes electrocardiographic recording,

programming of device, induction and termination of tachycardia via implanted pacemaker, and interpretation of recordings)

In Person93279 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the

function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead pacemaker system

93280 dual lead pacemaker system93281 multiple lead pacemaker system93288 Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified

health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system

93290 implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors

0389T Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report, leadless pacemaker system

0391T Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording and disconnection per patient encounter, leadless pacemaker system

Transtelephonic/Remote93293 Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple lead pacemaker system,

includes recording with and without magnet application with analysis, review and report(s) by a physician or other qualified health care professional, up to 90 days

93296 Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system or implantable cardioverter-defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results

93299 Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system or implantable loop recorder system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results

Pacemaker Procedures, cont’d.

2017 7 of 25


External 93229 External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real

time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; technical support for connection and patient instructions for use, attended surveillance, analysis and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional

Peri-Procedural93286 Peri-procedural device evaluation (in person) and programming of device system parameters before or after

a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead pacemaker system

0390T Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure or test with analysis, review and report, leadless pacemaker system

Frequency Guidelines:Medicare identifies the frequency guidelines for pacemaker clinic services in the Cardiac Pacemaker Evaluation Services Medicare National Coverage Determinations Manual (CMS Pub, 100-03) §20.8.1—Cardiac Pacemaker Evaluation Services (Rev. 173, Issued: 09-04-14) CIM 50-1. Contact your local payer to discuss this pacemaker evaluation National Coverage Determination and other Coding/Billing articles.

+ Codes with a + symbol are “add-on” codes. These procedures are always performed in addition to the primary service/procedure, and are never reported as stand-alone codes.

Possible C-APC and APC AssignmentsMedicare Comprehensive Ambulatory Payment Classifications (C-APCs) include device-intensive procedures and are assigned a “J1” status indicator. APC assignment may be applicable for other procedure codes.

CPT or Category III Codes

Abbreviated 2017 CPT or Category III Descriptions

C-APC or APC Group C-APC/APC Description

33222 Relocation of skin pocket for pacemaker 5054 Level 4 Skin Procedures

0388T Transcatheter removal of permanent leadless pacemaker, ventricular

5182 Level 2 Vascular Procedures

33215 Reposition previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular)

33226 Reposition previously implanted left ventricular electrode

0387T Transcatheter insertion or replacement of permanent leadless pacemaker, ventricular

5194 Level 4 Endovascular Procedures

33218 Repair of single transvenous electrode, pacemaker or implantable defibrillator

5221 Level 1 Pacemaker and Similar Procedures

33220 Repair of 2 transvenous electrodes, pacemaker or implantable defibrillator

33234 Remove transvenous pacemaker electrode; single lead system

33235 Remove transvenous pacemaker electrode(s); dual lead system

33210 Insert/replace temporary transvenous single chamber cardiac electrode


33211 Insert/replace temporary transvenous dual chamber pacing electrodes

33212 Insert pacemaker pulse generator only; with existing single lead

33216 Insert single transvenous electrode, pacemaker or implantable defibrillator

33217 Insert 2 transvenous electrodes, pacemaker or implantable defibrillator

33227 Remove and replace pacemaker generator; single lead system

33233 Remove pacemaker pulse generator only

8 of 25 2017





33206 Insert new or replacement pacemaker with transvenous electrode; atrial


33207 Insert new or replacement pacemaker with transvenous electrode; ventricular

33208 Insert new or replacement pacemaker with transvenous electrodes; atrial and ventricular

33213 Insert pacemaker pulse generator only; with existing dual leads

33214 Upgrade pacemaker system, conversion of single chamber to dual chamber system

33224 Insert LV lead, with attachment to previously placed pacemaker or implantable defibrillator generator

33228 Remove and replace pacemaker generator; dual lead system

33221 Insert pacemaker pulse generator only; with existing multiple leads


33229 Remove and replace pacemaker generator; multiple lead system

93308 Transthoracic echo, follow-up or limited study 5523 Level 3 Diagnostic Imaging without Contrast

93303 Transthoracic echo for congenital cardiac anomalies; complete

5524 Level 4 Diagnostic Imaging without Contrast

93304 Transthoracic echo for congenital cardiac anomalies; follow-up or limited study

93306 Transthoracic echo, complete, with spectral and color flow Doppler

93307 Transthoracic echo, complete, without spectral and color flow Doppler

93229 External mobile cardiovascular telemetry up to 30 days

5733 Level 3 Minor Procedures

0389T Programming device evaluation (in person), leadless pacemaker system

5741 Level 1 Electronic Analysis of Devices

0391T Interrogation device evaluation (in person), leadless pacemaker system

93279 Programming device evaluation (in person), single lead pacemaker system

93280 Programming device evaluation (in person), dual lead pacemaker system

93281 Programming device evaluation (in person), multiple lead pacemaker system

93288 Interrogation device evaluation (in person); single, dual, or multiple lead pacemaker system

93290 Interrogation device evaluation (in person); implantable cardiovascular monitor (ICM) system

93293 Transtelephonic rhythm strip evaluation(s) single, dual, or multiple lead pacemaker system, up to 90 days

93296 Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker or implantable defibrillator system

93299 Interrogation device evaluation(s) (remote), up to 30 days; ICM or ILR

2017 9 of 25




93724 Electronic analysis of antitachycardia pacemaker system


0390T Peri-procedural device evaluation, leadless pacemaker system

Status N, Not separately payable "Items and Service Packaged into APC Rates"

+33225 Insert LV lead, at time of insertion of pacemaker or implantable defibrillator generator

93286 Peri-procedural device evaluation, pacemaker system

+93320 Doppler echo, complete

+93321 Doppler echo, follow-up or limited study

+93325 Doppler echo color flow velocity mapping

Status “C” Procedures— Inpatient Only*

CPT Codes CPT Description

33202 Insertion of epicardial electrode(s); open incision (e.g., thoracotomy, median sternotomy, subxiphoid approach)

33203 Insertion of epicardial electrode(s); endoscopic approach (e.g., thoracoscopy, pericardioscopy)

33236 Removal of permanent epicardial pacemaker and electrodes by thoracotomy; single lead system, atrial or ventricular

33237 Removal of permanent epicardial pacemaker and electrodes by thoracotomy; dual lead system

33238 Removal of permanent transvenous electrode(s) by thoracotomy

* The Addendum E file includes the codes that are paid only as Inpatient procedures in CY 2017. Log on to: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices.html, then access, CMS-1656-FC, click on CY 2017 OPPS Final Rule Addenda and open Addendum E.


https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices.html



10 of 25 2017

2017 11 of 25

IMPLANTABLE DEFIBRILLATOR PROCEDURESHOSPITAL INPATIENT:An example of ICD-10 Inpatient Hospital coding for a dual chamber defibrillator system implant and a cardiac resynchronization therapy defibrillator implant is available at this website address: http://www.medtronic.com/content/dam/medtronic-com/01_crhf/PDF/icd-10-pcs-procedure-coding-examples-for-crhf.pdf



222 223

Cardiac defibrillator implant w/cardiac cath w/principal dx of AMI, HF or Shock w/MCCCardiac defibrillator implant w/cardiac cath w/principal dx of AMI, HF or Shock w/o MCC

224225

Cardiac defibrillator implant w/cardiac cath w/o principal dx of AMI, HF or Shock w/MCCCardiac defibrillator implant w/cardiac cath w/o principal dx of AMI, HF or Shock w/o MCC

226 227

Cardiac defibrillator implant w/o cardiac cath w/MCCCardiac defibrillator implant w/o cardiac cath w/o MCC

245 AICD generator procedures

265 AICD lead procedures

MCC: Major complication or comorbidity

HOSPITAL OUTPATIENT CPT CODES:Implantable Defibrillator Procedures

Insertion33216 Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator33217 Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator33224 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously

placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator)

+33225 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for upgrade to dual chamber system) (List separately in addition to code for primary procedure)

33230 Insertion of pacing cardioverter-defibrillator pulse generator only; with existing dual leads33231 with existing multiple leads 33240 with existing single lead33249 Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s),

single or dual chamber33270 Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous

electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed

33271 Insertion of subcutaneous implantable defibrillator electrode

Insertion or Replacement of Temporary Pacemaker(May be applicable to Implantable Defibrillator Procedures, verify with payers as deemed appropriate)33210 Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter

(separate procedure)33211 Insertion or replacement of temporary transvenous dual chamber pacing electrodes (separate procedure)

Removal and Replacement33262 Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse

generator; single lead system33263 dual lead system 33264 multiple lead system

Removal33241 Removal of implantable defibrillator pulse generator only33244 Removal of single or dual chamber implantable defibrillator electrode(s); by transvenous extraction 33272 Removal of subcutaneous implantable defibrillator electrode

Implantable

Defibrillator

Procedures




http://www.medtronic.com/wcm/groups/mdtcom_sg/@mdt/@crdm/documents/documents/icd-10-icd-proc-code-10-7-15.pdf

12 of 25 2017

Repositioning, Repair, Relocation33215 Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or

right ventricular) electrode33218 Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator33220 Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator33223 Relocation of skin pocket for implantable defibrillator33226 Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including

removal, insertion and/or replacement of existing generator)33273 Repositioning of previously implanted subcutaneous implantable defibrillator electrode

Intra-operative Device Testing93640 Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including

defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement;

93641 with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator

Follow-Up Device Testing93642 Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator (includes

defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters)

93644 Electrophysiologic evaluation of subcutaneous implantable defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters)

Echocardiography93303 Transthoracic echocardiography for congenital cardiac anomalies; complete93304 follow-up or limited study93306 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording,

when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography

93307 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography

93308 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study

+93320 Doppler echocardiography, pulsed wave and/or continuous wave with spectral display; complete (List separately in addition to codes for echocardiographic imaging) (Use 93320 in conjunction with 93303, 93304, 93312, 93314, 93315, 93317, 93350, 93351)2

+93321 follow-up or limited study (List separately in addition to codes for echocardiographic imaging) (Use 93321 in conjunction with 93303, 93304, 93308, 93312, 93314, 93315, 93317, 93350, 93351)2

+93325 Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography) (Use 93325 in conjunction with 76825, 76826, 76827, 76828, 93303, 93304, 93308, 93312, 93314, 93315, 93317, 93350, 93351)2

Cardiac Device Analysis, Interrogation, and Programming EvaluationIn Person93260 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the

function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; implantable subcutaneous lead defibrillator system

93261 Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable subcutaneous lead defibrillator system

93282 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead transvenous implantable defibrillator system

93283 dual lead transvenous implantable defibrillator system93284 multiple lead transvenous implantable defibrillator system93289 Interrogation device evaluation (in person) with analysis, review and report by a physician or other

qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead transvenous implantable defibrillator system, including analysis of heart rhythm derived data elements

Remote93296 Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker

system or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results

Implantable Defibrillator Procedures, cont’d.

2017 13 of 25


External93229 External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized

real-time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; technical support for connection and patient instructions for use, attended surveillance, analysis and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional

93292 Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; wearable defibrillator system

93745 Initial set-up and programming by a physician or other qualified health care professional of wearable cardioverter-defibrillator includes initial programming of system, establishing baseline electronic ECG, transmission of data to data repository, patient instruction in wearing system and patient reporting of problems or events

Peri-Procedural 93287 Peri-procedural device evaluation (in person) and programming of device system parameters before or after

a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead implantable defibrillator system

ICD/CRT-D Devices with OptiVol™ Technology Cardiac Device Analysis InterrogationIn Person93290 Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified

health care professional, includes connection, recording and disconnection per patient encounter; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors

Remote93299 Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system or

implantable loop recorder system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results



CPT Codes Abbreviated 2017 CPT Descriptions C-APC or APC Group C-APC/APC Description

33223 Relocation of skin pocket for implantable defibrillator 5054 Level 4 Skin Procedures

33215 Reposition previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular)

5182 Level 2 Vascular Procedures

33226 Reposition previously implanted left ventricular electrode

93642 Electrophysiologic evaluation of single/dual chamber implantable defibrillator (not at initial implant or replacement)

5211 Level 1 Electrophysiologic Procedures

14 of 25 2017


33218 Repair of single transvenous electrode, pacemaker or implantable defibrillator


33220 Repair of 2 transvenous electrodes, pacemaker or implantable defibrillator

33241 Remove implantable defibrillator pulse generator only

33244 Remove single or dual chamber implantable defibrillator electrode(s), transvenous extraction

33272 Remove subcutaneous implantable defibrillator electrode

33273 Reposition previously implanted subcutaneous implantable defibrillator electrode

33210 Insert/replace temporary transvenous single chamber cardiac electrode


33211 Insert/replace temporary transvenous dual chamber pacing electrodes

33216 Insert single transvenous electrode, pacemaker or implantable defibrillator

33217 Insert 2 transvenous electrodes, pacemaker or implantable defibrillator

33271 Insert subcutaneous implantable defibrillator electrode

33224 Insert LV lead, with attachment to previously placed pacemaker or implantable defibrillator generator


33230 Insert implantable defibrillator generator only; with existing dual leads

5231 Level 1 ICD and Similar Procedures

33240 Insert implantable defibrillator generator only; with existing single lead

33262 Remove and replace implantable defibrillator generator; single lead system

33263 Remove and replace implantable defibrillator generator; dual lead system

33231 Insert implantable defibrillator generator only; with existing multiple leads

5232 Level 2 ICD and Similar Procedures

33249 Insert or replace implantable defibrillator system, with transvenous lead(s), single or dual chamber

33264 Remove and replace implantable defibrillator generator; multiple lead system

33270 Insert or replace subcutaneous implantable defibrillator system

93308 Transthoracic echo, follow-up or limited study 5523 Level 3 Imaging without Contrast

93303 Transthoracic echo for congenital cardiac anomalies; complete

5524 Level 4 Imaging without Contrast

93304 Transthoracic echo for congenital cardiac anomalies; follow-up or limited study

93306 Transthoracic echo, complete, with spectral and color flow Doppler

93307 Transthoracic echo, complete, without spectral and color flow Doppler

93229 External mobile cardiovascular telemetry up to 30 days



2017 15 of 25


93260 Programming device evaluation (in person), implantable subcutaneous lead defibrillator system


93261 Interrogation device evaluation (in person), implantable subcutaneous lead defibrillator system

93282 Programming device evaluation (in person), single lead transvenous implantable defibrillator system

93283 Programming device evaluation (in person), dual lead transvenous implantable defibrillator system

93284 Programming device evaluation (in person), multiple lead transvenous implantable defibrillator system

93289 Interrogation device evaluation (in person); single, dual, or multiple lead transvenous implantable defibrillator system

93290 Interrogation device evaluation (in person); implantable cardiovascular monitor (ICM) system

93292 Interrogation device evaluation (in person); wearable defibrillator system


93299 Interrogation device evaluation(s) (remote), up to 30 days; ICM or ILR


5743Level 3 Electronic Analysis of Devices93745 Initial set-up and programming of wearable

defibrillator

+33225 Insert LV lead, at time of insertion of pacemaker or implantable defibrillator generator

Status N, Not separately payable "Items and Service Packaged into APC Rates"

93287 Peri-procedural device evaluation, implantable defibrillator system

+93320 Doppler echo, complete

+93321 Doppler echo, follow-up or limited study

+93325 Doppler echo color flow velocity mapping

93640 Electrophysiologic evaluation of single/dual chamber implantable defibrillator leads at time of initial implant or replacement

93641 Electrophysiologic evaluation of single/dual chamber implantable defibrillator leads and generator at time of initial implant or replacement

93644 Electrophysiologic evaluation of subcutaneous implantable defibrillator (not at initial implant or replacement)

Status “C” Procedures—Inpatient Only*

CPT Codes CPT Description

33202 Insertion of epicardial electrode(s); open incision (e.g., thoracotomy, median sternotomy, subxiphoid approach)

33203 Insertion of epicardial electrode(s); endoscopic approach (e.g., thoracoscopy,pericardioscopy)

33243 Removal of single or dual chamber implantable defibrillator electrode(s); by thoracotomy

* The Addendum E file includes the codes that are paid only as Inpatient procedures in CY 2017. Log on to: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices.html, then access, CMS-1656-FC, click on CY 2017 OPPS Final Rule Addenda and open Addendum E.





16 of 25 2017

2017 17 of 25

ELECTROPHYSIOLOGY PROCEDURESHOSPITAL INPATIENT:An example of ICD-10 Inpatient Hospital coding for a pulmonary vein isolation catheter ablation is available at this website address: http://www.medtronic.com/content/dam/medtronic-com/01_crhf/PDF/icd-10-pcs-procedure-coding-examples-for-crhf.pdf



228229230

Other cardiothoracic procedures w/MCCOther cardiothoracic procedures w/CC Other cardiothoracic procedures w/o CC/MCC

273 274

Percutaneous cardiovascular procedure w/o coronary artery stent w/MCC Percutaneous intracardiac procedures w/o MCC


HOSPITAL OUTPATIENT CPT CODES:Recording, Mapping, and Pacing Procedures93600 Bundle of His recording93602 Intra-atrial recording93603 Right ventricular recording+93609 Intraventricular and/or intra-atrial mapping of tachycardia site(s) with catheter manipulation to record from

multiple sites to identify origin of tachycardia (List separately in addition to code for primary procedure)93610 Intra-atrial pacing93612 Intraventricular pacing+93613 Intracardiac electrophysiologic 3-dimensional mapping (List separately in addition to code for primary

procedure)93615 Esophageal recording of atrial electrogram with or without ventricular electrogram(s);93616 with pacing 93618 Induction of arrhythmia by electrical pacing

Electrophysiologic Evaluations93619 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

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

+93621 with left atrial pacing and recording from coronary sinus or left atrium (List separately in addition to code for primary procedure)

+93622 with left ventricular pacing and recording (List separately in addition to code for primary procedure)

Pharmacologic Assessment during EPS+93623 Programmed stimulation and pacing after intravenous drug infusion (List separately in addition to code

for primary procedure)

EP Follow-Up Study93624 Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including

induction or attempted induction of arrhythmia

Intra-Operative Cardiac Pacing and Mapping93631 Intra-operative epicardial and endocardial pacing and mapping to localize the site of tachycardia or zone

of slow conduction for surgical correction

Intra-Operative Device Testing93640 Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including

defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement;

93641 with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator

Electrophysiology Procedures




http://www.medtronic.com/wcm/groups/mdtcom_sg/@mdt/@crdm/documents/documents/icd-10-ep-ablation-cod-10-7-15.pdf

18 of 25 2017

Follow-Up Device Testing93642 Electrophysiologic evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator

(includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters)

93644 Electrophysiologic evaluation of subcutaneous implantable defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters)

Intracardiac Echocardiography+93662 Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision

and interpretation (List separately in addition to code for primary procedure)

External and Internal Cardioversion92960 Cardioversion, elective, electrical conversion of arrhythmia; external92961 internal (separate procedure)

Catheter Ablation93650 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

93654 with treatment of ventricular tachycardia or focus of ventricular ectopy including intracardiac electrophysiologic 3D mapping, when performed, and left ventricular pacing and recording, when performed

+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 (List separately in addition to code for primary procedure)

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 fibrillation by pulmonary vein isolation

+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 (List separately in addition to code for primary procedure)

Transseptal Puncture+93462 Left heart catheterization by transseptal puncture through intact septum or by transapical puncture

(List separately in addition to code for primary procedure) (Use 93462 in conjunction with 34777, 93452-93453, 93458-93461, 93582, 93653-93654)

Tilt Table Testing93660 Evaluation of cardiovascular function with tilt table evaluation, with continuous ECG monitoring and

intermittent blood pressure monitoring, with or without pharmacological intervention

Cardiac Device Analysis, Interrogation, and Programming Evaluation93724 Electronic analysis of antitachycardia pacemaker system (includes electrocardiographic recording,

programming of device, induction and termination of tachycardia via implanted pacemaker, and interpretation of recordings)


Electrophysiology Procedures, continued

2017 19 of 25

Electrophysiology Procedures, continued

Possible C-APC and APC Assignments Medicare Comprehensive Ambulatory Payment Classifications (C-APCs) include device-intensive procedures and are assigned a “J1” status indicator. APC assignment may be applicable for other procedure codes.


93603 Right ventricular recording 5211 Level 1 Electrophysiologic Procedures

93615 Esophageal recording of atrial electrogram with/without ventricular electrogram(s)

93616 Esophageal recording of atrial electrogram with/without ventricular electrogram(s); with pacing

93618 Induction of arrhythmia by electrical pacing

93642 Electrophysiologic evaluation of single/dual chamber implantable defibrillator (not at initial implant or replacement)

93600 Bundle of His recording 5212 Level 2 Electrophysiologic Procedures

93602 Intra-atrial recording

93610 Intra-atrial pacing

93612 Intraventricular pacing

93619 Comprehensive electrophysiologic evaluation, without induction or attempted induction of arrhythmia

93620 Comprehensive electrophysiologic evaluation, with induction or attempted induction of arrhythmia

93624 Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy

93650 Intracardiac catheter ablation of AV node function

93653 Comprehensive electrophysiologic evaluation, with induction or attempted induction of arrhythmia, treatment of SVT

5213 Level 3 Electrophysiologic Procedures

93654 Comprehensive electrophysiologic evaluation, with induction or attempted induction of arrhythmia, treatment of VT

93656 Comprehensive electrophysiologic evaluation including transseptal catheterizations with induction or attempted induction of arrhythmia, catheter ablation of atrial fibrillation by PVI

93660 Tilt table evaluation 5723 Level 3 Diagnostic Tests and Related Services



92960 Cardioversion, elective, electrical conversion of arrhythmia; external

5781 Resuscitation and Cardioversion

92961 Cardioversion, elective, electrical conversion of arrhythmia; internal

+93462 Left heart catheterization by transseptal puncture Status N, Not separately payable "Items and Service Packaged into APC Rates"

+93609 Intraventricular and/or intra-atrial mapping of tachy sites with catheter manipulation

+93613 Intracardiac electrophysiologic 3-dimensional mapping

+93621 Comprehensive electrophysiologic evaluation; with left atrial pacing and recording

+93622 Comprehensive electrophysiologic evaluation; with left ventricular pacing and recording

20 of 25 2017


+93623 Programmed stimulation and pacing after intravenous drug infusion

Status N, Not separately payable “Items and Service Packaged into APC Rates”

93631 Intra-operative epicardial and endocardial pacing and mapping

93640 Electrophysiologic evaluation of single/dual chamber implantable defibrillator leads at time of initial implant or replacement

93641 Electrophysiologic evaluation of single/dual chamber implantable defibrillator leads and generator at time of initial implant or replacement

93644 Electrophysiologic evaluation of subcutaneous implantable defibrillator (not at initial implant or replacement)

+93655 Intracardiac catheter ablation of discrete mechanism of arrhythmia which is distinct from the primary ablated mechanism

+93657 Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation after PVI

93662 Intracardiac echocardiography during therapeutic/diagnostic intervention

Electrophysiology Procedures, cont’d.

2017 21 of 25

IMPLANTABLE DEVICES FOR DIAGNOSTIC PROCEDURESHOSPITAL INPATIENT IMPLANTABLE PATIENT-ACTIVATED CARDIAC EVENT RECORDERS:An example of ICD-10 Inpatient Hospital coding for an implantable patient-activated cardiac event recorder is available at this website address: http://www.medtronic.com/content/dam/medtronic-com/01_crhf/PDF/icd-10-pcs-procedure-coding-examples-for-crhf.pdf



040 Peripheral/Cranial nerve & other nervous system w/MCC (MS-DRG 040-042 is assigned when the patient has a principal diagnosis of stroke)

041 Peripheral/Cranial nerve & other nervous system w/CC (MS-DRG 040-042 is assigned when the patient has a principal diagnosis of stroke)

042 Peripheral/Cranial nerve & other nervous system w/o CC/MCC (MS-DRG 040-042 is assigned when the patient has a principal diagnosis of stroke)

260 Pacemaker revision w/MCC (MS-DRG 260-262 is assigned when the patient has a principal diagnosis of syncope, for example)

261 Pacemaker revision w/CC (MS-DRG 260-262 is assigned when the patient has a principal diagnosis of syncope, for example)

262 Pacemaker revision w/o CC/MCC (MS-DRG 260-262 is assigned when the patient has a principal diagnosis of syncope, for example)


HOSPITAL OUTPATIENT CPT CODES:Insertion33282 Implantation of patient-activated cardiac event recorder

Removal33284 Removal of an implantable, patient-activated cardiac event recorder

Cardiac Device Analysis, Interrogation, and Programming EvaluationIn Person 93285 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the

function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; implantable loop recorder system

93291 Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable loop recorder system, including heart rhythm derived data analysis

Remote93299 Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system or



CPT Codes Abbreviated 2017 CPT Descriptions


33284 Remove implantable, patient-activated cardiac event recorder

5071 Level 1 Excision/ Biopsy/ Incision and Drainage

33282 Implant patient-activated cardiac event recorder


93291 Interrogation device evaluation (in person), implantable loop recorder (ILR)


93285 Programming device evaluation (in person), implantable loop recorder (ILR)


93299 Interrogation device evaluation(s), up to 30 days; ICM or ILR

Implantable D

evices for D

iagnostic Procedures




22 of 25 2017

2017 23 of 25

MEDTRONIC CARELINK™ NETWORK PROCEDURESOUTPATIENT CPT CODES:Pacemaker and Implantable Defibrillator Systems93296 Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker

system or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results

Implantable Cardiovascular Monitor (ICM) and Implantable Loop Recorder (ILR)93299 Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system or


Possible C-APC and APC Assignments Medicare Comprehensive Ambulatory Payment Classifications (C-APCs) include device-intensive procedures and are assigned a “J1” status indicator. APC assignment may be applicable for other procedure codes.

CPT Codes Abbreviated 2017 CPT DescriptionsC-APC or APC Group C-APC/APC Description


5741 Level I Electronic Analysis of Devices

93299 Interrogation device evaluation(s), up to 30 days; ICM or ILR

Frequency Guidelines:Medicare identifies the frequency guidelines for pacemaker clinic services in the Cardiac Pacemaker Evaluation Services Medicare National Coverage Determinations Manual (CMS Pub, 100-03) §20.8.1—Cardiac Pacemaker Evaluation Services (Rev. 173, Issued: 09-04-14) CIM 50-1. Contact your local payer to discuss this pacemaker evaluation National Coverage Determination and other Coding/Billing articles.

Medtronic

CareLink

™ Netw

ork Procedures

24 of 25 2017

ADDITIONAL CODING INFORMATION:It is important to refer to the CPT® code2 descriptions to ensure that a billed code meets the specific requirements defined for each individual code. The local Medicare contractor/payer should be contacted for interpretation of applicable policies. In addition, the National Correct Coding Initiative (NCCI) edits should be checked.

Cardiac device evaluation CPT codes include both in person and remote monitoring services. Remote monitoring codes represent either a 30- or 90-day monitoring period and there are separate codes for the professional component (PC) and the technical component (TC).

Physician Billing: Remote monitoring services require billing two different CPT codes for an office Place of Service (POS),3 when both components of the service are performed by the office. One code represents the professional component (PC) and another code represents the technical component (TC). These code pairs are: CPT 93294 and 93296, 93295 and 93296, 93297 and 93299, and 93298 and 93299. The in person codes are configured as a global code. When the in person device evaluation or interrogation is performed in a facility (hospital) setting, modifier -26 should be appended to the applicable in person code when billing the professional component (PC). This -26 modifier is not applicable for remote monitoring services since there is a separate PC code, CPT 93294, 93295, 93297, and 93298. The professional component reflects physician time and intensity in furnishing the service, including activities before and after direct patient contact.4

The technical component4 refers to the resources used in furnishing the service, such as office rent, wages of personnel, and other office practice expenses. For remote monitoring, the CPT code description (CPT codes 93296 & 93299) identifies the work involved with remote monitoring technical services, including remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results.

Hospital Inpatient or Outpatient Billing: The service is “split-billed” with the professional component (PC) billed on a 1500 (professional claim form), and the technical component (TC, facility fee) is billed by the hospital on a UB-04 claim form.

Physician Supervision Requirements Cardiac device monitoring services are defined by Medicare as diagnostic services.5 As such, Medicare regulations require specific supervision for diagnostic tests. These are applicable to the technical component of the electronic analysis of implanted cardiac devices. These supervision requirements are in addition to any other Medicare coverage requirements. The Medicare supervision requirements for individual CPT codes are available on the Physician Fee Schedule (PFS) lookup function on the Medicare website6 or under “PFS Relative Value Files” for 2017.6

Medicare requires: § General supervision of the technical component for all remote interrogation services and transtelephonic pacemaker monitoring

(codes 93296, 93299, and 93293)§ Direct supervision of the technical component for all in person cardiac device evaluations when performed with an office POS

General supervision7 means the procedure is furnished under the physician’s overall direction and control but the physician’s presence is not required during the performance of the procedure. Under general supervision, the training of the non-physician personnel who actually performs the diagnostic procedure and the maintenance of the necessary equipment and supplies are the continuing responsibility of the physician.

Direct supervision8 in a hospital (facility) setting means that the physician must be immediately available to furnish assistance and direction throughout the performance of the procedure. The physician is not required to be present in the room where the procedure is being performed in this hospital (facility) setting or within any other physical boundary as long as he or she is immediately available.

Medicare diagnostic testing rules state that the supervisor must be a Physician. A Non-Physician Practitioner (NPP) such as a nurse practitioner or a physician assistant cannot supervise staff.5

These coding suggestions 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 specific 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 service.

2017 25 of 25

NOTES

medtronic.comUC200802507i EN ©2017 Medtronic. Minneapolis, MN. All Rights Reserved. Printed in USA. 01/2017

Medtronic 710 Medtronic Parkway Minneapolis, MN 55432-5604 USA

Toll-free in USA: 800.633.8766Worldwide: +1.763.514.4000

Medtronic and the Medtronic logo are trademarks of Medtronic. ™Third party brands are trademarks of their respective owners. All other brands are trademarks of a Medtronic company.

References1 The Medicare final rule was published in the Federal Register on November 14, 2016 with corrections published in the Federal Register on January 3, 2017.

The C-APC and APC tables and other files are available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html2 CPT copyright 2016 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

The Medicare alpha-numeric HCPCS (Healthcare Common Procedure Coding System) modifiers are available at: http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html

3 Medicare Place of Service (POS) information is located in Chapter 26 of the Medicare Claims Processing Manual at: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c26.pdf New and Revised Place of Service Codes (POS) for Outpatient Hospital effective January 1, 2016 can be found at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3315CP.pdf

4 Medicare Learning Network® Definition of Technical Component for Diagnostic Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Radiology_FactSheet_ICN907164.pdf

5 Publication #100-04 Medicare Claims Processing Manual Chapter 13 is located at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c13.pdf

6 The Medicare supervision requirements are available by accessing the “PFS Relative Value Files” or “Medicare Physician Schedule Look-Up” located at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html

7 Publication #100-02 Medicare Benefit Policy Manual Chapter 15 is available at: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf

8 Publication #100-02 Medicare Benefit Policy Manual Chapter 6 is available at: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c06.pdf

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c06.pdf

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c06.pdf

2017 hospital coding - medtronic · 2 of 25 2017 hospital coding systems and medicare payment...

Documents