hospital physician coding guide...pm-97 disclaimer while terumo medical corporation has made...
Post on 28-Jan-2020
1 Views
Preview:
TRANSCRIPT
2018 HOSPITAL & PHYSICIAN CODING GUIDE
PM-00097
DisclaimerWhile Terumo Medical Corporation has made reasonable efforts to ensure the accuracy of the information set forth herein, Terumo does not guarantee reimbursement coverage or amounts for any product or procedure nor does Terumo recommend any particular product or procedure for any individual patient. The information described herein is provided solely as a guide for Terumo products and is based on publicly available information from CMS. It is the responsibility of the provider to report codes that accurately describe the products, procedures, and individual patient’s medical condition(s). Providers should contact the appropriate payers directly if they have questions or need specific information. Terumo Medical Corporation does not promote the use of its products outside of the uses or indications as described in the applicable labeling.
PM-00097
TABLE OF CONTENTS
C-Code Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
AZUR® Peripheral HydroCoil Embolization System . . . . . . . . . . . . . . . . . . . . . . . 4
MISAGO® RX Self-expanding Peripheral Stent . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
METACROSS™ RX PTA Balloon Dilatation Catheter . . . . . . . . . . . . . . . . . . . . . . 6
PRIORITYONE® Aspiration Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
– 2 – – 3 –PM-00097
C-CODE SUMMARY
Overview:The Centers for Medicare and Medicaid Services (CMS) requires the reporting of appropriate C-Codes for all device-dependent Ambulatory Payment Classifications (APCs) for hospital oupatient services. If a hospital outpatient bill includes a device-related CPT/HCPCS II procedure code but the C-Code for the associated device is not present, the claim is edited and returned to the hospital. Furthermore, if a C-Code is billed without the appropriate procedure code, the claim will be returned. For the majoirty of C-Codes, the hospital does not receive additional reimbursement for devices. However, the C-Codes are required as CMS is collecting charge data for these devices for use in setting future APC payment rates.
C-Codes are only reportable for hospital oupatient procedures, and not all devices have applicable C-Codes. This guide includes a summary list of Terumo products and the corresponding C-Code. This guide is intended to provide general coding guidance. The full list of C-Codes is avalable at https://www .cms .gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/Complet-list-DeviceCats-OPPS .pdf .1 Physicians and hospitals are responsible for selecting and reporting the codes that most accurately desribe the procedure(s) performed. Providers should follow coding guidelines from the insurer as well as review the appropriate coding authorities for further guidance.
Terumo Product C-Code Description
Closure/Compression Devices
ANGIO-SEAL® VIP
C1760 Closure device, vascular (implantable/insertable)ANGIO-SEAL® STS Plus
ANGIO-SEAL® Evolution™
TR BAND® Radial Compression Device N/A There is no applicable C code for this product
Sheaths
VADO® Steerable Sheath C1766 Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away
PINNACLE® DESTINATION® Guiding Sheath C1887 Catheter, guiding (may include infusion/perfusion capability)
PINNACLE PRECISION ACCESS SYSTEM® Sheath
C1894 Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser
PINNACLE® R/O II Radiopaque Marker Introducer Sheath
PINNACLE® TIF TIP™ Introducer Sheath - Peripheral
PINNACLE® TIF TIP™ Introducer Sheath - Coronary
GLIDEACCESS® System - Micro Accessing Kits
GLIDESHEATH™ Introducer Sheath - Hydrophilic Coated
GLIDESHEATH SLENDER® Introducer Sheath
SOLOPATH® Balloon Expandable TransFemoral System
SOLOPATH® Re-collapsible Balloon Access System
Disposable Inflation Device N/A Included in C code of introducer/sheath
Guidewires
GLIDEWIRE® Hydrophilic Coated Guidewire - Regular
C1769 Guidewire
GLIDEWIRE® Hydrophilic Coated Guidewire - Shapeable Tip
GLIDEWIRE® with Stiff Shaft Guidewire
GLIDEWIRE® Gold Hydrophilic Coated Guidewire
GLIDEWIRE® GT Guidewire
GLIDEWIRE ADVANTAGE® Guidewire
RUNTHROUGH® NS Coronary Guidewire - Extra Floppy
RUNTHROUGH® NS HYPERCOAT™ Coronary Guidewire
RUNTHROUGH® NS Coronary Guidewire
– 2 – – 3 –PM-00097
Terumo Product C-Code Description
Microcatheters
PROGREAT® MicrocatheterC1887 Catheter, guiding (may include infusion/perfusion capability)
PROGREAT® Coaxial Microcatheter System
Catheters - Coronary
PRIORITYONE® Aspiration Catheter C1757 Catheter, thrombectomy/embolectomy
FINECROSS® MG Coronary Micro-Guide Catheter
C1887 Catheter, guiding (may include infusion/perfusion capability)OPTITORQUE® Diagnostic Catheter - TR Shape
OPTITORQUE® Diagnostic Catheter - COM Shape
HEARTRAIL® III Guiding Catheter
Catheters - Peripheral
NAVICROSS® Catheter
C1887 Catheter, guiding (may include infusion/perfusion capability)GLIDECATH® Hydrophilic Coated Catheter
GLIDECATH® Yashiro Catheter
GLIDECATH® XP Hydrophilic Coated Catheter
Embolotherapy
AZUR® Peripheral HydroCoil Embolization System
N/A There is no applicable C code for this product
AZUR® Detachment Controller
AZUR® Detachable Hydrocoil
AXUR® CX Detachable Hydrocoil
AZUR® Pushable Hydrocoil
AZUR® Framing Coil
Interventional Devices
MISAGO® RX Self-expanding Peripheral Stent C1876 Stent, non-coated/non-covered, with delivery system
METACROSS™ RX PTA Balloon Dilatation Catheter C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)
Note: Stents packaged with delivery systems generally include the following components: stent mounted or unmounted on a balloon angioplasty catheter, introducer, and sheath. These components should not be reported separately.
Accessories
Obturators
N/A There is no applicable C code for this product
TORQUE™ Device
C-CODE SUMMARY
– 4 – – 5 –PM-00097
Hospital Inpatient
Possible ICD-10 Procedure Codes Description Typical MS-DRG Assignment **
04LE3DT Occlusion of Left Uterine Artery with Intraluminal Device, Percutaneous Approach749750
Other Female Reproductive System O.R. Procedures with CC/MCCOther Female Reproductive System O.R. Procedures without CC/MCC04LF3DU Occlusion of Right Uterine Artery with Intraluminal Device, Percutaneous Approach
* Due to the number of vessels, arteries and veins this device can be placed, they are not included here. Please refer to your ICD-10-PCS materials for the appropriate code(s) that describe where the devices were placed** MS-DRG assignment is based on patient specific diagnoses and procedures performed during the hospital stay.Source: DRG Expert, 2017, Optum360
Hospital Outpatient
CPT™ Code Description APC Description Status Indicator
37241
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles)
5183 Level 3 Endovascular Procedures J1
37242
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms)
37243Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction
37244Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation
Status Indicator “J1”: Paid under OPPS; all covered Part B services on the claim are packaged with the primary “J1” service for the claim, except services with OPPS SI=F,G, H, L and U; ambulance services; diagnostic and screening mammography; all preventive services; and certain Part B inpatient services.Source: CMS-1678-FC, Addendum A, B
Physician
CPT™ Code Description Status Indicator Total Non-Facility RVUs Total Facility
RVUs
37241
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles)
A 134.18 12.91
37242
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms)
A 207.62 13.95
37243Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction
A 275.01 16.38
37244Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation
A 191.70 19.37
Status Indicator “A”: Active code - these codes are separately payable under the Physician Fee ScheduleSource: CMS-1676-F, Addendum B
CPT is a trademark of the American Medical Association
AZUR®
Peripheral HydroCoil Embolization System
– 4 – – 5 –PM-00097
Hospital Inpatient
Possible ICD-10 Procedure Codes Description Typical MS-DRG Assignment **
047K3DZ Dilation of Right Femoral Artery with Intraluminal Device, Percutaneous Approach RT
252
253
254
Other Vascular Procedures with MCC
Other Vascular Procedures with CC
Other Vascular Procedures without MCC/CC
047L3DZ Dilation of Left Femoral Artery with Intraluminal Device, Percutaneous Approach LT
047M3DZ Dilation of Right Popliteal Artery with Intraluminal Device, Percutaneous Approach RT
047N3DZ Dilation of Left Popliteal Artery with Intraluminal Device, Percutaneous Approach LT
04CK3ZZ Extirpation of Matter from Right Femoral Artery, Percutaneous Approach RT
04CL3ZZ Extirpation of Matter from Left Femoral Artery, Percutaneous Approach LT
04CM3ZZ Extirpation of Matter from Right Popliteal Artery, Percutaneous Approach RT
04CN3ZZ Extirpation of Matter from Left Popliteal Artery, Percutaneous Approach
** MS-DRG assignment is based on patient specific diagnoses and procedures performed during the hospital stay.Source: DRG Expert, 2017, Optum360
Hospital Outpatient
CPT™ Code Description APC Description Status Indicator
37226Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
5193 Level 3 Endovascular Procedures J1
37227Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
5194 Level 4 Endovascular Procedures J1
Status Indicator “J1”: Paid under OPPS; all covered Part B services on the claim are packaged with the primary “J1” service for the claim, except services with OPPS SI=F,G, H, L and U; ambulance services; diagnostic and screening mammography; all preventive services; and certain Part B inpatient services.Source: CMS-1678-FC, Addendum A, B
Physician
CPT™ Code Description Status Indicator Total Non-Facility RVUs Total Facility
RVUs
37226Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
A 252.77 15.25
37227Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
A 418.38 21.26
Status Indicator “A”: Active code - these codes are separately payable under the Physician Fee ScheduleSource: CMS-1676-F
CPT is a trademark of the American Medical Association
MISAGO® RXSelf-Expanding Peripheral Stent
– 6 – – 7 –PM-00097
Hospital Inpatient
Possible ICD-10 Procedure Codes Description Typical MS-DRG Assignment
047C3DZ Dilation of Right Common Iliac Artery with Intraluminal Device, Percutaneous Approach
252
253
254
Other Vascular Procedures with MCC
Other Vascular Procedures with CC
Other Vascular Procedures without MCC/CC
047D3DZ Dilation of Left Common Iliac Artery with Intraluminal Device, Percutaneous Approach
047E3DZ Dilation of Right Internal Iliac Artery with Intraluminal Device, Percutaneous Approach
047F3DZ Dilation of Left Internal Iliac Artery with Intraluminal Device, Percutaneous Approach
047H3DZ Dilation of Right External Iliac Artery with Intraluminal Device, Percutaneous Approach
047J3DZ Dilation of Left External Iliac Artery with Intraluminal Device, Percutaneous Approach
047K3DZ Dilation of Right Femoral Artery with Intraluminal Device, Percutaneous Approach
047L3DZ Dilation of Left Femoral Artery with Intraluminal Device, Percutaneous Approach
047M3DZ Dilation of Right Popliteal Artery with Intraluminal Device, Percutaneous Approach
047N3DZ Dilation of Left Popliteal Artery with Intraluminal Device, Percutaneous Approach
04CK3ZZ Extirpation of Matter from Right Femoral Artery, Percutaneous Approach
04CL3ZZ Extirpation of Matter from Left Femoral Artery, Percutaneous Approach
04CM3ZZ Extirpation of Matter from Right Popliteal Artery, Percutaneous Approach
04CN3ZZ Extirpation of Matter from Left Popliteal Artery, Percutaneous Approach
04793ZZ Dilation of Right Renal Artery, Percutaneous Approach
047A3ZZ Dilation of Left Renal Artery, Percutaneous Approach
047B3ZZ Dilation of Inferior Mesenteric Artery, Percutaneous Approach
047C3ZZ Dilation of Right Common Iliac Artery, Percutaneous Approach
047D3ZZ Dilation of Left Common Iliac Artery, Percutaneous Approach
047E3ZZ Dilation of Right Internal Iliac Artery, Percutaneous Approach
047F3ZZ Dilation of Left Internal Iliac Artery, Percutaneous Approach
047H3ZZ Dilation of Right External Iliac Artery, Percutaneous Approach
047J3ZZ Dilation of Left External Iliac Artery, Percutaneous Approach
047K3ZZ Dilation of Right Femoral Artery, Percutaneous Approach
047L3ZZ Dilation of Left Femoral Artery, Percutaneous Approach
047M3ZZ Dilation of Right Popliteal Artery, Percutaneous Approach
047N3ZZ Dilation of Left Popliteal Artery, Percutaneous Approach
047P3ZZ Dilation of Right Anterior Tibial Artery, Percutaneous Approach
047Q3ZZ Dilation of Left Anterior Tibial Artery, Percutaneous Approach
047R3ZZ Dilation of Right Posterior Tibial Artery, Percutaneous Approach
047S3ZZ Dilation of Left Posterior Tibial Artery, Percutaneous Approach
047T3ZZ Dilation of Right Peroneal Artery, Percutaneous Approach
047U3ZZ Dilation of Left Peroneal Artery, Percutaneous Approach
047V3ZZ Dilation of Right Foot Artery, Percutaneous Approach
047W3ZZ Dilation of Left Foot Artery, Percutaneous Approach
047Y3ZZ Dilation of Lower Artery, Percutaneous Approach
Source: DRG Expert, 2017, Optum360
METACROSS™ RXPTA Balloon Dilatation Catheter
– 6 – – 7 –PM-00097
Hospital Outpatient
CPT™ Code Description APC Description Status Indicator
37220 Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty 5192 Level 2 Endovascular Procedures J1
37221Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
5193 Level 3 Endovascular Procedures J1
+37222Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)
N/A N
+37223
Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
N/A N
37224 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty 5192 Level 2 Endovascular Procedures J1
37225Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed
5193 Level 3 Endovascular Procedures J1
37226Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
5193 Level 3 Endovascular Procedures J1
37227Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
5194 Level 4 Endovascular Procedures J1
37246
Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery
5192 Level 2 Endovascular Procedures J1
37247 Each additional artery N/A N
Status Indicator “J1”: Paid under OPPS; all covered Part B services on the claim are packaged with the primary “J1” service for the claim, except services with OPPS SI=F,G, H, L and U; ambulance services; diagnostic and screening mammography; all preventive services; and certain Part B inpatient services.Status Indicator “N”: Paid under OPPS; payment is packaged into payment for other services. Therefore, there is no separate APC payment.Source: CMS-1678-FC, Addendum A, B
Physician
CPT™ Code Description Status Indicator
Total Non-Facility RVUs
Total Facility RVUs
37220 Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty A 86.71 11.72
37221 Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed A 128.63 14.46
+37222 Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure) A 24.37 5.45
+37223 Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure) A 72.08 6.23
37224 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty A 105.29 12.97
37225 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed A 309.18 17.69
37226 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed A 252.77 15.25
37227Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
A 418.38 21.26
37246 Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery
A 60.61 10.14
37247 A 24.49 4.98
Status Indicator “A”: Active code - these codes are separately payable under the Physician Fee Schedule“+” indicates the CPT code is an add-on codeSource: CMS-1676-F, Addendum B CPT is a trademark of the American Medical Association
METACROSS™ RXPTA Balloon Dilatation Catheter
– 8 – – 9 –PM-00097
PRIORITYONE®
Aspiration Catheter
Hospital Inpatient
Possible ICD-10 Procedure Codes Description Typical MS-DRG Assignment **
02CW3ZZ Extirpation of Matter from Thoracic Aorta, Percutaneous Approach
These procedure codes can map to various MS-DRGs based on the
patient’s diagnoses and other procedures being performed
03C23ZZ Extirpation of Matter from Innominate Artery, Percutaneous Approach
03C33ZZ Extirpation of Matter from Right Subclavian Artery, Percutaneous Approach
03C43ZZ Extirpation of Matter from Left Subclavian Artery, Percutaneous Approach
03C53ZZ Extirpation of Matter from Right Axillary Artery, Percutaneous Approach
03C63ZZ Extirpation of Matter from Left Axillary Artery, Percutaneous Approach
03C73ZZ Extirpation of Matter from Right Brachial Artery, Percutaneous Approach
03C83ZZ Extirpation of Matter from Left Brachial Artery, Percutaneous Approach
03C93ZZ Extirpation of Matter from Right Ulnar Artery, Percutaneous Approach
03CA3ZZ Extirpation of Matter from Left Ulnar Artery, Percutaneous Approach
03CB3ZZ Extirpation of Matter from Right Radial Artery, Percutaneous Approach
03CC3ZZ Extirpation of Matter from Left Radial Artery, Percutaneous Approach
03CH3ZZ Extirpation of Matter from Right Common Carotid Artery, Percutaneous Approach
03CJ3ZZ Extirpation of Matter from Left Common Carotid Artery, Percutaneous Approach
03CK3ZZ Extirpation of Matter from Right Internal Carotid Artery, Percutaneous Approach
03CL3ZZ Extirpation of Matter from Left Internal Carotid Artery, Percutaneous Approach
03CM3ZZ Extirpation of Matter from Right External Carotid Artery, Percutaneous Approach
03CN3ZZ Extirpation of Matter from Left External Carotid Artery, Percutaneous Approach
04C03ZZ Extirpation of Matter from Abdominal Aorta, Percutaneous Approach
04C13ZZ Extirpation of Matter from Celiac Artery, Percutaneous Approach
04C53ZZ Extirpation of Matter from Superior Mesenteric Artery, Percutaneous Approach
04C93ZZ Extirpation of Matter from Right Renal Artery, Percutaneous Approach
04CA3ZZ Extirpation of Matter from Left Renal Artery, Percutaneous Approach
04CB3ZZ Extirpation of Matter from Inferior Mesenteric Artery, Percutaneous Approach
04CC3ZZ Extirpation of Matter from Right Common Iliac Artery, Percutaneous Approach
04CD3ZZ Extirpation of Matter from Left Common Iliac Artery, Percutaneous Approach
04CE3ZZ Extirpation of Matter from Right Internal Iliac Artery, Percutaneous Approach
04CF3ZZ Extirpation of Matter from Left Internal Iliac Artery, Percutaneous Approach
04CH3ZZ Extirpation of Matter from Right External Iliac Artery, Percutaneous Approach
04CJ3ZZ Extirpation of Matter from Left External Iliac Artery, Percutaneous Approach
04CK3ZZ Extirpation of Matter from Right Femoral Artery, Percutaneous Approach
04CL3ZZ Extirpation of Matter from Left Femoral Artery, Percutaneous Approach
04CM3ZZ Extirpation of Matter from Right Popliteal Artery, Percutaneous Approach
04CN3ZZ Extirpation of Matter from Left Popliteal Artery, Percutaneous Approach
04CP3ZZ Extirpation of Matter from Right Anterior Tibial Artery, Percutaneous Approach
04CQ3ZZ Extirpation of Matter from Left Anterior Tibial Artery, Percutaneous Approach
04CR3ZZ Extirpation of Matter from Right Posterior Tibial Artery, Percutaneous Approach
04CS3ZZ Extirpation of Matter from Left Posterior Tibial Artery, Percutaneous Approach
04CT3ZZ Extirpation of Matter from Right Peroneal Artery, Percutaneous Approach
04CU3ZZ Extirpation of Matter from Left Peroneal Artery, Percutaneous Approach
02C03ZZ Extirpation of Matter from Coronary Artery, One Site, Percutaneous Approach 246
247
248
249
Percutaneous CV procedure with DES with MCC, or 4+ vessels/stents
Percutaneous CV procedure with DES without MCC
Percutaneous CV procedure with non-DES with MCC, or 4+ vessels/stents
Percutaneous CV procedure with non-DES without MCC
X2C0361 Extirpation of Matter from Coronary Artery, One Site using Orbital Atherectomy Technology, Percutaneous Approach, New Technology Group 1
** MS-DRG assignment is based on patient specific diagnoses and procedures performed during the hospital stay.Source: DRG Expert, 2017, Optum360
– 8 – – 9 –PM-00097
Hospital Outpatient
CPT™ Code Description APC Description Status Indicator
34001 Embolectomy or thrombectomy, with or without catheter; carotid, subclavian or innominate artery, by neck incision N/A C
34051 Embolectomy or thrombectomy, with or without catheter; innominate, subclavian artery, by thoracic incision N/A C
34101 Embolectomy or thrombectomy, with or without catheter; axillary, brachial, innominate, subclavian artery, by arm incision 5184 Level 4 Vascular Procedures T
34111 Embolectomy or thrombectomy, with or without catheter; radial or ulnar artery, by arm incision 5184 Level 4 Vascular Procedures T
34151 Embolectomy or thrombectomy, with or without catheter; renal, celiac, mesentery, aortoiliac artery, by abdominal incision N/A C
34201 Embolectomy or thrombectomy, with or without catheter; femoropopliteal, aortoiliac artery, by leg incision 5184 Level 4 Vascular Procedures T
34203 Embolectomy or thrombectomy, with or without catheter; popliteal-tibio-peroneal artery, by leg incision 5184 Level 4 Vascular Procedures T
92941
Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel
N/A C
C9606
Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel
5194 Level 4 Endovascular Procedures J1
Status Indicator “C”: Not paid under OPPS; Admit patient; Bill as inpatient.Status Indicator “T”: Paid under OPPS; separate APC payment; multiple surgical reduction applies.Status Indicator “J1”: Paid under OPPS; all covered Part B services on the claim are packaged with the primary “J1” service for the claim, except services with OPPS SI=F,G, H, L and U; ambulance services; diagnostic and screening mammography; all preventive services; and certain Part B inpatient services.Source: CMS-1678-FC, Addendum A, B
Physician
CPT™ Code Description Status Indicator Total Facility RVUs
34001 Embolectomy or thrombectomy, with or without catheter; carotid, subclavian or innominate artery, by neck incision A 26.57
34051 Embolectomy or thrombectomy, with or without catheter; innominate, subclavian artery, by thoracic incision A 28.78
34101 Embolectomy or thrombectomy, with or without catheter; axillary, brachial, innominate, subclavian artery, by arm incision A 17.43
34111 Embolectomy or thrombectomy, with or without catheter; radial or ulnar artery, by arm incision A 17.42
34151 Embolectomy or thrombectomy, with or without catheter; renal, celiac, mesentery, aortoiliac artery, by abdominal incision A 40.61
34201 Embolectomy or thrombectomy, with or without catheter; femoropopliteal, aortoiliac artery, by leg incision A 29.96
34203 Embolectomy or thrombectomy, with or without catheter; popliteal-tibio-peroneal artery, by leg incision A 27.74
92941
Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel
A 19.33
Status Indicator “A”: Active code - these codes are separately payable under the Physician Fee Schedule.Source: CMS-1676-F, Addendum B
CPT is a trademark of the American Medical Association
PRIORITYONE®
Aspiration Catheter
Reference: 1. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ HospitalOutpatientPPS/passthrough_payment.html
©2018 Terumo Medical Corporation. All rights reserved. All brand names are trademarks or registered trademarks of Terumo. PM-00097
265 Davidson Avenue Suite 320 Somerset, NJ 08873 terumobusinessedge.com
top related