jim collins, cpc, ccc president, … · 3/28/17 2 infusion & induction 93623-26 –programmed...
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Electrophysiology
JimCollins,CPC,CCCPresident,CardiologyCoder.Com,Inc.
1(c)2017CardiologyCoder.Com client#756
TwoTypesofDiagnosticEPStudies
93619Basic,ComprehensiveStudy
• RARecord
• HisRecord
• RVRecord
• RAPace
• RVPace
93620ComprehensiveStudy+Stimulation
• IncludesallofthecomponentsofacomprehensivestudyPLUS Inductionorattemptedinductionofanarrhythmia
“Acomprehensivediagnosticelectrophysiologicevaluationmustincludethoseservicesusedtoderivediagnosticinformationasdescribedbycodes93600,93602,93603,93610,and93612.For93620,anattemptedarrhythmiainductionmustalsobeincludedwithalloftheabove.”HRSOnLine.Org
“ReducedServices:Undercertaincircumstancesaserviceorprocedureispartiallyreducedoreliminatedatthediscretionofthephysicianorotherqualifiedhealthcareprofessional.Underthesecircumstancestheserviceprovidedcanbeidentifiedbyitsusualprocedurenumberandtheadditionofmodifier52.”AMA2017CurrentProceduralTerminology
2(c)2017CardiologyCoder.Comclient#756
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Infusion&Induction
93623-26– Programmedstimulationandpacingafterintravenousdruginfusion(Listseparatelyinadditiontocodeforprimaryprocedure)
• Thisisan“add-on”codethatmustbereportedwithaprimaryprocedure:• 93610– RApacing• 93612– RVpacing• 93619– BasiccomprehensiveEPS• 93620– EPSwithinductionattempt• 93653– SVTablation• 93654– VTablation• 93656– PVIablation
• Billablewhendrugsareusedtoinduce&diagnosisanarrhythmia• “Toscreenforarrhythmias,Isuprelwasinfused...
• Notbillablewhenusedtoconfirmthesuccessofanablation• “Toconfirmthesuccessoftheablation,Isuprelwasinfused…”
“29.CPTcode93623(programmedstimulationandpacingafterintravenousdruginfusion)isanadd-oncodethatmaybereportedperCPTManualinstructionsonlywithCPTcodes93619or93620(comprehensiveelectrophysiologicevaluation).CPTcode93623shouldnotbereportedforinjectionsofadrugwithstimulationandpacingfollowinganintracardiac catheterablationprocedure(e.g.,CPTcodes93650-93657)toconfirmadequacyoftheablation.PerCPTManualinstructions,CPTcode93623isnotintendedtobereportedwiththeintracardiac catheterablationprocedurecodes,anconfirmationoftheadequacyofablationisincludedintheintracardiac catheterablationprocedure.”
NationalCorrectCodingInitiative
3(c)2017CardiologyCoder.Comclient#756
Mapping
• 93609-26– 2DMapping• Standardcathetermapping
• 93613- 3DMapping• Medicalnecessityguidelineshavenotyetbeenpublished
Onlyoneformofmappingmaybereportedduringanygivenprocedure.
MappingshouldnotbereportedinconjunctionwithAVnodeablations.
*2017MedicarePhysicianFeeschedule– NationalAveragepayment
4(c)2017CardiologyCoder.Comclient#756
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LeftSidedPacing&Recording
93621-26– Comprehensiveelectrophysiologic evaluationincludinginsertionandrepositioningofmultipleelectrodecatheterswithinductionorattemptedinductionofarrhythmia;withleftatrialpacingand recordingfromcoronarysinusorleftatrium(Listseparatelyinadditiontocodeforprimaryprocedure)• NotemustestablishpacingANDrecordingwasperformed
• Withoutboth– addthereducedservicemodifier(52)• Thisisan“add-on”codethatmustbereportedwithaprimaryprocedure:
• 93620– ComprehensiveEPSwithinductionattempt• 93653– SVTablation• 93654– VTablation
• Thisserviceisbundledintopulmonaryveinisolation93622-26– LVpacing&recording• NotemustestablishpacingANDrecordingwasperformed• Thisisan“add-on”codethatmustbereportedwithaprimaryprocedure:
• 93620– ComprehensiveEPSwithinductionattempt• 93653– SVTablation• 93656– pulmonaryveinisolation
• ThisserviceisbundledintoVTablation
5(c)2017CardiologyCoder.Comclient#756
PulmonaryVeinIsolation
• 93656– Comprehensiveelectrophysiologicevaluationincludingtransseptalcatheterizations,insertionandrepositioningofmultipleelectrodecatheterswithinductionorattemptedinductionofanarrhythmiawithatrialrecordingandpacing,whenpossible,rightventricularpacingandrecording,Hisbundlerecordingwithintracardiaccatheterablationofarrhythmogenic focus,withtreatmentofatrialfibrillationbypulmonaryveinisolation.
q All6componentsofacomprehensivestudywithinduction:ü Rightatrialpacingü Rightatrialrecordingü Rightventricularpacingü Rightventricularrecordingü Hisbundlerecordingü Inductionorattemptedinductionofanarrhythmia
q Pulmonaryveinisolationq Multipletrans-septalcatheterizations
• Don’treport93462q Leftatrialpacing&recording
• Don’treport93621
• “Code93656includeseachofleftatrialpacing/recording,rightventricularpacing/recording,andHisbundlerecordingwhenclinicallyindicated.Whenperformanceofoneormorecomponentsisnotpossibleorindicated,documentthereasonfornotperforming.”CPT
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Add-onAblationProcedures
• 93657– Additionallinearorfocalintracardiaccatheterablationoftheleftorrightatriumfortreatmentofatrialfibrillationremainingaftercompletionofpulmonaryveinisolation• Onlyreportedwith93656(A-Fibablation)
• 93655– Intracardiaccatheterablationofadiscretemechanismofarrhythmiawhichisdistinctfromtheprimaryablatedmechanism,includingrepeatdiagnosticmaneuvers,totreataspontaneousorinducedarrhythmia• Reportedwith93653(SVT),93654(VT),or93656(AF)• MUE:93655istypicallyonlybilled1X
• MUE:MedicallyUnlikelyEdit
Sequence&documentationmatters:1. Pulmonaryveinisolationcomplete(93656)2. Patientremainsinatrialfibrillation3. AdditionallesionsarecreatedtotreatAF(93657)4. Patientconvertstoatrialflutter5. Additionallesionsarecreatedtotreatatrialflutter(93655)
7(c)2017CardiologyCoder.Comclient#756
AtrialFibrillationAblationHotTopic
• “insufficientevidencetodrawconclusionsregardingtheefficacy,effectiveness,andsafetyofcatheterablation”
CMSTechnologyAssessmentofAFAblation,April,2015
• PotentialcoverageandregulatoryfocuslikePMs&ICDs• Quantifiedsymptomseverity&AFburden• Medicalmanagementstandards(drug&dosage)• First-linetreatmentforOSA andobesity
• CentersofExcellence• Safetyandeffectivenessoftreatment• Notcurrentlyquantifiedortracked
8(c)2017CardiologyCoder.Comclient#756
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SVTAblation
• 93653- Comprehensiveelectrophysiologicevaluationincludinginsertionandrepositioningofmultipleelectrodecatheterswithinductionorattemptedinductionofanarrhythmiawithrightatrialpacingandrecording,rightventricularpacingandrecording,Hisrecordingwithintracardiaccatheterablationofarrhythmogenicfocus;withtreatmentofsupraventriculartachycardiabyablationoffastorslowatrioventricularpathway,accessoryatrioventricularconnection,cavo-tricuspidisthmusorothersingleatrialfocusorsourceofatrialre-entry.• IncludedServices:
qAll6componentsofacomprehensivestudy:üRightatrialpacing(whenpossible)(rightand/orleft)üRightatrialrecording(whenpossible)(rightand/orleft)üRightventricularpacingüRightventricularrecordingüHisbundlerecordingü Inductionorattemptedinductionofanarrhythmia
qSVTablation
Documentthereasonfornotperforminganyof
these
*2017MedicarePhysicianFeeschedule– NationalAveragepayment
9(c)2017CardiologyCoder.Comclient#756
VTAblation
• 93654- Comprehensiveelectrophysiologic evaluationincludinginsertionandrepositioningofmultipleelectrodecatheterswithinductionorattemptedinductionofanarrhythmiawithrightatrialpacingandrecording,rightventricularpacingandrecording(whennecessary),andHisbundlerecording(whennecessary)withintracardiac catheterablationofarrhythmogenic focus;withtreatmentofventriculartachycardiaorfocusofventricularectopyincludingintracardiacelectrophysiologic 3Dmapping,whenperformed,andleftventricularpacingandrecording,whenperformedqAll6componentsofacomprehensivestudy:
ü Rightatrialpacing(whenpossible)(rightand/orleft)ü Rightatrialrecording(whenpossible)(rightand/orleft)ü Rightventricularpacingü Rightventricularrecordingü Hisbundlerecordingü Inductionorattemptedinductionofanarrhythmia
qVTablationq3Dmapping(93613)whenperformedq2Dmapping(93609)whenperformedqLVpacing&recording(93622) whenperformed
Documentthereasonfornotperforminganyof
these
10(c)2017CardiologyCoder.Comclient#756
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AVNodeAblation,ArterialLine,ICE,Peri-Procedural
• AVNodeAblation93650– Intracardiacablationofatrioventricularnodefunction,atrioventricularconductionforcreationofcompleteheartblock,withorwithouttemporarypacemakerplacement.
• ICE93662– Intracardiac echocardiographyduringtherapeutic/diagnosticintervention,includingimagingsupervisionandinterpretation(Listseparatelyinadditiontocodeforprimaryprocedure)
• Thisisan“add-on”codethatmustbereportedwithaprimaryprocedure:• Use93662inconjunctionwith92987,93453,93460-93462,93532,93580,
93581,93620,93621,93622,93653,93654,93656asappropriate– CPT• ArterialLinePlacement
36620-59- Arterialcatheterizationorcannulationforsampling,monitoringortransfusion
• Peri-Proceduraldevicereprogramming• 93286(pacemaker)93287(defibrillator)• BillablewithEPproceduresbutnotdeviceprocedures• Billonetimeforpre-procedurereprogramming– Example93287• Billasecondtimeforpost-procedurereprogramming– Example93287-76
76- RepeatProcedureorServicebySamePhysicianorOtherQualifiedHealthCareProfessional 11(c)2017CardiologyCoder.Comclient#756
CorrectCodingInitiativeEdits
93609 93613 93621 93622 93623
SVT - 93653
VT- 93654 0 0 0
Addtl – 93655
AFib– 93656 0
Addtl - 93657
12(c)2017CardiologyCoder.Comclient#756
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ModerateSedation• Includedinproceduralpaymentuntil2017• Sedation,anditsassociatedpayment,isnowcarvedout.
• Expected2017paymentfordualchamberpacemaker(33208)• 2016payment=$553.53+• 2017MACRA&BudgetNeutralityadj.(0.24%)=$1.32• Expected2017payment=$554.85
• Actual2017payment=$543.35
• Totalreductionformoderatesedation=$11.50
Appliesto:implantablelooprecordersurgeries,pacemakersurgeries,defibrillatorsurgeries,EPstudies,ablations,cardioversions(internalandexternal),andtransesophagealecho.
13(c)2017CardiologyCoder.Comclient#756
ModerateSedationCoding
• Moderatesedationisbillablein15-minuteincrements• 1st 15minutecodebillableafter10minutes• Additional15-minutecodebillableafter23minutes
• 2setsofcodes• Sedationbyoperator:
• 99152– 1st 15minutes(0.25wRVU)• 99153– eachaddtl.15minutes(nowRVU)
• Sedationbyotherqualifiedprofessional:• 99156– 1st 15minutes(1.65wRVU)• 99157– eachaddtl.15minutes(1.25wRVU)
• Someproceduresarereportedwithmultiplecodesthateachhadmoderatesedationcarvedoutofthem- unintendedpaymentreduction:• Defibrillatorimplant(33249)&DFT(93641)• Electroderemoval,electroderepair,orskinpocketrelocationatthetimeofadeviceprocedure(implant,genchange)
Forpatients<5yrs.Oldsubstitute99151for99152and99155for99156
1hour=0.25wRVUs
1hour=5.4wRVUs
Documentmedicalnecessity
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ModerateSedationDocumentation• Theoperativereportneedstosupportthecodesreported
• 99152- Moderatesedationservicesprovidedbythesamephysicianorotherqualifiedhealthcareprofessionalperformingthediagnosticortherapeuticservicethatthesedationsupports,requiringthepresenceofanindependenttrainedobservertoassistinthemonitoringofthepatient'slevelofconsciousnessandphysiologicalstatus;initial15minutesofintraservice time,patientage5yearsorolder• Establish“administrationofmoderatesedation”• Establishdurationofintraservice time
• Startswhensedatingagent(s)areadministered• Endswiththeprocedure– whenface-to-facetimeconcludes
• Documentthepresenceofadedicated,trainedobserver• 99156- Moderatesedationservicesprovidedbyaphysicianorotherqualifiedhealthcareprofessionalotherthanthephysicianorotherqualifiedhealthcareprofessionalperformingthediagnosticortherapeuticservicethatthesedationsupports;initial15minutesofintraservice time,patientage5yearsorolder• Sameasabove,butnoneedforadedicated,trainedobserver
15(c)2017CardiologyCoder.Comclient#756
ServicesIncludedintheGlobalSurgicalPackage
1. PreoperativeVisits:• Theinitialevaluationforaminorsurgicalprocedure.• Critical care related to the performance of the procedure.
2. IntraoperativeServices:servicesthatarenormallyausualandnecessarypartofthesurgicalprocedure.
3. ComplicationsFollowingSurgery:includealladditionalmedicalorsurgicalservicesrequiredofthesurgeonduringthepostoperativeperiodofthesurgeryduetocomplicationsthatdonotrequireadditionaltripstotheoperatingroom.
4. PostoperativeVisits:follow-upvisitsduringthepostoperativeperiodofthesurgerythatarerelatedtorecoveryfromthesurgery.
5. Postsurgicalpainmanagementbythesurgeon.6. MiscellaneousServices:includesitemssuchasdressingchanges;local
incisioncare;removalofoperativepack;removalofcutaneoussutures,staples,lines,wires,tubes,drains,casts,andsplints;insertion,irrigationandremovalofurinarycatheters;routineperipheralintravenouslines,nasogastricandrectaltubes;andchangesandremovaloftracheostomytubes.
16(c)2017CardiologyCoder.Comclient#756
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ServicesNotIncludedintheGlobalSurgicalPackage
1. Visitsunrelatedtothediagnosisforwhichthesurgicalprocedureisperformed,unlessthevisitsoccurduetocomplicationsfromthesurgery.
2. Postoperativecomplicationsthatrequireareturntriptotheoperatingroom.AnoperatingroomforthispurposeisdefinedinMedicareregulationsas:• Aplaceofservicespecificallyequippedandstaffedforthesolepurposeofperforming
surgicalprocedures.Thetermincludesacardiaccatheterizationsuite,alasersuite,andanendoscopysuite.Itdoesnotincludeapatient’sroom,aminortreatmentroom,arecoveryroom,oranintensivecareunitunlessthepatient’sconditionwassocriticaltherewouldbeinsufficienttimefortransportationtoanoperatingroom.
3. Diagnostictestsandprocedures4. Criticalcareservices(procedurecodes99291and99292)unrelated tothe
surgerywhenaseriouslyinjuredorburnedpatientiscriticallyillandrequiresconstantattendancebytheprovider.Usemodifier24or25asappropriate.
5. Evaluationandmanagement(E/M)servicesunrelatedtoasurgicalprocedure.
17(c)2017CardiologyCoder.Comclient#756
CommonICD-10Codes
ProgrammingEvaluations*
RemoteMonitoring&Interrogations*
*Alsoreportdeviceindication
(unspecified)(unspecifiedcause)
18(c)2017CardiologyCoder.Comclient#756
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Newvs.EstablishedPatientStatus
• Cardiologyconsistsofthreespecialties:1. Generalcardiology2. Interventionalcardiology3. Electrophysiology
• WhenageneralcardiologistreferstoanEP,theEPcanbillnewpatient.• Highlevelnewpatientvisit:99205- $209.23*• Highlevelest patientvisits:99215- $146.43*• Newpatientpremium=$62.80(43%)
*2017MedicarePhysicianFeeschedule– NationalAveragepayment
19(c)2017CardiologyCoder.Comclient#756
JimCollins,CPC,CCCCertifiedProfessionalCoder,[email protected] (518)320-4376
• BillingServices
• Chartauditing
• Training
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