2012 Head and Neck Reconstruction/ENT Repair Coding Observations

Size: px
Start display at page:

Download "2012 Head and Neck Reconstruction/ENT Repair Coding Observations"

Transcription

1 Health Policy, Economics & Reimbursement Reimbursement Hotline Tel: Fax: Head and Neck Reconstruction/ENT Repair Coding Observations CPT Codes & Descriptors Relative Value Units [RVUs] Non / Physician Non / Hospital Outpatient Ambulatory Surgery Center [ASC] Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; total wound surface area up to 100 sq cm or less, first 25 sq cm or less wound surface area Each additional 25 sq cm wound surface area, or part thereof [List separately in addition to code for primary procedure] 4.24/2.58 $154.87/ $ /0.73 $33.70/ $24.85 $ $ $ $ Implantation of biologic implant [e.g., acellular dermal matrix] for soft tissue reinforcement [e.g., breast, trunk] 6.29 $ $1, $ HCPCS Codes & Descriptors Q 4112 Q 4116 Cymetra, injectable, 1cc AlloDerm, per sq cm Revenue Codes & Descriptors 272 Medical/Surgical Supplies and Devices Sterile Supply 278 Medical/Surgical Supplies and Devices Other Implants [e.g., AlloDerm RTM and Cymetra Micronized AlloDerm Tissue (MAT)]

2 CPT Codes & Descriptors Relative Value Units [RVUs] Non / Physician Non / Hospital Outpatient Ambulatory Surgery Center [ASC] Nose Rhinoplasty, primary; including major septal repair Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip only Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft Repair nasal septal perforations $1, $3, $1, $ $3, $1, $ $1, $1, $ $1, $1, Larynx Layrngoplasty; cricoid split $1, Inpatient only Inpatient only Salivary Glands Laryngoplasty, not otherwise specified Laryngeal reinnervation by neuromuscular pedicle Plastic repair of salivary duct, sialodochoplasty; primary or simple Plastic repair of salivary duct, sialodochoplasty; secondary or complicated $1, $3, $1, $ $3, $1, /10.46 $451.68/$ $1, $1, /13.78 $577.96/$ $3, $1, Pharynx Limited pharyngectomy $1, $3, $1, Resection of lateral pharyngeal wall or pyriform sinus, direct closure by advancement of lateral and posterior pharyngeal walls Resection of pharyngeal wall requiring closure with myocutaneous flap $1, $3, $1, $2, Inpatient only Inpatient only

3 CPT Codes & Descriptors Relative Value Units [RVUs] Non / Physician Non / Hospital Outpatient Ambulatory Surgery Center [ASC] Middle Ear Transmastoid antrotomy [simple mastoidectomy] $ $3, $1, Mastoidectomy; complete $1, $1, $1, Mastoidectomy; modified radical Revision mastoidectomy; resulting in complete mastoidectomy Revision mastoidectomy; resulting in modified radical mastoidectomy Revision mastoidectomy; resulting in tympanoplasty Tympanoplasty with mastoidectomy; without ossicular chain reconstruction Tympanoplasty with mastoidectomy; with ossicular chain reconstruction Tympanoplasty with mastoidectomy; with intact or reconstructed wall, without ossicular chain reconstruction Tympanoplasty with mastoidectomy; with intact or reconstructed canal wall, with ossicular chain reconstruction Tympanoplasty with mastoidectomy; radical or complete, without ossicular chain reconstruction Tympanoplasty with mastoidectomy, radical or complete, with ossicular chain reconstruction Palate Palatoplasty for cleft palate, with closure of alveolar ridge; soft tissue only Palatoplasty for cleft palate, with closure of alveolar ridge; with bone graft to alveolar ridge Palatoplasty for cleft palate; major revision $1, $3, $1, $1, $3, $1, $1, $3, $1, $1, $3, $1, $1, $3, $1, $1, $3, $1, $1, $3, $1, $1, $3, $1, $1, $3, $1, $1, $3, $1, $ $3, $1, $1, $3, $1, $ $3, $1,817.30

4 ICD-9-CM Procedure Codes & Descriptors MS-DRG [series] Repair of blepharoptosis and lid retraction 115, 907, [series] Other reconstruction of eyelid 115, 579, 907, [series] Repair and plastic operations on the nose 133, [series] Repair of salivary gland or duct 139, [series] Excision of other parts of mouth 137, 579, [series] Plastic repair of mouth 133, 579, 907, [series] Palatoplasty 137, Plastic operation of pharynx 040, 041, 133, 907, [series] Other repair of pharynx 133, [series] Repair of blepharoptosis and lid retraction 115, 907, [series] Dermal Regenerative Skin [e.g., AlloDerm RTM] ICD-9-CM Diagnosis Codes & Descriptors Fracture nasal bones Bell s palsy Cleft palate and cleft lip Benign neoplasm of bone and articular cartilage, lower jaw bone Neoplasm of uncertain behavior of bone and articular cartilage Neoplasm of uncertain behavior of lip, oral cavity and pharynx Neoplasm of uncertain behavior, major salivary gland Ptosis of eyelid, unspecified Myogenic ptosis Mechanical ptosis Disease of lips Congenital deformities of eyelids Scar conditions and fibrosis of skin

5 Diagnostic Related Groups [DRGs] Codes & Descriptors 040 Peripheral/Cranial Nerve and Other Nervous System Procedures with major complications and comorbidities [MCC] Medicare National Average $21, Peripheral/Cranial Nerve and Other Nervous System Procedures with $11, complications and comorbidities [CC] or Peripheral Neurostimulator 115 Extraocular Procedures Except Orbit $ 6, Other Ear, Nose, Mouth and Throat O.R. Procedures with CC/MCC $ 8, Mouth Procedures with CC/MCC $ 6, Salivary Gland Procedures $ 4, Other Skin, Subcutaneous Tissue and Breast Procedures with MCC $14, Other Endocrine, Nutritional and Metabolic OR Procedures with MCC $16, Other O.R. Procedures for Injuries with MCC $20, Nonextensive O.R. Procedure Unrelated to Principal Diagnosis with MCC $17, Sources: EncoderPro for Payers, Professional 2011 [Ingenix] CPT is a registered trademark of the American Medical Association. Physician CPT rates reflect a conversion factor of $ as of January 9, Inpatient facility rates reflective of 2012 National Medicare Average s. Centers for Medicare & Medicaid Services. Federal Register notices, [CMS-1518-F; CMS-1518-CN3], August 18, 2011 and September 25, Outpatient facility rates reflective of 2012 National Medicare Average s. Centers for Medicare & Medicaid Services. Federal Register notice, [CMS FC ], November 30, Disclaimer: This has been prepared for providers using LifeCell TM products and intended for informational purposes only. It does not represent a guarantee, promise or statement by LifeCell Corporation concerning levels of reimbursement, payment or charges. It is not intended to increase or maximize reimbursement. The decision as to how to complete a claim form, including the amounts to bill, is exclusively the responsibility of the provider. Consult the LifeCell TM Reimbursement Hotline at or reimbursement@lifecell.com for additional information.

6 Reimbursement service available! AlloDerm Regenerative Tissue Matrix and Cymetra Micronized AlloDerm Tissue reimbursement questions? LifeCell Corporation s commitment to surgeons and facilities using AlloDerm RTM, AlloDerm RTU and Cymetra Micronized AlloDerm Tissue to treat patients includes a Case Management Hotline. The Hotline is staffed by credentialed nurses and professional medical coders to help with: Coverage Coding Reimbursement Denied claims Appeals support Case pre-certifications/pre-determinations LifeCell TM Reimbursement Hotline Monday to Friday 8:00 a.m. - 8:00 p.m. ET Tel: Fax: reimbursement@lifecell.com LifeCell Corporation One Millennium Way Branchburg, NJ Tel: Fax: LifeCell TM Customer Solutions LifeCell Corporation. All rights reserved. LifeCell TM, AlloDerm and Strattice TM are trademarks of LifeCell Corporation. MLC 2106-R2/1883/2-2012

2017 PHYSICIAN CODING GUIDE

2017 PHYSICIAN CODING GUIDE 2017 PHYSICIAN CODING GUIDE Breast Repair and/or Reconstruction Surgeon s Procedure Codes 11970 Replacement of tissue expander with permanent prosthesis 8.01 $628.05 +15777 Implantation of biologic implant

More information

2017 FACILITY CODING GUIDE

2017 FACILITY CODING GUIDE 2017 FACILITY CODING GUIDE Breast Repair and/or Reconstruction CPT 1 Procedure Codes CPT Code Descriptors Relative Value Units (RVUs) 2 Non Facility/ Facility Payment Classification (APC) 3 Hospital Outpatient

More information

2017 FACILITY CODING GUIDE

2017 FACILITY CODING GUIDE 2017 FACILITY CODING GUIDE Breast Repair and/or Reconstruction CPT 1 Procedure Codes CPT Code Descriptors Relative Value Units (RVUs) 2 Non Facility/ Facility Payment Classification (APC) 3 Hospital Outpatient

More information

2017 Rhinoplasty Coding and Reimbursement Guide

2017 Rhinoplasty Coding and Reimbursement Guide 2017 Rhinoplasty Coding and Reimbursement Guide Profile Costal Cartilage Allograft A Pre-shaped costal cartilage allograft for rhinoplasty procedures HCPCS Description * Status Indicator APC HOPPS¹ ASC¹

More information

2017 FlexHD Abdominal Wall Reconstruction Reimbursement Coding Reference

2017 FlexHD Abdominal Wall Reconstruction Reimbursement Coding Reference 2017 FlexHD Abdominal Wall Reconstruction Reimbursement Coding Reference Most Commonly Reported ICD-10-CM Procedure Codes and Descriptors ICD-10-CM Description 0WUF0KZ Supplement Abdominal Wall with Nonautologous

More information

Suture of Tendon Sheath of Hand , , Delayed suture of other tendon of hand , Other Suture of Flexor Tendon of Hand

Suture of Tendon Sheath of Hand , , Delayed suture of other tendon of hand , Other Suture of Flexor Tendon of Hand Coding and Reimbursement Guide for Integra BioFix Amniotic Membrane Allograft, Integra BioFix Plus Amniotic Membrane Allograft & Integra BioFix Flow Placental Tissue Matrix Allograft For Use In Repair

More information

Inpatient ICD-9-CM Mapping to ICD-10 PCS Procedures Involving the Application of PriMatrix AG Antimicrobial Dermal Repair Scaffold

Inpatient ICD-9-CM Mapping to ICD-10 PCS Procedures Involving the Application of PriMatrix AG Antimicrobial Dermal Repair Scaffold Inpatient ICD-9-CM Mapping to ICD-10 PCS Procedures Involving the Application of PriMatrix AG Antimicrobial Dermal Repair Scaffold Effective October 1, 2015, the Centers for & Medicaid Services (CMS) is

More information

Surgical Preparation Codes for Skin Replacement Surgery** Hospital Outpatient/Ambulatory Surgical Center Setting

Surgical Preparation Codes for Skin Replacement Surgery** Hospital Outpatient/Ambulatory Surgical Center Setting 2018 National Medicare Reimbursement Rate Summary* for Integra Dermal Regeneration Template, & Office Settings Integra LifeSciences Corporation compiles this summary of Medicare payment rates to provide

More information

Wound & Burn. Reimbursement & Coding Guide

Wound & Burn. Reimbursement & Coding Guide Wound & Burn Reimbursement & Coding Guide Wound & Burn Reimbursement and Coding Guide MicroMatrix and Cytal devices facilitate the remodeling of functional, site-appropriate tissue. Comprised of ACell

More information

Coding and Reimbursement Guide for Integra Reinforcement Matrix 2018

Coding and Reimbursement Guide for Integra Reinforcement Matrix 2018 Coding and Reimbursement Guide for Integra Reinforcement Matrix 2018 Effective October 1, 2015, the Centers for & Medicaid Services (CMS) is implementing International Classification of Diseases, 10 th

More information

2017 FACILITY AND PHYSICIAN REIMBURSEMENT GUIDE

2017 FACILITY AND PHYSICIAN REIMBURSEMENT GUIDE 2017 AND PHYSICIAN REIMBURSEMENT GUIDE NASAL/SINUS ENDOSCOPIC SURGERY Some of the Current Procedure Terminology (CPT ) Codes for endoscopic nasal/sinus surgery are listed below. CPT codes 31295, 31296

More information

CYGNUS REIMBURSEMENT GUIDE

CYGNUS REIMBURSEMENT GUIDE CYGNUS REIMBURSEMENT GUIDE The CYGNUS amnion patch is an immune-privileged tissue containing the natural regenerative factors responsible for creating a wound healing environment conducive to tissue regeneration.

More information

Coding and Reimbursement Guide for TenoGlide Tendon Protector Sheet 2018

Coding and Reimbursement Guide for TenoGlide Tendon Protector Sheet 2018 Coding and Reimbursement Guide for TenoGlide Protector Sheet 2018 Effective October 1, 2015, the Centers for & Medicaid Services (CMS) is implementing International Classification of Diseases, 10 th Revision

More information

Inpatient ICD-9-CM Mapping to ICD-10 PCS Procedures Involving the Application of Integra Bilayer Wound Matrix

Inpatient ICD-9-CM Mapping to ICD-10 PCS Procedures Involving the Application of Integra Bilayer Wound Matrix Inpatient ICD-9-CM Mapping to ICD-10 PCS Procedures Involving the Application of Integra Bilayer Wound Matrix Effective October 1, 2015, the Centers for & Medicaid Services (CMS) is implementing International

More information

CODING SHEET HYDROCEPHALUS REIMBURSEMENT. All Medicare information is current as of the time of printing.

CODING SHEET HYDROCEPHALUS REIMBURSEMENT. All Medicare information is current as of the time of printing. CODING SHEET HYDROCEPHALUS REIMBURSEMENT All Medicare information is current as of the January 2014 Hydrocephalus ing Coding Options Commonly Billed Codes for Physicians, Hospitals, and Ambulatory Surgery

More information

2018 EAR, NOSE & THROAT (ENT) SURGERY MEDICARE REIMBURSEMENT CODING GUIDE

2018 EAR, NOSE & THROAT (ENT) SURGERY MEDICARE REIMBURSEMENT CODING GUIDE 2018 EAR, NOSE & THROAT (ENT) SURGERY REIMBURSEMENT CODING GUIDE Effective January 1, 2018 Medicare National Average Rates and Allowables (Not Adjusted for Geography) PHYSICIAN 3 HOSPITAL OUTPATIENT 4

More information

DermACELL AWM Comprehensive Reimbursement Resource Guide. Prepared by Musculoskeletal Clinical Regulatory Advisers, LLC. Version 01/2018.

DermACELL AWM Comprehensive Reimbursement Resource Guide. Prepared by Musculoskeletal Clinical Regulatory Advisers, LLC. Version 01/2018. 2018 Comprehensive Reimbursement Resource Guide Prepared by Musculoskeletal Clinical Regulatory Advisers, LLC. Version 01/2018. DermACELL AWM Disclaimer: This information is for educational/informational

More information

2017 Hospital Coding and Payment Guide

2017 Hospital Coding and Payment Guide Reimbursement Men s Health 2017 Hospital Coding and Payment Guide This coding reference guide is intended to illustrate the common coding and payment groups for male prosthetic urology procedures and related

More information

CERVICAL PROCEDURES PHYSICIAN CODING

CERVICAL PROCEDURES PHYSICIAN CODING CERVICAL PROCEDURES PHYSICIAN CODING Anterior Cervical Discectomy with Interbody Fusion (ACDF) Anterior interbody fusion, with discectomy and decompression; cervical below C2 22551 first interspace 22552

More information

Pelvic Floor. Reimbursement & Coding Guide

Pelvic Floor. Reimbursement & Coding Guide Pelvic Floor Reimbursement & Coding Guide Pelvic Floor Reimbursement and Coding Guide ACell Pelvic Floor Matrix products are biologically-derived devices comprised of porcine Urinary Bladder Matrix (UBM),

More information

code it ACTISHIELD HCPCS Device Codes Amniotic Barrier Membrane HCPCS Code C9399 Description Q4100 C5271

code it ACTISHIELD HCPCS Device Codes Amniotic Barrier Membrane HCPCS Code C9399 Description Q4100 C5271 code it HCPCS Device Codes 2015 Reimbursement Codes The following codes contained within this document are representative of possible services or diagnoses that may be associated with use of Wright products.

More information

ABBOTT CODING GUIDE STRUCTURAL HEART AND VALVES CONGENITAL DEFECTS SURGICAL HEART VALVES AMPLATZER PFO OCCLUDER. Effective January 1, 2019

ABBOTT CODING GUIDE STRUCTURAL HEART AND VALVES CONGENITAL DEFECTS SURGICAL HEART VALVES AMPLATZER PFO OCCLUDER. Effective January 1, 2019 ABBOTT CODING GUIDE STRUCTURAL HEART AND VALVES Effective January 1, 2019 STRUCTURAL HEART AND VALVES Effective Janaury 1, 2019 Introduction The Structural Heart and Valves Coding Guide is intended to

More information

ABBOTT CODING GUIDE CHRONIC PAIN. Effective January 1, 2019 INTRO SPINAL CORD STIMULATION (SCS) RADIOFREQUENCY ABLATION (RFA)

ABBOTT CODING GUIDE CHRONIC PAIN. Effective January 1, 2019 INTRO SPINAL CORD STIMULATION (SCS) RADIOFREQUENCY ABLATION (RFA) ABBOTT CODING GUIDE CHRONIC PAIN Effective January 1, 2019 CHRONIC PAIN Effective January 1, 2019 Introduction The Chronic Pain Coding Guide is intended to provide reference material related to general

More information

MedStar Health considers Septoplasty-Rhinoplasty medically necessary for the following indications:

MedStar Health considers Septoplasty-Rhinoplasty medically necessary for the following indications: MedStar Health, Inc. POLICY AND PROCEDURE MANUAL MP.038.MH Septoplasty-Rhinoplasty This policy applies to the following lines of business: MedStar Employee (Select) MedStar MA DSNP CSNP MedStar CareFirst

More information

Hernia & Surgical. Reimbursement & Coding Guide

Hernia & Surgical. Reimbursement & Coding Guide Hernia & Surgical Reimbursement & Coding Guide Hernia and General Surgery Reimbursement and Coding Guide Gentrix devices facilitate the remodeling of functional, site-appropriate tissue. Compromised of

More information

Product Name or Headline

Product Name or Headline Product Name or Headline Subhead goes here Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding, or site of service requirements. The coding options listed

More information

Inspire Medical Systems. Hospital Billing Guide

Inspire Medical Systems. Hospital Billing Guide Inspire Medical Systems Hospital Billing Guide Inspire Medical Systems Hospital Billing Guide This Hospital Billing Guide was developed to help centers correctly bill for Inspire Upper Airway Stimulation

More information

Men s Health Coding & Payment Quick Reference

Men s Health Coding & Payment Quick Reference Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes

More information

code it PRO-TOE C2 HCPCS Device Codes CPT Codes Physician Coding Hammertoe Implant HCPCS Code Description C1713 CPT CODE Description RVUs

code it PRO-TOE C2 HCPCS Device Codes CPT Codes Physician Coding Hammertoe Implant HCPCS Code Description C1713 CPT CODE Description RVUs code it HCPCS Device Codes 2015 Reimbursement Codes The following codes contained within this document are representative of possible services or diagnoses that may be associated with use of Wright products.

More information

Departmental Segregated Total Form for Plastic and Reconstructive Surgery

Departmental Segregated Total Form for Plastic and Reconstructive Surgery Departmental Segregated Total Form for Plastic and Reconstructive Surgery American Osteopathic Association and the American College of Osteopathic Surgeons Revised, COPT 11/2001 Revised, BOT 2/2006, Effective,

More information

Foot and Ankle Systems Coding Reference Guide

Foot and Ankle Systems Coding Reference Guide Foot and Ankle Systems Coding Reference Guide Physician Arthrodesis 27870 Arthrodesis, ankle, open 27871 Arthrodesis, tibiofibular joint, proximal or distal 28705 Arthrodesis; pantalar 28715 Arthrodesis;

More information

2018 REIMBURSEMENT GUIDE

2018 REIMBURSEMENT GUIDE TABLE OF CONTENTS: Component Separation Technique and Hiatal Hernia Repair...08 Hernia Repair...03 Laparoscopic Repair Hernia...06 Stoma Procedures...11 Level II Codes...13 -PCS Codes...14 Modifiers...13

More information

Stone Management Coding & Payment Quick Reference

Stone Management Coding & Payment Quick Reference Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes

More information

CD Horizon Spire. CD Horizon Spire Z PHYSICIAN REIMBURSEMENT REIMBURSEMENT GUIDE. Spinal System and. Spinal System

CD Horizon Spire. CD Horizon Spire Z PHYSICIAN REIMBURSEMENT REIMBURSEMENT GUIDE. Spinal System and. Spinal System REIMBURSEMENT GUIDE CD Horizon Spire Spinal System and CD Horizon Spire Z Spinal System The CD Horizon Spire Plate is a posterior, single level, non-pedicle supplemental fixation device intended for use

More information

2015 ST. JUDE MEDICAL THERAPY CODING GUIDE Cardiac Pacemakers

2015 ST. JUDE MEDICAL THERAPY CODING GUIDE Cardiac Pacemakers 2015 ST. JUDE MEDICAL THERAPY CODING GUIDE Cardiac Pacemakers This guide provides physician and hospital coding and reimbursement information for cardiac pacemaker procedures. In addition, St. Jude Medical

More information

TOTAL Head and Neck Congenital Defects 50

TOTAL Head and Neck Congenital Defects 50 Operative Minimums Effective July 1, 2014 Review Committee for Plastic Surgery NOTE: The index procedure number for Laser is tracked by Total Laser and not by the subcategories of Aesthetic Laser and Reconstructive

More information

Coding for Wound Care

Coding for Wound Care Coding for Wound Care ****IMPORTANT*** Disclaimer ***Information provided is to the best of our knowledge and as current as possible. ***Please verify all policy and reimbursement information with your

More information

2019 ACCLARENT REIMBURSEMENT GUIDE. Physician and Facility

2019 ACCLARENT REIMBURSEMENT GUIDE. Physician and Facility 2019 ACCLARENT REIMBURSEMENT GUIDE Physician and Facility TABLE OF CONTENTS This guide has been developed to assist you in obtaining physician and facility reimbursement for: Nasal/Sinus Endoscopic Surgery

More information

Diagnostic and interventional venous procedures (lower extremity)

Diagnostic and interventional venous procedures (lower extremity) 2017 Coding and Medicare payment guide Diagnostic and interventional venous procedures (lower extremity) All coding, coverage, billing and payment information provided herein by Philips Volcano is gathered

More information

2015 Facility and Physician Billing Guide Heart Valve Technologies

2015 Facility and Physician Billing Guide Heart Valve Technologies 2015 Facility and Physician Billing Guide Heart Valve Technologies PHYSICIAN BILLING CODES Clinicians use Current Procedural Terminology (CPT 1 ) codes to bill for procedures and services. Each CPT code

More information

Fractional Flow Reserve (FFR) and instant wave-free Ratio (The ifr modality)

Fractional Flow Reserve (FFR) and instant wave-free Ratio (The ifr modality) 2017 Coding and Medicare payment guide Fractional Flow Reserve (FFR) and instant wave-free Ratio (The ifr modality) All coding, coverage, billing and payment information provided herein by Philips Volcano

More information

code it EVOLVE EPS HCPCS Device Codes CPT Codes Physician Coding Elbow Plating System HCPCS Code Description C1713 CPT CODE Description RVUs

code it EVOLVE EPS HCPCS Device Codes CPT Codes Physician Coding Elbow Plating System HCPCS Code Description C1713 CPT CODE Description RVUs HCPCS Device Codes HCPCS codes are developed and maintained by CMS and are used to report items such as medical devices, implants, drugs and supplies. C-codes are a special type of HCPCS code designed

More information

Coronary intravascular ultrasound (IVUS)

Coronary intravascular ultrasound (IVUS) 2017 Coding and Medicare payment guide Coronary intravascular ultrasound (IVUS) All coding, coverage, billing and payment information provided herein by Philips Volcano is gathered from third-party sources

More information

Summary of Package Insert 1 for PuraPly Wound Matrix

Summary of Package Insert 1 for PuraPly Wound Matrix Summary of Package Insert 1 for PuraPly Wound Matrix For NGS Indications Indicated for the management of wounds including: Partial and full-thickness wounds Venous ulcers Diabetic ulcers Drainage wounds

More information

2018 Cerebrovascular Reimbursement Coding Fact Sheet

2018 Cerebrovascular Reimbursement Coding Fact Sheet The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Cordis Corporation concerning levels of reimbursement, payment,

More information

Dynamic Tissue Systems. Reimbursement & Coding Guide

Dynamic Tissue Systems. Reimbursement & Coding Guide Dynamic Tissue Systems Reimbursement & Coding Guide Dynamic Tissue Systems Reimbursement and Coding Guide The following information is shared for educational purposes only to help answer common coding

More information

CODING SHEETS CHRONIC INTRACTABLE PAIN MANAGEMENT. Effective January 1, 2009 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE

CODING SHEETS CHRONIC INTRACTABLE PAIN MANAGEMENT. Effective January 1, 2009 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE CODING SHEETS CHRONIC INTRACTABLE PAIN MANAGEMENT Effective January 1, 2009 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE Phone: 800-609-1108 Email: codmanpump@aol.com Fax: 303-703-1572

More information

Coding Companion for Plastics/OMS/Dermatology. A comprehensive illustrated guide to coding and reimbursement

Coding Companion for Plastics/OMS/Dermatology. A comprehensive illustrated guide to coding and reimbursement Coding Companion for Plastics/OMS/Dermatology A comprehensive illustrated guide to coding and reimbursement Contents Getting Started with Coding Companion... i Skin...1 Nails...28 Pilonidal Cyst...32 Repair...33

More information

Reconstructive and Cosmetic Services

Reconstructive and Cosmetic Services Reconstructive and Cosmetic Services Policy Number: 10.01.09 Last Review: 4/2018 Origination: 2/2006 Next Review: 4/2019 Policy Determination of whether a proposed therapy would be considered reconstructive

More information

2018 Hysterectomy Reimbursement Fact Sheet

2018 Hysterectomy Reimbursement Fact Sheet 2018 Hysterectomy Reimbursement Fact Sheet The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Ethicon concerning

More information

CD Horizon Solera 5.5/6.0mm Fenestrated Screw Set

CD Horizon Solera 5.5/6.0mm Fenestrated Screw Set REIMBURSEMENT GUIDE CD Horizon Solera 5.5/6.0mm Fenestrated Screw Set DEVICE DESCRIPTION The CD Horizon Solera 5.5/6.0mm Fenestrated Screw Set consists of a variety of cannulated multi-axial screws (MAS)

More information

2016 ST. JUDE MEDICAL THERAPY CODING GUIDE Cardiac Pacemakers

2016 ST. JUDE MEDICAL THERAPY CODING GUIDE Cardiac Pacemakers 2016 ST. JUDE MEDICAL THERAPY CODING GUIDE Cardiac Pacemakers This guide provides physician and hospital coding and reimbursement information for cardiac pacemaker procedures. In addition, St. Jude Medical

More information

Summary of Package Insert 1 for PuraPly Antimicrobial Wound Matrix

Summary of Package Insert 1 for PuraPly Antimicrobial Wound Matrix Summary of Package Insert 1 for PuraPly Antimicrobial Wound Matrix For States with Non-Published Policies-Novitas Indications Indicated for the management of wounds as an effective barrier to resist microbial

More information

Shunt Reimbursement Guide

Shunt Reimbursement Guide Shunt Guide - 2018 Effective October 1, 2015, the Centers for & Medicaid Services (CMS) is implementing International Classification of Diseases, 10 th Revision (ICD-10) Procedure Coding System (PCS) in

More information

2017 OSTEOID OSTEOMA RADIOFREQUENCY ABLATION MEDICARE REIMBURSEMENT GUIDE

2017 OSTEOID OSTEOMA RADIOFREQUENCY ABLATION MEDICARE REIMBURSEMENT GUIDE 2017 OSTEOID OSTEOMA RADIOFREQUENCY ABLATION MEDICARE REIMBURSEMENT GUIDE Coding Information The final decision of billing for any procedure must be made by the provider of care considering the medical

More information

SAMPLE. Relative Values for Dentists Relative values based on survey data from Relative Value Studies, Inc. ICD-10

SAMPLE. Relative Values for Dentists Relative values based on survey data from Relative Value Studies, Inc. ICD-10 www.optumcoding.com Relative Values for Dentists Relative values based on survey data from Relative Value Studies, Inc. 2017 a ICD-10 A full suite of resources including the latest code set, mapping products,

More information

SCOPE OF PRACTICE PGY-6 PGY-7 PGY-8

SCOPE OF PRACTICE PGY-6 PGY-7 PGY-8 PGY-6 Round on all plastic surgery inpatients every day. Assess progress of patients and identify real or potential problems. Review patients progress with attending physicians daily and participate in

More information

Vascular Plug Procedures 2014 CODING AND PAYMENT REFERENCE GUIDE ST. JUDE MEDICAL - CARDIOVASCULAR DIVISION

Vascular Plug Procedures 2014 CODING AND PAYMENT REFERENCE GUIDE ST. JUDE MEDICAL - CARDIOVASCULAR DIVISION Vascular Plug Procedures 2014 CODING AND PAYMENT REFERENCE GUIDE ST. JUDE MEDICAL - CARDIOVASCULAR DIVISION IMPORTANT: St. Jude Medical provides this reference guide for general information purposes only

More information

Codes for internal or external fixation are to be used only when internal or external fixation is not already listed as part of the basic procedure.

Codes for internal or external fixation are to be used only when internal or external fixation is not already listed as part of the basic procedure. HCPCS Device Codes HCPCS codes are developed and maintained by CMS and are used to report items such as medical devices, implants, drugs and supplies. C-codes are a special type of HCPCS code designed

More information

2019 MITRACLIP CODING AND PAYMENT GUIDE

2019 MITRACLIP CODING AND PAYMENT GUIDE CLAIM 2019 MITRACLIP AND PAYMENT GUIDE MitraClip Transcatheter Mitral Valve Repair Hospital Rates: Effective October 1, 2018 Physician Rates: Effective January 1, 2019 References and Brief Summary 1 CLAIM

More information

2017 Coding & Payment Quick Reference

2017 Coding & Payment Quick Reference 2017 Coding & Payment Quick Reference Select Pulmonary Procedures Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding or site of service requirements.

More information

2017 Coding and Reimbursement Survival Guide

2017 Coding and Reimbursement Survival Guide 2017 Coding and Reimbursement Survival Guide Chapter 8: General Surgery Integumentary Procedures: 4 Questions Focus Your Skin Substitute Graft Coding Hint: Graft size doesn t matter. If your surgeon treats

More information

Clinical Policy Title: Cosmetic, plastic, and scar revision surgery

Clinical Policy Title: Cosmetic, plastic, and scar revision surgery Clinical Policy Title: Cosmetic, plastic, and scar revision surgery Clinical Policy Number: CCP.1184 Effective Date: October 1, 2015 Initial Review Date: August 19, 2015 Most Recent Review Date: September

More information

2018 HEMODIALYSIS CATHETERS CODING AND REIMBURSEMENT GUIDE

2018 HEMODIALYSIS CATHETERS CODING AND REIMBURSEMENT GUIDE 2018 HEMODIALYSIS CATHETERS CODING AND REIMBURSEMENT GUIDE Contents Overview of Central Venous Access s for Hemodialysis 2 Procedures Using Hemodialysis s 2 Physician Reimbursement for Hemodialysis s 3

More information

Chapter 11 Worksheet Code It

Chapter 11 Worksheet Code It Class: Date: Chapter 11 Worksheet 3 2 1 Code It True/False Indicate whether the statement is true or false. 1. Surgical destruction is considered part of the surgical procedure description. 2. Prepping

More information

Uphold LITE Vaginal Support System 2015 Coding & Quick Reference Guide

Uphold LITE Vaginal Support System 2015 Coding & Quick Reference Guide Hospital Outpatient Coding Scenarios This guide contains specific information for two (2) common coding/reimbursement scenarios related to the use of the Uphold LITE Vaginal Support System when performed

More information

REIMBURSEMENT GUIDE. Sovereign. Spinal System

REIMBURSEMENT GUIDE. Sovereign. Spinal System REIMBURSEMENT GUIDE Sovereign Spinal System REIMBURSEMENT GUIDE The Sovereign Spinal System is indicated for use with autogenous bone graft in patients with degenerative disc disease The Sovereign Spinal

More information

CROSS CODER. Sample page. Anesthesia. codes to ICD-10-CM and HCPCS. Essential links from CPT. Power up your coding optum360coding.

CROSS CODER. Sample page. Anesthesia. codes to ICD-10-CM and HCPCS. Essential links from CPT. Power up your coding optum360coding. CROSS CODER 2019 Anesthesia Essential links from CPT codes to ICD-10-CM and HCPCS Power up your coding optum360coding.com Contents Introduction...i CPT Anesthesia to Procedure Code Crosswalk... i Format...

More information

Medical Policy Original Effective Date: Revised Date: Page 1 of 8

Medical Policy Original Effective Date: Revised Date: Page 1 of 8 Page 1 of 8 Disclaimer Description Coverage Determination Refer to the member s specific benefit plan and Schedule of Benefits to determine coverage. This may not be a benefit on all plans, or the plan

More information

Coding and Payment Guide for Anesthesia Services. An essential coding, billing, and reimbursement resource for anesthesiology and pain management

Coding and Payment Guide for Anesthesia Services. An essential coding, billing, and reimbursement resource for anesthesiology and pain management Coding and Payment Guide for Anesthesia Services An essential coding, billing, and reimbursement resource for anesthesiology and pain management Contents Introduction... 1 Coding Systems... 1 Claim Forms...

More information

Intensity Modulated Radiation Therapy (IMRT)

Intensity Modulated Radiation Therapy (IMRT) Intensity Modulated Radiation Therapy (IMRT) Policy Number: Original Effective Date: MM.05.006 03/09/2004 Line(s) of Business: Current Effective Date: HMO; PPO 06/24/2011 Section: Radiology Place(s) of

More information

Understanding Your Costs and Coverage

Understanding Your Costs and Coverage Understanding Your Costs and Coverage Thank you for choosing UW. We know that understanding your healthcare costs can be a challenge we re here to help. Your healthcare costs depend on many factors such

More information

SECTION N: PLASTIC SURGERY

SECTION N: PLASTIC SURGERY Visits 5N Initial Assessment $91.80 -- of a specific condition includes: pertinent family history, patient history, history of presenting complaint, functional enquiry, examination of affected part(s)

More information

MedStar Health, Inc. POLICY AND PROCEDURE MANUAL

MedStar Health, Inc. POLICY AND PROCEDURE MANUAL MedStar Health, Inc. POLICY AND PROCEDURE MANUAL MP.138.MH Oral Maxillofacial Prosthesis This policy applies to the following lines of business: MedStar Employee (Select) MedStar MA DSNP CSNP MedStar CareFirst

More information

SAMPLE. Plastics/ Dermatology. A comprehensive illustrated guide to coding and reimbursement ICD-10. Coding Companion

SAMPLE. Plastics/ Dermatology. A comprehensive illustrated guide to coding and reimbursement ICD-10. Coding Companion Coding Companion www.optumcoding.com Plastics/ Dermatology comprehensive illustrated guide to coding and reimbursement 2017 a ICD-10 full suite of resources including the latest code set, mapping products,

More information

WATCHMAN. For questions regarding WATCHMAN reimbursement, please contact:

WATCHMAN. For questions regarding WATCHMAN reimbursement, please contact: WATCHMAN IMPORTANCE OF DOCUMENTATION & THE IMPACT ON MS- DRG ASSIGNMENT This guide stresses the importance of documentation in capturing the appropriate acuity level for patients considered WATCHMAN candidates.

More information

Delineation Of Privileges Otolaryngology Privileges

Delineation Of Privileges Otolaryngology Privileges Delineation Of s Otolaryngology s OTOLARYNGOLOGY PRIVILEGES Criteria - New Applicants: Board Certification or qualified for certification by the American Board of Otolaryngology. Criteria - Current Staff

More information

CLINICAL MEDICATION POLICY

CLINICAL MEDICATION POLICY CLINICAL MEDICATION POLICY Policy Name: Opdivo (nivolumab) injection Policy Number: Approved By: Medical Management, Clinical Pharmacy Products: Highmark Health Options Application: All participating hospitals

More information

Diagnostic and interventional venous procedures (lower extremity)

Diagnostic and interventional venous procedures (lower extremity) Coding and Medicare national payment guide 2018 Diagnostic and interventional venous procedures (lower extremity) All coding, coverage, billing and payment information provided herein by Philips is gathered

More information

Medical Necessity Guidelines: Reconstructive and Cosmetic Surgery

Medical Necessity Guidelines: Reconstructive and Cosmetic Surgery Medical Necessity Guidelines: Reconstructive and Cosmetic Surgery Effective: April 12, 2017 Clinical Documentation and Prior Authorization Coverage Guideline, No Prior Required Authorization Applies to:

More information

WPS Medicare Policy Primer

WPS Medicare Policy Primer WPS Medicare Policy Primer Medicare Jurisdiction (J5 & J8) NE, KS, IA, MO, IN, & MI Retired skin substitute LCD 3/2016 Indications Apligraf Non-infected partial and full-thickness skin ulcers due to VSU

More information

Medtronic ENT Transnasal Endoscopic Procedures Coding Guide. Effective January 1, 2009

Medtronic ENT Transnasal Endoscopic Procedures Coding Guide. Effective January 1, 2009 Medtronic ENT Transnasal Endoscopic Procedures Coding Guide Transnasal Esophagoscopy Laryngeal Sensory Testing FEES FEEST Transnasal Fiberoptic Laryngoscopy Stroboscopy Disposable Sheaths Effective January

More information

Coding Companion for General Surgery/ Gastroenterology. A comprehensive illustrated guide to coding and reimbursement

Coding Companion for General Surgery/ Gastroenterology. A comprehensive illustrated guide to coding and reimbursement Coding Companion for General Surgery/ Gastroenterology A comprehensive illustrated guide to coding and reimbursement 2011 Contents Getting Started with Coding Companion...i Skin...1 Pilonidal Cyst...23

More information

Blepharoptosis repair is covered as functional/reconstructive surgery to correct: Visual impairment due to droop or displacement of the upper lid.

Blepharoptosis repair is covered as functional/reconstructive surgery to correct: Visual impairment due to droop or displacement of the upper lid. Premier Health Insuring Corporation POLICY AND PROCEDURE MANUAL MP.074.PC - Blepharoplasty This policy applies to the following line(s) of business: Premier Health Insuring Corporation MA DSNP Premier

More information

Payment Policy: Cosmetic Procedures Reference Number: CC.PP.024 Product Types: ALL

Payment Policy: Cosmetic Procedures Reference Number: CC.PP.024 Product Types: ALL Payment Policy: Cosmetic Procedures Reference Number: CC.PP.024 Product Types: ALL Effective Date: 01/01/2014 Last Review Date: 06/20/2018 Coding Implications Revision Log See Important Reminder at the

More information

Loma Linda University Children s Hospital Loma Linda, CA PLASTIC AND RECONSTRUCTIVE SURGERY PRIVILEGE FORM

Loma Linda University Children s Hospital Loma Linda, CA PLASTIC AND RECONSTRUCTIVE SURGERY PRIVILEGE FORM Name: Page 1 of 6 REQUEST CATEGORY MEMBERSHIP CATEGORY Provisional (Bylaws 4.3) Administrative (Bylaws 4.7) Affiliate (Bylaws(4.9) Active (Bylaws 4.2) Courtesy (Bylaws 4.4) Consulting (Bylaws 4.5) All

More information

SECTION N: PLASTIC SURGERY

SECTION N: PLASTIC SURGERY Visits 5N Initial Assessment $91.80 -- of a specific condition includes: pertinent family history, patient history, history of presenting complaint, functional enquiry, examination of affected part(s)

More information

Skin Deep. Agenda. Burns Wounds Debridement Evaluation and Management Services. Presented by: Mike Strong, SFM The Work Comp Experts.

Skin Deep. Agenda. Burns Wounds Debridement Evaluation and Management Services. Presented by: Mike Strong, SFM The Work Comp Experts. Presented by: Mike Strong, SFM The Work Comp Experts Agenda Wounds Debridement Evaluation and Management Services 2 1 Types of First Degree Second Degree Third Degree Rule of 9 Adults Infants Burn Coding

More information

Delineation Of Privileges Otolaryngology Privileges

Delineation Of Privileges Otolaryngology Privileges OTOLARYNGOLOGY PRIVILEGES Criteria - New Applicants: Board Certification or qualified for certification by the American Board of Otolaryngology. Criteria - Current Staff Members Only: Successful completion

More information

Coding Hot Topics. Lawrence A. Santi, DPM, FASPS Member, APMA Coding Committee

Coding Hot Topics. Lawrence A. Santi, DPM, FASPS Member, APMA Coding Committee Coding Hot Topics Lawrence A. Santi, DPM, FASPS Member, APMA Coding Committee 1 Disclaimer Participants in the APMA Coding Webinar are reminded that CPT code descriptors and coding policies do not reflect

More information

FOR QUESTIONS PLEASE CONTACT US AT

FOR QUESTIONS PLEASE CONTACT US AT NASAL AND SINUS ENDOSCOPY PROCEDURES EFFECTIVE JANUARY 2018 Medtronic provides this information for your convenience only. It does not constitute legal advice or a recommendation regarding clinical practice.

More information

Loma Linda University Medical Center Loma Linda, CA 92354

Loma Linda University Medical Center Loma Linda, CA 92354 Name: Page 1 of 6 REQUEST CATEGORY MEMBERSHIP CATEGORY Provisional (Bylaws 4.3) Administrative (Bylaws 4.7) Affiliate (Bylaws(4.9) Active (Bylaws 4.2) Courtesy (Bylaws 4.4) Consulting (Bylaws 4.5) All

More information

SPINAL CORD STIMULATION FOR CHRONIC PAIN-TRUNK AND/OR LIMBS COMMONLY BILLED CODES EFFECTIVE JANUARY 2016

SPINAL CORD STIMULATION FOR CHRONIC PAIN-TRUNK AND/OR LIMBS COMMONLY BILLED CODES EFFECTIVE JANUARY 2016 FOR CHRONIC PAIN-TRUNK AND/OR LIMBS EFFECTIVE JANUARY 2016 Medtronic provides this information for your convenience only. It does not constitute legal advice or a recommendation regarding clinical practice.

More information

Pelvic Health Coding & Payment Quick Reference

Pelvic Health Coding & Payment Quick Reference Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes

More information

COMMONLY BILLED CODES

COMMONLY BILLED CODES COMMONLY BILLED CODES SACRAL NEUROMODULATION FOR BLADDER CONTROL OR BOWEL CONTROL EFFECTIVE JANUARY 2018 UC201002977oEN Medtronic provides this information for your convenience only. It does not constitute

More information

Palmetto Medicare Policy Primer

Palmetto Medicare Policy Primer Palmetto Medicare Policy Primer Medicare Jurisdiction (JM) NC, SC, WV & VA Application of Skin Substitutes LCD #L36466 Indications Presence of neuropathic diabetic foot ulcer(s) having failed to respond

More information

Icd 10 dx code skin lesion of back

Icd 10 dx code skin lesion of back Icd 10 dx code skin lesion of back The Borg System is 100 % Icd 10 dx code skin lesion of back ICD-10-CM Codes; ; L00-L99 Diseases of the skin and subcutaneous tissue; ; L80-L99 Other disorders of the

More information

Lumify. Lumify reimbursement guide {D DOCX / 1

Lumify. Lumify reimbursement guide {D DOCX / 1 Lumify Lumify reimbursement guide {D0672917.DOCX / 1 {D0672917.DOCX / 1 } Contents Overview 4 How claims are paid 4 Documentation requirements 5 Billing codes for ultrasound: Non-hospital setting 6 Billing

More information