Thrombectomy, open, arteriovenous fistula without revision, autogenous or nonautogenous dialysis graft (separate procedure)

Transcription

1 Dialysis Vascular Access Coverage, Coding and Reimbursement Overview Hospital Outpatient 2019 Edition All Reimbursement Amounts are Listed at ational Unadjusted Medicare Rates and Do ot Include the 2% Sequestration Reduction HOSPITAL OUTPATIET REVIEW Hospital Outpatient rates effective January 1, 2019 through December 31, 2019 APC SIB RateC C1768 C by upper arm basilic vein transposition by forearm vein transposition direct, any site (eg, Cimino type) (separate procedure) $2,642 Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); autogenous graft nonautogenous graft (eg, biological collagen, thermoplastic graft) Imaging Injection procedure for extremity venography (including introduction of needle or intracatheter) Venography, extremity, unilateral, radiological supervision and interpretation Q2 $620 Venography, extremity, bilateral, radiological supervision and interpretation Q2 $1,094 Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study S $113 Thrombectomy, open, arteriovenous fistula without revision, autogenous or Device Code* Graft, vascular Stent, coated/covered, with delivery system CREATIOA Arteriovenous anastomosis, open; by upper arm cephalic vein transposition MAITEACEA A. Listed are common procedures. Review CPT coding guidelines, modifiers, and CCI edits for these codes. Current Terminology (CPT ) is a registered B. Status Indicators: -Hospital Part B Services Paid Through a Comprehensive APC; -ltems and Services into APC Rates; Q2-T- Codes; S- or Service, ot Discounted When Multiple. C. Rates are from CY 2019 Hospital Outpatient Prospective Payment System Final Rule, CMS-1695-C2, Centers for Medicare and Medicaid Services. *Per CMS-1695-FC, device-intensive procedures require the reporting of a device HCPCS code. Device code reporting requirements apply.

2 HOSPITAL OUTPATIET REVIEW Hospital Outpatient rates effective January 1, 2019 through December 31, 2019 APC SIB RateC Distal revascularization and interval ligation (DRIL), upper extremity hemodialysis access (steal syndrome) Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report; T $1, $4, dialysis segment 5193 $9, $4, $9, dialysis circuit 5194 $15,355 MAITEACEA Revision, open, arteriovenous fistula; without thrombectomy, autogenous or with thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure) Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s); A. Listed are common procedures. Review CPT coding guidelines, modifiers, and CCI edits for these codes. Current Terminology (CPT ) is a registered B. Status Indicators: -Hospital Part B Services Paid Through a Comprehensive APC; -ltems and Services into APC Rates; T- or Service, Multiple Reduction Applies. C. Rates are from CY 2019 Hospital Outpatient Prospective Payment System Final Rule, CMS-1695-F, Centers for Medicare and Medicaid Services.

3 HOSPITAL OUTPATIET REVIEW Hospital Outpatient rates effective January 1, 2019 through December 31, 2019 APC SIB RateC Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysis segment (List separately in addition to code for primary procedure) Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention (List separately in addition to code for primary procedure) Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty Other Hemodialysis access flow study to determine blood flow in grafts and arteriovenous fistulae by an indicator method $4, Duplex scan of hemodialysis access (including arterial inflow, body of access and venous outflow) Q1 $113 MAITEACEA Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the angioplasty (List separately in addition to code for primary procedure) A. Listed are common procedures. Review CPT coding guidelines, modifiers, and CCI edits for these codes. Current Terminology (CPT ) is a registered B. Status Indicators: -Hospital Part B Services Paid Through a Comprehensive APC; -ltems and Services into APC Rates; Q1-STV- Codes. C. Rates are from CY 2019 Hospital Outpatient Prospective Payment System Final Rule, CMS-1695-C2, Centers for Medicare and Medicaid Services.

4 AMBULATORY SURGERY CETER (ASC) ASC rates effective January 1, 2019 through December 31, 2019 Rate by upper arm basilic vein transposition by forearm vein transposition direct, any site (eg, Cimino type) (separate procedure) $1,306 Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); autogenous graft nonautogenous graft (eg, biological collagen, thermoplastic graft) Imaging Injection procedure for extremity venography (including introduction of needle or intracatheter) Venography, extremity, unilateral, radiological supervision and interpretation Venography, extremity, bilateral, radiological supervision and interpretation Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study on-covered Thrombectomy, open, arteriovenous fistula without revision, autogenous or Revision, open, arteriovenous fistula; without thrombectomy, autogenous or Distal revascularization and interval ligation (DRIL), upper extremity hemodialysis access (steal syndrome) on-covered Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report; $523 CREATIOA Arteriovenous anastomosis, open; by upper arm cephalic vein transposition MAITEACEA with thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure) A. Listed are common procedures. Review CPT coding guidelines, modifiers, and CCI edits for these codes. Current Terminology (CPT ) is a registered B. Rates are from the CY 2019 Ambulatory Surgical Center Payment Final Rule, CMS-1695-C2, Centers for Medicare and Medicaid Services.

5 AMBULATORY SURGERY CETER (ASC) ASC rates effective January 1, 2019 through December 31, 2019 Rate $2, dialysis segment $6,003 MAITEACEA Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s); $2, $4, dialysis circuit $9,726 Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the angioplasty (List separately in addition to code for primary procedure) Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysis segment (List separately in addition to code for primary procedure) Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention (List separately in addition to code for primary procedure) Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty $2,888 A. Listed are common procedures. Review CPT coding guidelines, modifiers, and CCI edits for these codes. Current Terminology (CPT ) is a registered B. Rates are from the CY 2019 Ambulatory Surgical Center Payment Final Rule, CMS-1695-C2, Centers for Medicare and Medicaid Services.

6 AMBULATORY SURGERY CETER (ASC) ASC rates effective January 1, 2019 through December 31, 2019 MAITEACEA Other Hemodialysis access flow study to determine blood flow in grafts and arteriovenous fistulae by an indicator method Duplex scan of hemodialysis access (including arterial inflow, body of access and venous outflow) Rate on-covered on-covered A. Listed are common procedures. Review CPT coding guidelines, modifiers, and CCI edits for these codes. Current Terminology (CPT ) is a registered B. Rates are from the CY 2019 Ambulatory Surgical Center Payment Final Rule, CMS-1695-C2, Centers for Medicare and Medicaid Services. REV021819PT