AXIUM DETACHABLE COILS (FAMILY) CODING AND REIMBURSEMENT GUIDE

Transcription

1 AXIUM DETACHABLE COILS (FAMILY) CODING AND REIMBURSEMENT GUIDE

2 Axium Detachable Coils (Family) Axium detachable coils consist of a platinum embolization coil attached to a delivery pusher. When activated, a hand-held device detaches the coil from the delivery pusher tip. Some models of Axium detachable coils are bioactive and some are non-bioactive: Axium coils Axium MicroFX 3D PGLA coils Axium MicroFX Helix PGLA coils Axium MicroFX Helix nylon coils Axium Prime detachable coils (Frame) (Soft) (Super Soft) non-bioactive (bare metal) bioactive bioactive non-bioactive (nylon) non-bioactive (bare metal) Axium detachable coils and Axium Prime detachable coils are intended for the endovascular embolization of intracranial aneurysms. Axium and Axium Prime detachable coils are also intended for the embolization of other neurovascular abnormalities such as arteriovenous malformations and arteriovenous fistulae. Embolization with Axium coils is typically performed in the inpatient setting. 1

3 DIAGNOSIS CODING Medtronic provides this information for your convenience only. It does not constitute legal advice or a recommendation regarding clinical practice. Information provided is gathered from third-party sources and is subject to change without notice due to frequently changing laws, rules and regulations. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other payers as to the correct form of billing or the amount that will be paid to providers of service. Please contact your Medicare contractor, other payers, reimbursement specialists and/or legal counsel for interpretation of coding, coverage and payment policies. This document provides assistance for FDA approved or cleared indications. Where reimbursement is sought for use of a product that may be inconsistent with, or not expressly specified in, the FDA cleared or approved labeling (eg, instructions for use, operator s manual or package insert), consult with your billing advisors or payers on handling such billing issues. Some payers may have policies that make it inappropriate to submit claims for such items or related service. The following information is calculated per the footnotes included and does not take into effect Medicare payment reductions resulting from sequestration associated with the Budget Control Act of Sequestration reductions went into effect on April 1, For questions please contact us at neuro.us.reimbursement@medtronic.com ICD-10-CM DIAGNOSIS CODES 1 effective October 1, 2017 ICD-10-CM diagnosis codes are used by both physicians and hospitals to report the indication for the procedure. ICD-10-CM CODE 2 CODE DESCRIPTION ANEURYSM CEREBRAL ANEURYSM, RUPTURED, WITH SUBARACHNOID HEMORRHAGE 3 I60.00 Nontraumatic subarachnoid hemorrhage from unspecified carotid siphon and bifurcation I60.01 Nontraumatic subarachnoid hemorrhage from right carotid siphon and bifurcation I60.02 Nontraumatic subarachnoid hemorrhage from left carotid siphon and bifurcation I60.10 Nontraumatic subarachnoid hemorrhage from unspecified middle cerebral artery I60.11 Nontraumatic subarachnoid hemorrhage from right middle cerebral artery I60.12 Nontraumatic subarachnoid hemorrhage from left middle cerebral artery I60.2 Nontraumatic subarachnoid hemorrhage from anterior communicating artery I60.30 Nontraumatic subarachnoid hemorrhage from unspecified posterior communicating artery I60.31 Nontraumatic subarachnoid hemorrhage from right posterior communicating artery I60.32 Nontraumatic subarachnoid hemorrhage from left posterior communicating artery I60.4 Nontraumatic subarachnoid hemorrhage from basilar artery I60.50 Nontraumatic subarachnoid hemorrhage from unspecified vertebral artery I60.51 Nontraumatic subarachnoid hemorrhage from right vertebral artery I60.52 Nontraumatic subarachnoid hemorrhage from left vertebral artery I60.6 Nontraumatic subarachnoid hemorrhage from other intracranial arteries I60.7 Nontraumatic subarachnoid hemorrhage from unspecified intracranial artery I60.9 Nontraumatic subarachnoid hemorrhage, unspecified CEREBRAL ANEURYSM, NON-RUPTURED 4 I67.1 Cerebral aneurysm, nonruptured CEREBRAL ANEURYSM, CONGENITAL, NON-RUPTURED 5 Q28.3 Other malformations of cerebral vessels ICD-10-CM CODE CODE DESCRIPTION ARTERIOVENOUS FISTULA CEREBRAL ARTERIOVENOUS FISTULA, RUPTURED, WITH SUBARACHNOID HEMORRHAGE 6 I60.8 Other nontraumatic subarachnoid hemorrhage CEREBRAL ARTERIOVENOUS FISTULA, NON-RUPTURED 4 I67.1 Cerebral aneurysm, nonruptured (includes acquired cerebral arteriovenous fistula, nonruptured) CEREBRAL ARTERIOVENOUS FISTULA, CONGENITAL, NON-RUPTURED 7 Q28.2 Arteriovenous malformation of cerebral vessels (includes congenital cerebral arteriovenous fistula, nonruptured) 2

4 HOSPITAL INPATIENT PROCEDURE CODING AND DRG PAYMENT ICD-10-PCS PROCEDURE CODES 8 effective October 1, 2017 ICD-10-PCS procedure codes are used by hospitals to report surgeries and procedures performed in the inpatient setting. ICD-10-PCS CODE CODE DESCRIPTION 9, 10, 11 PLACEMENT OF AXIUM DETACHABLE EMBOLIZATION COILS FOR ANEURYSM 03VG3BZ Restriction of intracranial artery with bioactive intraluminal device, percutaneous approach 03VG3DZ Restriction of intracranial artery with intraluminal device, percutaneous approach FOR ARTERIOVENOUS FISTULA 03LG3BZ Occlusion of intracranial artery with bioactive intraluminal device, percutaneous approach 03LG3DZ Occlusion of intracranial artery with intraluminal device, percutaneous approach CEREBRAL ARTERIOGRAPHY B31R1ZZ Fluoroscopy of intracranial arteries using low osmolar contrast B31RYZZ Fluoroscopy of intracranial arteries using other contrast 12 DRG ASSIGNMENT FY2018 effective October 1, 2017 Under Medicare s MS-DRG methodology for hospital inpatient payment, each inpatient stay is assigned to one of about 750 diagnosis-related groups, based on the ICD-10 codes assigned to the diagnoses and procedures. MS-DRG has a relative weight that is then converted to a flat payment amount. Implanted devices are typically included in the flat payment and are not paid separately. Only one MS-DRG is assigned for each inpatient stay, regardless of the number of procedures performed. MS-DRGs shown are those typically assigned to the following scenarios. MS-DRG 13 MS-DRG TITLE 13,14 RELATIVE GEOMETRIC WEIGHT MEAN LENGTH 13 OF STAY 13 RUPTURED INTRACRANIAL ANEURYSM, RUPTURED CEREBRAL ARTERIOVENOUS FISTULA 020 Intracranial Vascular Procedures W Principal Diagnosis of Hemorrhage W MCC Intracranial Vascular Procedures 021 W Principal Diagnosis of Hemorrhage W CC 022 Intracranial Vascular Procedures W Principal Diagnosis of Hemorrhage WO CC/MCC SUBJECT TO PACT 13,15 MEDICARE NATIONAL AVERAGE No $60, No $45, No $34,454 NON-RUPTURED INTRACRANIAL ANEURYSM, RUPTURED CEREBRAL ARTERIOVENOUS FISTULA 025 Craniotomy and Endovascular Intracranial Procedures W MCC Yes $25, Craniotomy and Endovascular Intracranial Procedures W CC Yes $18, Craniotomy and Endovascular Intracranial Procedures WO CC/MCC Yes $14,262 HCPCS DEVICE CODES 17 HCPCS device codes are assigned by the entity that purchased and supplied the device to the patient. In the case of Axium detachable embolization coils, that is the hospital. However, hospitals assign HCPCS device codes only when the device is provided in the hospital outpatient setting. HCPCS device codes cannot be assigned or billed for procedures performed in the inpatient setting. If a hospital requires a HCPCS device code for an inpatient case for internal purposes only, such as for tracking, please refer to the HCPCS addendum for references. 3

5 PHYSICIAN PROCEDURE CODING AND PAYMENT PHYSICIAN PROCEDURE CODING AND RBRVS PAYMENT FOR AXIUM DETACHABLE EMBOLIZATION COILS Physicians use CPT codes for all services. Under Medicare s Resource-Based Relative Value Scale (RBRVS) methodology for physician payment, each CPT code is assigned a point value, the relative value unit (RVU), which is then converted to a flat payment amount. CPT CODES 18 effective January 1, 2018 CY 2018 RBRVS FACTORS 20 effective January 1, 2018 CPT CODE 18 CODE DESCRIPTION MULTIPLE PROCEDURE DISCOUNTING 21 CY2018 MEDICARE RVUS (FACILITY SETTING) 22 CY2018 MEDICARE NATIONAL AVERAGE (FACILITY SETTING) 22,23 PLACEMENT OF AXIUM DETACHABLE EMBOLIZATION COILS 24, Transcatheter permanent occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method, central nervous system (intracranial, spinal cord) Yes $ Transcatheter therapy, embolization, any method, radiological supervision and interpretation Yes 2.05 $74 PRE-PROCEDURAL BALLOON OCCLUSION TEST Endovascular temporary balloon arterial occlusion, head or neck (extracranial/ intracranial) including selective catheterization of vessel to be occluded, positioning and inflation of occlusion balloon, concomitant neurological monitoring, and radiologic supervision and interpretation of all angiography required for balloon occlusion and to exclude vascular injury post occlusion CEREBRAL ANGIOGRAPHY 27, Selective catheter placement, internal carotid artery, unilateral, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed Yes $605 Yes $ Selective catheter placement, vertebral artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed Selective catheter placement, each intracranial branch of the internal carotid or vertebral arteries, unilateral, with angiography of the selected vessel circulation and all associated radiological supervision and interpretation (eg, middle cerebral artery, posterior inferior cerebellar artery) Yes $370 No 6.99 $252 CATHETERIZATION 29, Selective catheter placement, arterial system, initial second order or more selective thoracic or brachiocephalic branch, within a vascular family Selective catheter placement, arterial system, initial third order or more selective thoracic or brachiocephalic branch, within a vascular family Yes 7.95 $286 Yes 9.49 $342 COMPLETION ANGIOGRAPHY Angiography through existing catheter for follow-up study for transcatheter therapy, embolization, or infusion other than thrombolysis No 2.56 $92 4

6 REFERENCES 1. ICD-10-CM: Department of Health and Human Services, Centers for Disease Control and Prevention. International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) For codes in I60.-- and code I67.1, note that the first digit is the letter I and other digits are the number Codes in I60.-- are used for ruptured aneurysms, even when the aneurysm is specified as congenital. 4. According to the Index and Tabular instructional notes, code I67.1 includes the intracranial portion of the internal carotid artery. Aneurysm of the extracranial portion of the internal carotid artery is coded elsewhere. 5. Code Q28.3 includes non-ruptured congenital cerebral aneurysm, among other congenital malformations. 6. According to the Index, code I60.8 includes rupture of arteriovenous fistula of the brain, even when the fistula is specified as congenital. 7. Code Q28.2 includes non-ruptured congenital arteriovenous fistula of the brain, among other congenital arteriovenous malformations. 8. ICD-10-PCS: Department of Health and Human Services, Centers for Medicare & Medicaid Services. International Classification of Diseases, 10th Revision, Procedure Coding System (ICD- 10-PCS) In the coiling codes, the fourth character represents the body part : G-Intracranial Artery. There are other body part values for internal carotid artery, but these are not shown. From the petrous to the superior hypophyseal segment, the internal carotid artery lies within the cranial vault and is intracranial by definition (see also Coding Clinic, 1st Q 2016, p.19). 10. The difference between the two sets of codes for placement of Axium embolization coils is the third character for the root operation, which is assigned according to the objective of the procedure. Although the same devices may be used, the objective is different depending on the diagnosis. For coils placed for aneurysm, the root operation is V-Restriction which is defined as partially closing an orifice or the lumen of a tubular body part. When an aneurysm is repaired by placing a device such as a coil into the lumen of an artery, allowing blood to flow through the rest of the artery while excluding the aneurysmal portion, the procedure is coded to this root operation (Coding Clinic, 1st Q 2014, p.9). In contrast, for coils placed for arteriovenous fistula, the root operation is L-Occlusion which is defined as completely closing an orifice or the lumen of a tubular body part. This is the proper root operation because the objective in treating an arteriovenous fistula is to prevent blood flow between vein and artery by completely closing the unnatural connection, ie, sacrificing the vessel (Coding Clinic, 4th Q 2014, p.37). 11. The use of balloon-assisted coiling and stent-assisted coiling techniques does not alter the ICD-10-PCS codes assigned. Ballooning is considered an integral step in coil placement and is not coded separately. In stent-assisted coiling, both the implanted stent and the coils are being used at the same site for the same objective, and a single code suffices (Coding Clinic, 1st Q 2016, p.19). 12. Fifth character Y-Other Contrast can be used for iso-osmolar contrast, eg, Visipaque. Coding Clinic 3rd Q 2016, p Centers for Medicare & Medicaid Services. Medicare Program: Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Changes and FY2018 Rates Final Rule, 81 Fed. Reg gpo.gov/fdsys/pkg/fr /pdf/ pdf. Published August 14, Final Rule Correction, 82 Fed. Reg pdf/ pdf. Published October 4, W MCC in MS-DRG titles refers to secondary diagnosis codes that are designated as major complications or comorbidities. MS-DRGs W MCC have at least one major secondary complication or comorbidity. Similarly, W CC in MS-DRG titles refers to secondary diagnosis codes designated as other (non-major) complications or comorbidities, and MS-DRGs W CC have at least one other (non-major) secondary complication or comorbidity. MS-DRGs WO CC/MCCs have no secondary diagnoses that are designated as complications or comorbidities, major or otherwise. Note that some secondary diagnoses are only designated as CCs or MCCs when the conditions were present on admission, and do not count as CCs or MCCs when the conditions are acquired in the hospital during the stay. 15. Post-Acute Care Transfer (PACT) status refers to selected DRGs in which payment to the hospital may be reduced when the patient is discharged by being transferred out. The DRGs impacted are those marked Yes and the patient must be transferred out before the geometric mean length of stay to certain post-acute care providers, including rehabilitation hospitals, long term care hospitals, skilled nursing facilities, or to home under the care of a home health agency. When these conditions are met, the DRG payment is converted to a per diem and payment is made as double the per diem rate for the first day plus the per diem rate for each remaining day up to the full DRG payment. 16. Payment is based on the average standardized operating amount ($5,572.53) plus the capital standard amount ($453.95). Centers for Medicare & Medicaid Services. Medicare Program: Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Changes and FY2018 Rates; Correction, 82 Fed. Reg Tables 1A-1D. Published October 4, The payment rate shown is the standardized amounts for facilities with a wage index greater than one. The average standard amounts shown also assume facilities receive the full quality update. The payment is also adjusted by the Wage Index for specific geographic locality. Therefore, payment for a specific hospital will vary from the stated Medicare national average payment levels shown. Also note that any applicable coinsurance, deductible, and other amounts that are patient obligations are included in the national average payment amount shown. 17. HCPCS Level II codes are maintained by the Centers for Medicare and Medicaid Services. Healthcare Common Procedure Coding System. HCPCS II codes are updated once per quarter. Updates are available at HCPCS-Quarterly-Update.html 18. CPT copyright 2018 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. 19. Modifier -26 is appended to certain imaging codes to show that the physician is reporting only the professional interpretation, because the hospital is providing the imaging equipment and technicians. 20. Centers for Medicare & Medicaid Services. Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2018 Final Rule; 82 Fed. Reg Published November 15, For codes marked Y, multiple procedure discounting indicates that when a procedure code is reported on the same day as another higher-weighted procedure code, the highest-weighted code is paid at 100% of the fee schedule amount and additional codes are paid at 50% of the fee schedule amount. Procedure codes marked N are always paid at 100% of the fee schedule amount regardless of whether they are submitted with other procedure codes. January 2018 release of the PFS Relative Value File RVU18A at Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html. Released November 15, The total RVU as shown here is the sum of three components: physician work RVU, practice expense RVU, and malpractice RVU. RVUs and the Medicare National Average are shown for the facility setting only because the Pipeline embolization procedure is always performed in the hospital, rather than the non-facility (physician office) setting. 23. Medicare national average payment is determined by multiplying the sum of the three RVUs by the conversion factor. The conversion factor for CY 2018 is $ per 82 Fed. Reg Published November 15, See also the January 2018 release of the PFS Relative Value File RVU18A at cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/pfs-relative-value-files.html. Released November 15, Final payment to the physician is adjusted by the Geographic Practice Cost Indices (GPCI). Also note that any applicable coinsurance, deductible, and other amounts that are patient obligations are included in the payment amount shown. 24. Component coding conventions apply to code 61624, so radiological supervision and interpretation is coded separately. Code represents the radiologic service linked to code The use of balloon-assisted coiling and stent-assisted coiling techniques does not alter the CPT codes assigned. Ballooning is considered an integral step in coil placement and is not coded separately (see also NCCI Policy Manual, 01/01/2018, Chapter VIII, C-28). In stent-assisted coiling, when the stent and the coils are placed during the same operative encounter, code encompasses both and the stent is not coded separately (ACR Bulletin, March 2007, p.3; see also CPT Assistant, July 2016, p.6). 26. A balloon occlusion test may be performed immediately prior to coil embolization, particularly with arteriovenous fistula, to assess the neurological risks of permanently occluding the vessel. When performed, this may be coded and reported separately. 27. Codes and for Axium detachable coil embolization include intraprocedural roadmapping and fluoroscopic guidance necessary to perform the intervention. However, cerebral angiography may be coded separately with when it is truly diagnostic. According to CPT manual instructions (Radiology section, Vascular Procedures heading), a truly diagnostic study means that no prior angiography is available and the decision to intervene is based on the current angiography or, if angiography was previously performed, the patient s condition has changed since the prior angiography, there is inadequate visualization of the anatomy or pathology on prior angiography, or there is a clinical change during the procedure requiring new evaluation. See also CPT manual instructions (Surgery section, Cardiovascular System chapter, Diagnostic Studies of Cervicocerebral Arteries heading) and NCCI Policy Manual, 01/01/2018, Chapter V, D A 4-view cervical and cerebral angiography, from catheter placement in the internal carotid arteries and vertebral arteries bilaterally, is coded and Add-on code would also be assigned if additional angiography was performed from catheter placement in, for example, the superior hypophyseal artery. 29. Catheter placement may be coded separately with Code would typically represent catheterization of the left internal carotid artery. Code would typically represent catheterization of the right internal carotid artery or higher level, eg, the middle cerebral artery on either side. 30. If diagnostic cerebral angiography is also performed during the same operative encounter, catheterization is not coded at all. According to CPT manual instructions (Surgery section, Cardiovascular System chapter, Diagnostic Studies of Cervicocerebral Arteries heading), catheterization is already included in the diagnostic cerebral angiography codes and catheterization for the intervention would then be subsumed into the codes for the angiography. See also 2011 Interventional Radiology Coding Update, SIR and ACR, p.22 FAQ Code can be assigned multiple times, once for each completion or follow-up angiogram performed during the embolization. However, physicians are advised to assign judiciously and to maintain clear documentation on the medical necessity for each angiography. 5

7 Indications, Contraindications, Warnings and instructions for use can be found in the product labeling supplied with each device. CAUTION: Federal (USA) law restricts this device to sale by or on the order of a physician. Axium and Axium Prime detachable coils are intended for the endovascular embolization of intracranial aneurysms. Axium and Axium Prime detachable coils are also intended for the embolization of other neurovascular abnormalities such as arteriovenous malformations and arteriovenous fistulae. Axium Prime Detachable Coil (Frame): The Axium Prime detachable coil system is indicated for the endovascular embolization of intracranial aneurysms and other neurovascular abnormalities, such as arteriovenous malformations and arterio-venous fistulae. The Axium Prime detachable coils are also indicated for arterial and venous embolizations in the peripheral vasculature Toledo Way Irvine, CA USA Tel Fax medtronic.com 2018 Medtronic. All rights reserved. Medtronic, Medtronic logo and Further, Together are trademarks of Medtronic. CPT is a registered trademark of the American Medical Association. All other brands are trademarks of a Medtronic company. DC Rev B APR/2018