2015 ST. JUDE MEDICAL THERAPY CODING GUIDE Cardiac Pacemakers

Transcription

1 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 offers a reimbursement hotline, which provides live coding and billing information from dedicated reimbursement specialists. Hotline support is available from 8 a.m. to 5 p.m. Central Time, Monday through Friday at (855) or hce@sjm.com. Hotline reimbursement assistance is provided subject to the disclaimers set forth in this guide. This document and the information contained herein is for general information purposes only and is not intended and does not constitute legal, reimbursement, coding, business or other advice. Furthermore, it is not intended to increase or maximize payment by any payer. Nothing in this document should be construed as a guarantee by St. Jude Medical regarding levels of reimbursement, payment or charge, or that reimbursement or other payment will be received. Similarly, nothing in this document should be viewed as instructions for selecting any particular code. The ultimate responsibility for coding and obtaining payment/reimbursement remains with the customer. This includes the responsibility for accuracy and veracity of all coding and claims submitted to third-party payers. Also note that the information presented herein represents only one of many potential scenarios, based on the assumptions, variables and data presented. In addition, the customer should note that laws, regulations, coverage and coding policies are complex and updated frequently. Therefore, the customer should check with their local carriers or intermediaries often and should consult with legal counsel or a financial, coding or reimbursement specialist for any coding, reimbursement or billing questions or related issues. This information is for reference purposes only. It is not provided or authorized for marketing use. Hospital Inpatient Effective Dates: October 1, 2014 September 30, 2015 Possible ICD-9-CM code 1 Typical MS-DRG Assignment 2 Pacemaker System Implant Initial insertion of transvenous lead into ventricle Initial insertion of transvenous leads into atrium and ventricle Initial insertion of transvenous lead into atrium Replacement of transvenous atrial and/or ventricular lead(s) Insertion of permanent pacemaker, initial or replacement, type of device not specified Initial insertion of single-chamber device, not specified as rate responsive Initial insertion of single-chamber device, rate responsive Initial insertion of dual-chamber device Replacement of any type pacemaker device with single-chamber device, not specified as rate responsive Replacement of any type of pacemaker device with single-chamber device, rate responsive Replacement of any type pacemaker device with dual-chamber device Implantation of cardiac resynchronization pacemaker without mention of defibrillation, total system (CRT-P) MCC major complications or comorbidities; CC complications or comorbidities 242 Permanent cardiac pacemaker implant with MCC 243 Permanent cardiac pacemaker implant with CC 244 Permanent cardiac pacemaker implant without CC/MCC 1

2 Hospital Inpatient (continued) Effective Dates: October 1, 2014 September 30, 2015 Possible ICD-9-CM code 1 Typical MS-DRG Assignment Pacemaker Revision Insertion of permanent pacemaker, initial or replacement, type of device not specified Replacement of any type pacemaker device with single-chamber device, not specified as rate responsive Replacement of any type of pacemaker device with single-chamber device, rate responsive Replacement of any type pacemaker device with dual-chamber device Implantation or replacement of cardiac resynchronization pacemaker pulse generator only (CRT-P) Revision of lead Replacement of transvenous atrial and/or ventricular lead(s) Removal of lead(s) without replacement Revision or relocation of cardiac device pocket Revision or removal of pacemaker device MCC major complications or comorbidities; CC complications or comorbidities 258 Cardiac pacemaker replacement with MCC 259 Cardiac pacemaker replacement without MCC 260 Cardiac pacemaker revision except device replacement with MCC 261 Cardiac pacemaker revision except device replacement with CC 262 Cardiac pacemaker revision except device replacement without CC/MCC 2

3 Hospital Outpatient and ASC Effective Dates: January 1, 2015 December 31, 2015 Status CPT Code 3 APC Indicator 4 APC Pacemaker System Implant Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial ventricular atrial and ventricular Insertion of pacemaker pulse generator only; with existing single lead J with existing dual leads J with existing multiple leads 0655 Insertion of Lead(s) Insertion of a single lead Insertion of two leads Repositioning/Repair/Revision Insertion of pacing LV lead, with attachment to previously placed pacemaker or ICD generator including revision of pocket, removal, insertion and/or replacement of existing generator) Insertion of pacing LV lead at time of insertion of ICD or pacemaker generator (including upgrade to dual-chamber system) Repositioning of previously implanted transvenous pacemaker or ICD (right atrial or right ventricular) electrode Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator) Repair of single transvenous electrode, permanent pacemaker or ICD J1 N T Packaged Level II Pacemaker and Level IV Pacemaker and Level II Pacemaker and Miscellaneous Vascular Procedures Level I Pacemaker and Relocation of skin pocket for pacemaker 0328 Level III Skin Procedures Removal and/or Replacement Upgrade of implanted pacemaker system, conversion of single-chamber system to dual-chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator) Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system J dual lead system multiple lead system Removal of permanent pacemaker pulse generator only Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular Removal of transvenous pacemaker electrode(s); dual lead system Q Level II Pacemaker and Level IV Pacemaker and Removal of permanent pacemaker pulse generator only Level I Pacemaker and J1 = Hospital Part B services paid through a comprehensive APC. N = Items and services packaged into APC rates. T = Multiple procedure reduction applies. Q2 = T-packaged codes. + indicates add-on code. 3

4 HCPCS Device Category C-codes C-Code 5 C1785 Pacemaker, dual-chamber, rate-responsive (implantable) C2621 Pacemaker, other than single or dual-chamber (implantable) C2620 Pacemaker, single-chamber, non-rate-responsive (implantable) C1786 Pacemaker, single-chamber, rate-responsive (implantable) C2619 Pacemaker, dual-chamber, non-rate-responsive (implantable) Leads C1883 Adapter/extension, pacing lead or neurostimulator (implantable) C1900 Lead, left ventricular coronary venous system C1898 Lead, pacemaker, other than transvenous VDD single pass C1779 Lead, pacemaker, transvenous VDD single pass Physician Coding Effective Dates: January 1, 2015 December 31, 2015 CPT Code 3 Work Total RVUs 6 RVUs* 6 Pacemaker System Implant Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial ventricular atrial and ventricular Insertion of pacemaker pulse generator only; with existing single lead with existing dual leads with existing multiple leads Insertion of Lead(s) Insertion of a single lead Insertion of two leads Insertion of pacing LV lead, with attachment to previously placed pacemaker or ICD generator including revision of pocket, removal, insertion and/or replacement of existing generator) Insertion of pacing LV lead at time of insertion of ICD or pacemaker generator (including upgrade to dual-chamber system) Repositioning/Repair/Revision Repositioning of previously implanted transvenous pacemaker or ICD (right atrial or right ventricular) electrode Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator) Repair of single transvenous electrode, permanent pacemaker or ICD Relocation of skin pocket for pacemaker *In-facility + indicates add-on code. 4

5 Physician Coding (continued) Effective Dates: January 1, 2015 December 31, 2015 CPT Code Work Total RVUs RVUs* Removal and/or Replacement Upgrade of implanted pacemaker system, conversion of single-chamber system to dual-chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator) Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system dual lead system multiple lead system Removal of permanent pacemaker pulse generator only Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular Removal of transvenous pacemaker electrode(s); dual lead system *In-facility + indicates add-on code. A list of CPT code modifiers can be found at See SJM Professional for additional information on coding for cardiac device monitoring. 5

6 References 1. ICD-9-CM Code Book - v30 FY2015 (Effective October 1, 2014). 2. DRG Expert for ICD Book (Effective October 1, 2014). 3. Current Procedural Terminology 2014 American Medical Association. All Rights Reserved Per CMS List of Device Category Codes for Present or Previous Pass-Through Payment and Related Definitions, Updated November, Rx Only Brief Summary: Prior to using these devices, please review the User s Manual for a complete listing of indications, contraindications, warnings, precautions, potential adverse events and directions for use. CPT is a trademark of American Medical Association. Unless otherwise noted, indicates that the name is a trademark of, or licensed to, St. Jude Medical or one of its subsidiaries. ST. JUDE MEDICAL and the nine-squares symbol are trademarks and service marks of St. Jude Medical, Inc. and its related companies St. Jude Medical, Inc. All Rights Reserved. St. Jude Medical Inc. Global Headquarters One St. Jude Medical Drive St. Paul, Minnesota USA T F St. Jude Medical S.C., Inc. Americas Division 6300 Bee Cave Road Bldg. Two, Suite 100 Austin, TX USA T F SJM Coordination Center BVBA The Corporate Village Da Vincilaan 11-Box F1 B-1935 Zaventem, Belgium T F St. Jude Medical Brasil Ltda. Rua Itapeva, 538 5º ao 8º andares São Paulo SP Brazil T F St. Jude Medical (Hong Kong) Ltd. Suite 1608, 16/F Exchange Tower 33 Wang Chiu Road Kowloon Bay, Kowloon Hong Kong SAR T F St. Jude Medical Japan Co., Ltd. Shiodome City Center 15F Higashi Shinbashi, Minato-ku Tokyo Japan T F St. Jude Medical Australia Pty, Ltd. 17 Orion Road Lane Cove, NSW 2066 Australia T F SJMprofessional.com SJM-CRM (1) Item approved for U.S. use only.