BILLING BULLETIN. Re: Interventional Cardiology. Bulletin #: 1. Date Issued: November 10, Background
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1 BILLING BULLETIN Re: Interventional Cardiology Bulletin #: 1 Date Issued: November 10, 2016 Background This Billing Bulletin provides billing guidance when submitting claims to Manitoba Health, Seniors and Active Living (MHSAL) for tariffs regarding interventional cardiology found in the Cardiovascular System section of the Manitoba Physician s Manual (the Physician s Manual) The Physician s Manual is the authoritative reference when submitting medical claims to MHSAL. The Billing Bulletin reflects the Surgical Rules of Application and Notes set out in the Physician s Manual. For ease of reference the tariffs have been grouped into categories. Page 1 of 9
2 CATEGORY A One of the following tariffs can be claimed, per sitting. Combinations of the below tariffs are ineligible for payment and should not be claimed: Angiography- Angiocardiograms- Percutaneous Transluminal Balloon Coronary Angioplasty 6267 Percutaneous transluminal balloon coronary angioplasty including angiography with or without pressure measurements on one (1) or more sites on a single coronary artery 6268 on two (2) coronary arteries (i.e., right and circumflex, or right and anterior descending, or circumflex and anterior descending) 6270 on three (3) coronary arteries, right, circumflex, and anterior descending CATEGORY B One of the following tariffs may be claimed, per sitting. Combinations of the below tariffs are ineligible for payment and should not be claimed: Vascular Testing - Selective Coronary Artery Arteriography, With or Without Heart Catheterization 2307 Selective coronary artery arteriography 2308 and left heart catheterization 2325 and right heart catheterization 2327 and both left heart catheterization and right heart catheterization Page 2 of 9
3 CATEGORY C IF 1 tariff from any of the following 5 groups is claimed: Group 1: Vascular Testing - Cardiac Catheterization 2302 Cardiac catheterization, left heart 2304 left heart plus right heart 2306 Cardiac catheterization, right heart, outside the O.R. setting Group 2: Vascular Testing - Selective Coronary Arteriography, With or Without Catheterization 2307 Selective coronary artery arteriography 2308 and left heart catheterization 2325 and right heart catheterization 2327 and both left heart catheterization and right heart catheterization Group 3: Angiography- Angiocardiograms: Percutaneous Transluminal Balloon Coronary Angioplasty 6267 Percutaneous transluminal balloon coronary angioplasty including angiography with or without pressure measurements on one (1) or more sites on a single coronary artery 6268 on two (2) coronary arteries (i.e., right and circumflex, or right and anterior descending, or circumflex and anterior descending) 6270 on three (3) coronary arteries, right, circumflex, and anterior descending Group 4: Angiography - Angiocardiograms: Balloon Valvuplasty 6271 Aortic balloon valvuloplasty 6272 Coarctation balloon valvuloplasty 6273 Pulmonary balloon valvuloplasty 6274 Mitral valve balloon valvuloplasty Page 3 of 9
4 Group 5: Angiography- Angiocardiograms: Pulmonary Artery Stenosis 6275 Pulmonary artery stenosis, first vessel 6276 each additional vessel THEN, the following tariffs (in the below 3 groups) are ineligible for payment and should not be claimed: Group 1: Angiography Aortograms 6200 Abdominal 6201 Arch 6202 Intravenous 6203 Thoracic 6204 Translumbar 6205 Other Selective Angiograms 6210 Adrenal arteriogram 6211 Angiographic examination dialysis shunt 6212 Axillary 6213 Brachial 6208 Cerebral (brachial retrograde) 6214 Bronchial 6215 Carotid 6216 Celiac 6217 Common iliac 6229 Popliteal, with antegrade catheterization 6218 External carotid arteriogram 6219 Hepatic 6220 Inferior mesenteric 6221 Innominate 6222 Internal iliac 6223 Renal 6224 Superior mesenteric 6225 Subclavian Page 4 of 9
5 6226 Splenic 6227 Vertebral 6228 Transcatheter therapy, embolization, any method 6235 Bilateral selective angiogram or venogram 6206 Internal mammary 6207 Left gastric 6209 Gastroduodenal 6231 Internal carotid 6232 Super selective angiogram (e.g., Distal branch of any of the above selective) Femoral Arteriograms 6230 Unilateral Venograms 6236 Azygogram 6237 Femoral 6238 Iliac 6239 Inferior vena cavogram 6240 Intraosseous 6241 Jugular 6242 Lower limb 6243 Subclavian 6244 Superior vena cavogram 6245 Umbilical vein catheterization 6246 Upper limb 6247 Orbital venogram Selective Venograms 6250 Adrenal 6251 Hepatic 6252 Jugular 6253 Renal 6235 Bilateral selective angiogram or venogram Angiography 6255 By exposure of major vein, abdominal or thoracic 6256 Cerebral Page 5 of 9
6 Group 2: Vascular Testing Cardioversion 2312 Cardioversion, D.C. countershock, including immediate follow-up care Group 3: Pacemaker Pacemaker 2391 Percutaneous left ventricular pacemaker lead placement 2330 Change of pacemaker battery (independent procedure) 2334 repeat transvenous 2345 Repositioning of endocardial electrode 2373 Removal of pacemaker pack with or without partial removal of electrodes Page 6 of 9
7 CATEGORY D: IF one tariff is claimed from the following group: Percutaneous Transluminal Balloon Coronary Angioplasty 6267 Percutaneous transluminal balloon coronary angioplasty including angiography with or without pressure measurements on one (1) or more sites on a single coronary artery 6268 on two (2) coronary arteries (i.e., right and circumflex, or right and anterior descending, or circumflex and anterior descending) 6270 on three (3) coronary arteries, right, circumflex, and anterior descending THEN the following tariffs are ineligible for payment and should not be claimed: Vascular Testing- Selective Coronary Artery Arteriography 2307 Selective coronary artery arteriography 2308 and left heart catheterization 2325 and right heart catheterization 2327 and both left heart catheterization and right heart catheterization Page 7 of 9
8 CATEGORY E IF the following tariff is claimed: Vascular Testing: Cardiac Catheterization 2304 left heart plus right heart THEN the following tariffs are ineligible for payment and should not be claimed: Angiocardiograms 6260 Atrial, left 6261 Atrial, right 6263 Selective coronary angiogram 6264 Selective coronary angiogram with left and/or right heart catheterization 6265 Ventricular, left 6266 Ventricular, right Page 8 of 9
9 CATEGORY F IF one tariff is claimed from the following group: Percutaneous Transluminal Balloon Coronary Angioplasty 6267 Percutaneous transluminal balloon coronary angioplasty including angiography with or without pressure measurements on one (1) or more sites on a single coronary artery 6268 on two (2) coronary arteries (i.e., right and circumflex, or right and anterior descending, or circumflex and anterior descending) 6270 on three (3) coronary arteries, right, circumflex, and anterior descending THEN the following tariffs are ineligible for payment and should not be claimed: Angiocardiograms 6260 Atrial, left 6261 Atrial, right 6262 Pulmonary angiogram 6263 Selective coronary angiogram 6264 Selective coronary angiogram with left and/or right heart catheterization 6265 Ventricular, left 6266 Ventricular, right The Manitoba Physician s Manual is the authoritative reference when submitting medical claims to Manitoba Health, Seniors & Active Living Claims information and further assistance is also available by calling the Claims Unit staff at CLAIMS ENQUIRY Page 9 of 9
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