2018 HOSPITAL & PHYSICIAN CODING GUIDE

Transcription

1 2018 HOSPITAL & PHYSICIAN CODING GUIDE

2 Disclaimer While Terumo Medical Corporation has made reasonable efforts to ensure the accuracy of the information set forth herein, Terumo does not guarantee reimbursement coverage or amounts for any product or procedure nor does Terumo recommend any particular product or procedure for any individual patient. The information described herein is provided solely as a guide for Terumo products and is based on publicly available information from CMS. It is the responsibility of the provider to report codes that accurately describe the products, procedures, and individual patient s medical condition(s). Providers should contact the appropriate payers directly if they have questions or need specific information. Terumo Medical Corporation does not promote the use of its products outside of the uses or indications as described in the applicable labeling.

3 TABLE OF CONTENTS C-Code Summary... 2 AZUR Peripheral HydroCoil Embolization System... 4 MISAGO RX Self-expanding Peripheral Stent... 5 METACROSS RX PTA Balloon Dilatation Catheter... 6 PRIORITYONE Aspiration Catheter... 8

4 C-CODE SUMMARY Overview: The Centers for Medicare and Medicaid Services (CMS) requires the reporting of appropriate C-Codes for all device-dependent Ambulatory Payment Classifications (APCs) for hospital oupatient services. If a hospital outpatient bill includes a device-related CPT/HCPCS II procedure code but the C-Code for the associated device is not present, the claim is edited and returned to the hospital. Furthermore, if a C-Code is billed without the appropriate procedure code, the claim will be returned. For the majoirty of C-Codes, the hospital does not receive additional reimbursement for devices. However, the C-Codes are required as CMS is collecting charge data for these devices for use in setting future APC payment rates. C-Codes are only reportable for hospital oupatient procedures, and not all devices have applicable C-Codes. This guide includes a summary list of Terumo products and the corresponding C-Code. This guide is intended to provide general coding guidance. The full list of C-Codes is avalable at Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/Complet-list-DeviceCats-OPPS.pdf. 1 Physicians and hospitals are responsible for selecting and reporting the codes that most accurately desribe the procedure(s) performed. Providers should follow coding guidelines from the insurer as well as review the appropriate coding authorities for further guidance. Closure/Compression Devices ANGIO-SEAL VIP Terumo Product C-Code Description ANGIO-SEAL STS Plus ANGIO-SEAL Evolution C1760 Closure device, vascular (implantable/insertable) TR BAND Radial Compression Device There is no applicable C code for this product Sheaths VADO Steerable Sheath C1766 Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away PINNACLE DESTINATION Guiding Sheath C1887 Catheter, guiding (may include infusion/perfusion capability) PINNACLE PRECISION ACCESS SYSTEM Sheath PINNACLE R/O II Radiopaque Marker Introducer Sheath PINNACLE TIF TIP Introducer Sheath - Peripheral PINNACLE TIF TIP Introducer Sheath - Coronary GLIDEACCESS System - Micro Accessing Kits GLIDESHEATH Introducer Sheath - Hydrophilic Coated GLIDESHEATH SLENDER Introducer Sheath SOLOPATH Balloon Expandable TransFemoral System SOLOPATH Re-collapsible Balloon Access System Disposable Inflation Device C1894 Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser Included in C code of introducer/sheath Guidewires GLIDEWIRE Hydrophilic Coated Guidewire - Regular GLIDEWIRE Hydrophilic Coated Guidewire - Shapeable Tip GLIDEWIRE with Stiff Shaft Guidewire GLIDEWIRE Gold Hydrophilic Coated Guidewire GLIDEWIRE GT Guidewire GLIDEWIRE ADVANTAGE Guidewire RUNTHROUGH NS Coronary Guidewire - Extra Floppy RUNTHROUGH NS HYPERCOAT Coronary Guidewire RUNTHROUGH NS Coronary Guidewire C1769 Guidewire 2

5 C-CODE SUMMARY Microcatheters Terumo Product C-Code Description PROGREAT Microcatheter PROGREAT Coaxial Microcatheter System C1887 Catheter, guiding (may include infusion/perfusion capability) Catheters - Coronary PRIORITYONE Aspiration Catheter C1757 Catheter, thrombectomy/embolectomy FINECROSS MG Coronary Micro-Guide Catheter OPTITORQUE Diagnostic Catheter - TR Shape OPTITORQUE Diagnostic Catheter - COM Shape HEARTRAIL III Guiding Catheter C1887 Catheter, guiding (may include infusion/perfusion capability) Catheters - Peripheral NAVICROSS Catheter GLIDECATH Hydrophilic Coated Catheter GLIDECATH Yashiro Catheter GLIDECATH XP Hydrophilic Coated Catheter C1887 Catheter, guiding (may include infusion/perfusion capability) Embolotherapy AZUR Peripheral HydroCoil Embolization System AZUR Detachment Controller AZUR Detachable Hydrocoil AXUR CX Detachable Hydrocoil AZUR Pushable Hydrocoil There is no applicable C code for this product AZUR Framing Coil Interventional Devices MISAGO RX Self-expanding Peripheral Stent C1876 Stent, non-coated/non-covered, with delivery system METACROSS RX PTA Balloon Dilatation Catheter C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) Note: Stents packaged with delivery systems generally include the following components: stent mounted or unmounted on a balloon angioplasty catheter, introducer, and sheath. These components should not be reported separately. Accessories Obturators TORQUE Device There is no applicable C code for this product 3

6 AZUR Peripheral HydroCoil Embolization System Possible ICD-10 Procedure Codes 04LE3DT 04LF3DU Hospital Inpatient Description Typical MS-DRG Assignment ** Occlusion of Left Uterine Artery with Intraluminal Device, Percutaneous Approach Occlusion of Right Uterine Artery with Intraluminal Device, Percutaneous Approach Other Female Reproductive System O.R. Procedures with CC/MCC Other Female Reproductive System O.R. Procedures without CC/MCC * Due to the number of vessels, arteries and veins this device can be placed, they are not included here. Please refer to your ICD-10-PCS materials for the appropriate code(s) that describe where the devices were placed ** MS-DRG assignment is based on patient specific diagnoses and procedures performed during the hospital stay. Source: DRG Expert, 2017, Optum360 Hospital Outpatient CPT Code Description APC Description complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms) complete the intervention; for tumors, organ ischemia, or infarction complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation 5183 Level 3 Endovascular Procedures J1 J1 : Paid under OPPS; all covered Part B services on the claim are packaged with the primary J1 service for the claim, except services with OPPS SI=F,G, H, L and U; ambulance services; diagnostic and screening mammography; all preventive services; and certain Part B inpatient services. Source: CMS-1678-FC, Addendum A, B Physician CPT Code Description Total Non-Facility RVUs Total Facility RVUs complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms) A A complete the intervention; for tumors, organ ischemia, or infarction A complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation A A : Active code - these codes are separately payable under the Physician Fee Schedule Source: CMS-1676-F, Addendum B CPT is a trademark of the American Medical Association 4

7 MISAGO RX Self-Expanding Peripheral Stent Possible ICD-10 Procedure Codes 047K3DZ 047L3DZ 047M3DZ Hospital Inpatient Description Typical MS-DRG Assignment ** Dilation of Right Femoral Artery with Intraluminal Device, Percutaneous Approach RT Dilation of Left Femoral Artery with Intraluminal Device, Percutaneous Approach LT Dilation of Right Popliteal Artery with Intraluminal Device, Percutaneous Approach RT 047N3DZ 04CK3ZZ Dilation of Left Popliteal Artery with Intraluminal Device, Percutaneous Approach LT Extirpation of Matter from Right Femoral Artery, Percutaneous Approach RT Other Vascular Procedures with MCC Other Vascular Procedures with CC Other Vascular Procedures without MCC/CC 04CL3ZZ Extirpation of Matter from Left Femoral Artery, Percutaneous Approach LT 04CM3ZZ Extirpation of Matter from Right Popliteal Artery, Percutaneous Approach RT 04CN3ZZ Extirpation of Matter from Left Popliteal Artery, Percutaneous Approach ** MS-DRG assignment is based on patient specific diagnoses and procedures performed during the hospital stay. Source: DRG Expert, 2017, Optum360 Hospital Outpatient CPT Code Description APC Description unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed 5193 Level 3 Endovascular Procedures J unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed 5194 Level 4 Endovascular Procedures J1 J1 : Paid under OPPS; all covered Part B services on the claim are packaged with the primary J1 service for the claim, except services with OPPS SI=F,G, H, L and U; ambulance services; diagnostic and screening mammography; all preventive services; and certain Part B inpatient services. Source: CMS-1678-FC, Addendum A, B Physician CPT Code Description Total Non-Facility RVUs Total Facility RVUs unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed A unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed A A : Active code - these codes are separately payable under the Physician Fee Schedule Source: CMS-1676-F CPT is a trademark of the American Medical Association 5

8 METACROSS RX PTA Balloon Dilatation Catheter Hospital Inpatient Possible ICD-10 Procedure Codes Description Typical MS-DRG Assignment 047C3DZ Dilation of Right Common Iliac Artery with Intraluminal Device, Percutaneous Approach 047D3DZ Dilation of Left Common Iliac Artery with Intraluminal Device, Percutaneous Approach 047E3DZ Dilation of Right Internal Iliac Artery with Intraluminal Device, Percutaneous Approach 047F3DZ Dilation of Left Internal Iliac Artery with Intraluminal Device, Percutaneous Approach 047H3DZ Dilation of Right External Iliac Artery with Intraluminal Device, Percutaneous Approach 047J3DZ Dilation of Left External Iliac Artery with Intraluminal Device, Percutaneous Approach 047K3DZ Dilation of Right Femoral Artery with Intraluminal Device, Percutaneous Approach 047L3DZ Dilation of Left Femoral Artery with Intraluminal Device, Percutaneous Approach 047M3DZ Dilation of Right Popliteal Artery with Intraluminal Device, Percutaneous Approach 047N3DZ Dilation of Left Popliteal Artery with Intraluminal Device, Percutaneous Approach 04CK3ZZ Extirpation of Matter from Right Femoral Artery, Percutaneous Approach 04CL3ZZ Extirpation of Matter from Left Femoral Artery, Percutaneous Approach 04CM3ZZ Extirpation of Matter from Right Popliteal Artery, Percutaneous Approach 04CN3ZZ Extirpation of Matter from Left Popliteal Artery, Percutaneous Approach 04793ZZ Dilation of Right Renal Artery, Percutaneous Approach 047A3ZZ Dilation of Left Renal Artery, Percutaneous Approach 047B3ZZ Dilation of Inferior Mesenteric Artery, Percutaneous Approach 047C3ZZ 047D3ZZ Dilation of Right Common Iliac Artery, Percutaneous Approach Dilation of Left Common Iliac Artery, Percutaneous Approach Other Vascular Procedures with MCC Other Vascular Procedures with CC Other Vascular Procedures without MCC/CC 047E3ZZ Dilation of Right Internal Iliac Artery, Percutaneous Approach 047F3ZZ Dilation of Left Internal Iliac Artery, Percutaneous Approach 047H3ZZ Dilation of Right External Iliac Artery, Percutaneous Approach 047J3ZZ Dilation of Left External Iliac Artery, Percutaneous Approach 047K3ZZ Dilation of Right Femoral Artery, Percutaneous Approach 047L3ZZ Dilation of Left Femoral Artery, Percutaneous Approach 047M3ZZ Dilation of Right Popliteal Artery, Percutaneous Approach 047N3ZZ Dilation of Left Popliteal Artery, Percutaneous Approach 047P3ZZ Dilation of Right Anterior Tibial Artery, Percutaneous Approach 047Q3ZZ Dilation of Left Anterior Tibial Artery, Percutaneous Approach 047R3ZZ Dilation of Right Posterior Tibial Artery, Percutaneous Approach 047S3ZZ Dilation of Left Posterior Tibial Artery, Percutaneous Approach 047T3ZZ Dilation of Right Peroneal Artery, Percutaneous Approach 047U3ZZ Dilation of Left Peroneal Artery, Percutaneous Approach 047V3ZZ Dilation of Right Foot Artery, Percutaneous Approach 047W3ZZ Dilation of Left Foot Artery, Percutaneous Approach 047Y3ZZ Dilation of Lower Artery, Percutaneous Approach Source: DRG Expert, 2017, Optum360 6

9 METACROSS RX PTA Balloon Dilatation Catheter Hospital Outpatient CPT Code Description APC Description Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure) Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) unilateral; with transluminal angioplasty unilateral; with atherectomy, includes angioplasty within the same vessel, when performed unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed 5192 Level 2 Endovascular Procedures J Level 3 Endovascular Procedures J Level 2 Endovascular Procedures J Level 3 Endovascular Procedures J Level 3 Endovascular Procedures J Level 4 Endovascular Procedures J1 N N Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery 5192 Level 2 Endovascular Procedures J Each additional artery N J1 : Paid under OPPS; all covered Part B services on the claim are packaged with the primary J1 service for the claim, except services with OPPS SI=F,G, H, L and U; ambulance services; diagnostic and screening mammography; all preventive services; and certain Part B inpatient services. N : Paid under OPPS; payment is packaged into payment for other services. Therefore, there is no separate APC payment. Source: CMS-1678-FC, Addendum A, B CPT Code Description Physician Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure) Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure) unilateral; with transluminal angioplasty unilateral; with atherectomy, includes angioplasty within the same vessel, when performed unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed Total Non-Facility RVUs Total Facility RVUs A A A A A A A A Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, A coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery A A : Active code - these codes are separately payable under the Physician Fee Schedule + indicates the CPT code is an add-on code Source: CMS-1676-F, Addendum B CPT is a trademark of the American Medical Association 7

10 PRIORITYONE Aspiration Catheter Possible ICD-10 Procedure Codes 02CW3ZZ 03C23ZZ 03C33ZZ 03C43ZZ 03C53ZZ 03C63ZZ 03C73ZZ 03C83ZZ 03C93ZZ 03CA3ZZ 03CB3ZZ 03CC3ZZ 03CH3ZZ 03CJ3ZZ 03CK3ZZ 03CL3ZZ 03CM3ZZ 03CN3ZZ 04C03ZZ 04C13ZZ 04C53ZZ 04C93ZZ 04CA3ZZ 04CB3ZZ 04CC3ZZ 04CD3ZZ 04CE3ZZ 04CF3ZZ 04CH3ZZ 04CJ3ZZ 04CK3ZZ 04CL3ZZ 04CM3ZZ 04CN3ZZ 04CP3ZZ 04CQ3ZZ 04CR3ZZ 04CS3ZZ 04CT3ZZ 04CU3ZZ Hospital Inpatient Description Typical MS-DRG Assignment ** Extirpation of Matter from Thoracic Aorta, Percutaneous Approach Extirpation of Matter from Innominate Artery, Percutaneous Approach Extirpation of Matter from Right Subclavian Artery, Percutaneous Approach Extirpation of Matter from Left Subclavian Artery, Percutaneous Approach Extirpation of Matter from Right Axillary Artery, Percutaneous Approach Extirpation of Matter from Left Axillary Artery, Percutaneous Approach Extirpation of Matter from Right Brachial Artery, Percutaneous Approach Extirpation of Matter from Left Brachial Artery, Percutaneous Approach Extirpation of Matter from Right Ulnar Artery, Percutaneous Approach Extirpation of Matter from Left Ulnar Artery, Percutaneous Approach Extirpation of Matter from Right Radial Artery, Percutaneous Approach Extirpation of Matter from Left Radial Artery, Percutaneous Approach Extirpation of Matter from Right Common Carotid Artery, Percutaneous Approach Extirpation of Matter from Left Common Carotid Artery, Percutaneous Approach Extirpation of Matter from Right Internal Carotid Artery, Percutaneous Approach Extirpation of Matter from Left Internal Carotid Artery, Percutaneous Approach Extirpation of Matter from Right External Carotid Artery, Percutaneous Approach Extirpation of Matter from Left External Carotid Artery, Percutaneous Approach Extirpation of Matter from Abdominal Aorta, Percutaneous Approach Extirpation of Matter from Celiac Artery, Percutaneous Approach Extirpation of Matter from Superior Mesenteric Artery, Percutaneous Approach Extirpation of Matter from Right Renal Artery, Percutaneous Approach Extirpation of Matter from Left Renal Artery, Percutaneous Approach Extirpation of Matter from Inferior Mesenteric Artery, Percutaneous Approach Extirpation of Matter from Right Common Iliac Artery, Percutaneous Approach Extirpation of Matter from Left Common Iliac Artery, Percutaneous Approach Extirpation of Matter from Right Internal Iliac Artery, Percutaneous Approach Extirpation of Matter from Left Internal Iliac Artery, Percutaneous Approach Extirpation of Matter from Right External Iliac Artery, Percutaneous Approach Extirpation of Matter from Left External Iliac Artery, Percutaneous Approach Extirpation of Matter from Right Femoral Artery, Percutaneous Approach Extirpation of Matter from Left Femoral Artery, Percutaneous Approach Extirpation of Matter from Right Popliteal Artery, Percutaneous Approach Extirpation of Matter from Left Popliteal Artery, Percutaneous Approach Extirpation of Matter from Right Anterior Tibial Artery, Percutaneous Approach Extirpation of Matter from Left Anterior Tibial Artery, Percutaneous Approach Extirpation of Matter from Right Posterior Tibial Artery, Percutaneous Approach Extirpation of Matter from Left Posterior Tibial Artery, Percutaneous Approach Extirpation of Matter from Right Peroneal Artery, Percutaneous Approach Extirpation of Matter from Left Peroneal Artery, Percutaneous Approach These procedure codes can map to various MS-DRGs based on the patient s diagnoses and other procedures being performed 02C03ZZ Extirpation of Matter from Coronary Artery, One Site, Percutaneous Approach X2C0361 Extirpation of Matter from Coronary Artery, One Site using Orbital Atherectomy 248 Technology, Percutaneous Approach, New Technology Group Percutaneous CV procedure with DES with MCC, or 4+ vessels/stents Percutaneous CV procedure with DES without MCC Percutaneous CV procedure with non-des with MCC, or 4+ vessels/stents Percutaneous CV procedure with non-des without MCC ** MS-DRG assignment is based on patient specific diagnoses and procedures performed during the hospital stay. Source: DRG Expert, 2017, Optum360 8

11 PRIORITYONE Aspiration Catheter Hospital Outpatient CPT Code Description APC Description Embolectomy or thrombectomy, with or without catheter; carotid, subclavian or innominate artery, by neck incision Embolectomy or thrombectomy, with or without catheter; innominate, subclavian artery, by thoracic incision Embolectomy or thrombectomy, with or without catheter; axillary, brachial, innominate, subclavian artery, by arm incision Embolectomy or thrombectomy, with or without catheter; radial or ulnar artery, by arm incision Embolectomy or thrombectomy, with or without catheter; renal, celiac, mesentery, aortoiliac artery, by abdominal incision 5184 Level 4 Vascular Procedures T 5184 Level 4 Vascular Procedures T C C C Embolectomy or thrombectomy, with or without catheter; femoropopliteal, aortoiliac artery, by leg incision 5184 Level 4 Vascular Procedures T C9606 Embolectomy or thrombectomy, with or without catheter; popliteal-tibio-peroneal artery, by leg incision Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel 5184 Level 4 Vascular Procedures T C 5194 Level 4 Endovascular Procedures J1 C : Not paid under OPPS; Admit patient; Bill as inpatient. T : Paid under OPPS; separate APC payment; multiple surgical reduction applies. J1 : Paid under OPPS; all covered Part B services on the claim are packaged with the primary J1 service for the claim, except services with OPPS SI=F,G, H, L and U; ambulance services; diagnostic and screening mammography; all preventive services; and certain Part B inpatient services. Source: CMS-1678-FC, Addendum A, B CPT Code Description Physician Embolectomy or thrombectomy, with or without catheter; carotid, subclavian or innominate artery, by neck incision Embolectomy or thrombectomy, with or without catheter; innominate, subclavian artery, by thoracic incision Embolectomy or thrombectomy, with or without catheter; axillary, brachial, innominate, subclavian artery, by arm incision Embolectomy or thrombectomy, with or without catheter; radial or ulnar artery, by arm incision Embolectomy or thrombectomy, with or without catheter; renal, celiac, mesentery, aortoiliac artery, by abdominal incision Embolectomy or thrombectomy, with or without catheter; femoropopliteal, aortoiliac artery, by leg incision Embolectomy or thrombectomy, with or without catheter; popliteal-tibio-peroneal artery, by leg incision Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel Total Facility RVUs A A A A A A A A A : Active code - these codes are separately payable under the Physician Fee Schedule. Source: CMS-1676-F, Addendum B CPT is a trademark of the American Medical Association 9

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