2017 OSTEOID OSTEOMA RADIOFREQUENCY ABLATION MEDICARE REIMBURSEMENT GUIDE

Transcription

1 2017 OSTEOID OSTEOMA RADIOFREQUENCY ABLATION MEDICARE REIMBURSEMENT GUIDE Coding Information The final decision of billing for any procedure must be made by the provider of care considering the medical necessity of the service, the regulations of insurers, and local, state or federal laws applicable to the care provided. Hospitals may allocate the charges for the device to Revenue Code 272 Medical/Surgical Supplies: Sterile, or Revenue Code 279 Medical/ Surgical Supplies: Other Supplies/Devices Medicare Physician, Hospital Outpatient, ASC Coding and Payment Medicare National Average Rates and Allowables (Not Adjusted for Geography) PHYSICIAN HOSPITAL OUTPATIENT CPT 1 HCPCS CODE PROCEDURE Ablation, bone tumor(s) (e.g., osteoid osteoma, metastasis) radiofrequency, percutaneous, including computed tomographic guidance NON- FACILITY MPFS 1 (CF=$ ) FACILITY $1, $ APC DESCRIPTOR APC RATE 2 ASC 3 Level 4 Musculoskeletal Procedures $5, $2, NOTE: HCPCS Level II code C1886 (Catheter, extravascular tissue ablation, any modality (insertable) may be used to report the ablation catheter used, however, the Medicare payment for the device is packaged with the APC and ASC procedure payments. Private payer policies may differ. Providers should check with their local payer to determine the applicable reporting and reimbursement policies. NOTES: Non-Facility Physician Office/Clinic Facility Hospital APC Ambulatory Payment Classification OPPS Outpatient Prospective Payment System ASC Ambulatory Surgical Center The above National Average APC and ASC (Freestanding) Rates represent the reimbursement amounts paid directly to the facility for the technical portion of the procedure. The Physician (surgeon) would separately receive the professional fee (MPFS Allowable) for the procedure performed.

2 2017 Inpatient Coding/ICD-10-PCS ICD-10 PCS PROCEDURE CODE 4 0N503ZZ 0N513ZZ 0N523ZZ 0N533ZZ 0N543ZZ 0N553ZZ 0N563ZZ 0N573ZZ 0N583ZZ 0N5B3ZZ 0N5C3ZZ 0N5D3ZZ 0N5F3ZZ 0N5G3ZZ 0N5H3ZZ 0N5J3ZZ 0N5K3ZZ 0N5L3ZZ 0N5M3ZZ 0N5N3ZZ 0N5P3ZZ 0N5Q3ZZ 0N5R3ZZ 0N5S3ZZ 0N5T3ZZ 0N5V3ZZ 0N5X3ZZ 0P503ZZ 0P513ZZ 0P523ZZ 0P533ZZ 0P543ZZ 0P553ZZ 0P563ZZ 0P573ZZ 0P583ZZ 0P593ZZ 0P5B3ZZ 0P5C3ZZ 0P5D3ZZ 0P5F3ZZ 0P5G3ZZ Destruction of Skull, Percutaneous Approach Destruction of Right Frontal Bone, Percutaneous Approach Destruction of Left Frontal Bone, Percutaneous Approach Destruction of Right Parietal Bone, Percutaneous Approach Destruction of Left Parietal Bone, Percutaneous Approach Destruction of Right Temporal Bone, Percutaneous Approach Destruction of Left Temporal Bone, Percutaneous Approach Destruction of Right Occipital Bone, Percutaneous Approach Destruction of Left Occipital Bone, Percutaneous Approach Destruction of Nasal Bone, Percutaneous Approach Destruction of Right Sphenoid Bone, Percutaneous Approach Destruction of Left Sphenoid Bone, Percutaneous Approach Destruction of Right Ethmoid Bone, Percutaneous Approach Destruction of Left Ethmoid Bone, Percutaneous Approach Destruction of Right Lacrimal Bone, Percutaneous Approach Destruction of Left Lacrimal Bone, Percutaneous Approach Destruction of Right Palantine Bone, Percutaneous Approach Destruction of Left Palantine Bone, Percutaneous Approach Destruction of Right Zygomatic Bone, Percutaneous Approach Destruction of Left Zygomatic Bone, Percutaneous Approach Destruction of Right Orbit, Percutaneous Approach Destruction of Left Orbit, Percutaneous Approach Destruction of Right Maxilla, Percutaneous Approach Destruction of Left Maxilla, Percutaneous Approach Destruction of Right Mandible Percutaneous Approach Destruction of Left Mandible, Percutaneous Approach Destruction of Hyoid Bone, Percutaneous Approach Destruction of Sternum, Percutaneous Approach Destruction of Right Rib, Percutaneous Approach Destruction of Left Rib, Percutaneous Approach Destruction of Cervical Vertebra, Percutaneous Approach Destruction of Thoracic Vertebra, Percutaneous Approach Destruction of Right Scapula, Percutaneous Approach Destruction of Left Scapula, Percutaneous Approach Destruction of Right Glenoid, Percutaneous Approach Destruction of Left Glenoid Percutaneous Approach Destruction of Right Clavicle, Percutaneous Approach Destruction of Left Clavicle, Percutaneous Approach Destruction of Right Humeral Head, Percutaneous Approach Destruction of Left Humeral Head, Percutaneous Approach Destruction of Right Humeral Shaft, Percutaneous Approach Destruction of Left Humeral Shaft, Percutaneous Approach

3 2017 Inpatient Coding/ICD-10-PCS ICD-10 PCS PROCEDURE CODE 4 0P5H3ZZ 0P5J3ZZ 0P5K3ZZ 0P5L3ZZ 0P5M3ZZ 0P5N3ZZ 0P5P3ZZ 0P5Q3ZZ 0P5R3ZZ 0P5S3ZZ 0P5T3ZZ 0P5V3ZZ 0Q503ZZ 0Q513ZZ 0Q523ZZ 0Q533ZZ 0Q543ZZ 0Q553ZZ 0Q563ZZ 0Q573ZZ 0Q583ZZ 0Q593ZZ 0Q5B3ZZ 0Q5C3ZZ 0Q5D3ZZ 0Q5F3ZZ 0Q5G3ZZ 0Q5H3ZZ 0Q5J3ZZ 0Q5K3ZZ 0Q5L3ZZ 0Q5M3ZZ 0Q5N3ZZ 0Q5P3ZZ 0Q5Q3ZZ 0Q5R3ZZ 0Q5S3ZZ Destruction of Right Radius, Percutaneous Approach Destruction of Left Radius, Percutaneous Approach Destruction of Right Ulna, Percutaneous Approach Destruction of Left Ulna, Percutaneous Approach Destruction of Right Carpal, Percutaneous Approach Destruction of Left Carpal, Percutaneous Approach Destruction of Right Metacarpal, Percutaneous Approach Destruction of Left Metacarpal, Percutaneous Approach Destruction of Right Thumb Phalanx, Percutaneous Approach Destruction of Left Thumb Phalanx, Percutaneous Approach Destruction of Right Finger Phalanx, Percutaneous Approach Destruction of Left Finger Phalanx, Percutaneous Approach Destruction of Lumbar Vertebra, Percutaneous Approach Destruction of Sacrum, Percutaneous Approach Destruction of Right Pelvic Bone, Percutaneous Approach Destruction of Left Pelvic Bone, Percutaneous Approach Destruction of Right Acetabulum, Percutaneous Approach Destruction of Left Acetabulum, Percutaneous Approach Destruction of Right Upper Femur, Percutaneous Approach Destruction of Left Upper Femur, Percutaneous Approach Destruction of Right Femoral Shaft, Percutaneous Approach Destruction of Left Femoral Shaft, Percutaneous Approach Destruction of Right Lower Femur, Percutaneous Approach Destruction of Left Lower Femur, Percutaneous Approach Destruction of Right Patella, Percutaneous Approach Destruction of Left Patella, Percutaneous Approach Destruction of Right Tibia, Percutaneous Approach Destruction of Left Tibia, Percutaneous Approach Destruction of Right Fibula, Percutaneous Approach Destruction of Left Fibula, Percutaneous Approach Destruction of Right Tarsal, Percutaneous Approach Destruction of Left Tarsal, Percutaneous Approach Destruction of Right Metatarsal, Percutaneous Approach Destruction of Left Metatarsal, Percutaneous Approach Destruction of Right Toe Phalanx, Percutaneous Approach Destruction of Left Toe Phalanx, Percutaneous Approach Destruction of Coccyx, Percutaneous Approach

4 2017 DRG Reimbursement MS-DRG 4 NATIONAL AVERAGE PAYMENT 131 Cranial/Facial Procedures with CC/MCC $15, Cranial/Facial Procedures without CC/MCC $ 8, Other Ear, Nose, Mouth and Throat O.R. Procedures with CC/MCC $11, Other Ear, Nose, Mouth and Throat O.R. Procedures without CC/MCC $ 6, Other Respiratory System O.R. Procedures with MCC $21, Other Respiratory System O.R. Procedures with CC $11, Other Respiratory System O.R. Procedures without CC/MCC $ 7, Foot Procedures with MCC $14, Foot Procedures with CC $ 9, Foot Procedures without CC/MCC $ 7, Hand or Wrist Procedures, Except Major Thumb or Joint Procedures with CC/MCC $ 8, Hand or Wrist Procedures, Except Major Thumb or Joint Procedures without CC/MCC $ 5, Other Musculoskeletal System and Connective Tissue O.R. Procedures with MCC $18, Other Musculoskeletal System and Connective Tissue O.R. Procedures with CC $12, Other Musculoskeletal System and Connective Tissue O.R. Procedures without CC/MCC $10, Other O.R. Procedures for Injuries without CC/MCC $23, Other O.R. Procedures for Injuries with CC $12, Other O.R. Procedures for Injuries without CC/MCC $ 7, Other O.R. Procedures for Multiple Significant Trauma with MCC $41, Other O.R. Procedures for Multiple Significant Trauma with CC $23, Other O.R. Procedures for Multiple Significant Trauma without CC/MCC $15, Extensive O.R. Procedure Unrelated to Principal Diagnosis with MCC $29, Extensive O.R. Procedure Unrelated to Principal Diagnosis with CC $16, Extensive O.R. Procedure Unrelated to Principal Diagnosis without CC/MCC $10, Nonextensive O.R. Procedure Unrelated to Principal Diagnosis with MCC $19, Nonextensive O.R. Procedure Unrelated to Principal Diagnosis with CC $10, Nonextensive O.R. Procedure Unrelated to Principal Diagnosis without CC/MCC $ 6, NOTES: MCC Major Complications and Comorbidities CC Complications and Comorbidities The ICD-10-PCS Hospital Procedure Codes listed above may be used in the MS-DRG Classifications (See Inpatient DRG Payment Rates Table). The appropriate MS-DRG classification is also dependent on the diagnosis code, demographics, sex and possible co-conditions. One DRG per patient is assigned to each inpatient stay.

5 REFERENCES: 1. CY 2017 Revision to Payment Policies under the Physicians Fee Schedule and Other Revisions to Part B; Addendum B. All MPFS Fee Schedules calculated using CF of $ effective January 1, Hospital Outpatient Prospective Payment Final Rule with Comment and Final CY 2017 Payment Rates (CMS-1656-CN); Jan 2017 Addendum B and Jan 2017 ASC Addenda. 3. ICD-10-PCS 2017, 2016 Optum360, LLC. All rights reserved. 4. DRG values calculated using a base rate of $ and Capital Standard Payment of $ The national average hospital Medicare base rate is the sum of the full update labor-related and non-labor related amount published in the Federal Register, FY 2017 IPPS Final Rule (Tables 1A, 1D and 5) AMA CPT Professional This information is taken from the materials published by the Centers for Medicare and Medicaid Services and the American Medical Association and may be helpful to providers in staying up to date on coding and billing of services. This information cannot guarantee coverage or reimbursement, and Medtronic makes no other representations as to selecting codes for procedures or compliance with any other billing protocols or prerequisites. As with all claims, providers are responsible for exercising their independent clinical judgment in selecting the codes that most accurately reflect the patient s condition and procedures performed for a patient. Providers should refer to current, complete, and authoritative publications such as AMA HCPCS Level II, CPT publications or insurer policies for selecting codes based on the care rendered to an individual patient, and may wish to contact individual carriers, fiscal intermediaries, or other third-party payers as needed. CPT is a registered trademark of the American Medical Association. This information is for educational purposes only and is not intended to serve as reimbursement advice. It is the responsibility of the provider to select the codes that most accurately reflect the patient s condition and procedures performed, and to consult with each patient s health plan for appropriate reporting of each procedure. In all cases, services must be medically necessary, actually performed and appropriately documented Medtronic. All rights reserved. Medtronic, Medtronic logo and Further, Together are trademarks of Medtronic. All other brands are trademarks of a Medtronic company. 03/2017 US160110c (1) Medtronic 5920 Longbow Drive Boulder, CO USA T: (303) US: (800) medtronic.com