Cardiac Rhythm Management Coder 2018

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1 Cardiac Rhythm Management Coder 2018 An easy-to-use tool for coding and reimbursement compliance Prepared and Published By: MedLearn Publishing, A Division of MedLearn Media, Inc. 445 Minnesota Street, Suite 514 St. Paul, MN

2 Introduction...1 Payment Issues for Medical Devices...1 How This Guide Is Organized...2 Acronyms Used in This Guide...2 Chapter 1: The Clinical Side of Cardiac Rhythm Management Procedures...5 Electrograms...5 Cardiovascular Stress Tests/Exercise Stress Test...6 External Cardiovascular Monitoring Services...6 Diagnostic EP Testing...7 Intracardiac Mapping...7 Ablation...8 Cardiovascular Implantable Electronic Device (CIED)...8 Pacemaker...8 Cardiac Resynchronization Therapy Pacemaker (CRT-P)...9 Implantable Cardioverter-Defibrillator (ICD)...9 Cardiac Resynchronization Therapy Defibrillator (CRT-D)...11 Implantable Cardiovascular Monitor (ICM)...11 Implantable Loop Recorder (ILR)...11 Left Atrial Appendage (LAA) Closure Device...12 Chapter 2: Indications and Coverage for Cardiac Rhythm Management Devices...13 National Coverage Determinations (NCDs)...13 ICD National Coverage...13 Leadless Pacemaker National Coverage...14 Left Atrial Appendage (LAA) Closure National Coverage...15 Q0 Modifier Requirement...16 Device Follow-Up National Coverage...18 Local Coverage Determinations (LCDs)...19 SECTION 1: Outpatient Procedure Coding Chapter 3: HCPCS/CPT Procedural Coding...23 HCPCS Level I...23 HCPCS Level II...23 Level II C Codes...23 Procedure-to-Procedure (PTP) Edits...24 XX Modifiers for Distinct Procedures Medicare Physician Fee Schedule Updates Related to CRM Procedures...26 Physician Documentation Tips for EP Procedures...28 Chapter 4: Hospital OPPS and ASC Payments...31 Hospital Outpatient PPS Medicare OPPS Payment Updates...32 iii

3 Important Device-Related OPPS Updates...32 Payments for ASCs Medicare ASC Payment Updates...36 Chapter 5: Diagnostic Cardiac Testing...37 Electrocardiograms ( )...37 Rhythm Strips ( ) Lead Electrocardiogram (0178T 0180T)...39 Computerized Database Analysis of Multiple Cycles of Digitized Cardiac Electrical Data From Two or More ECG Leads (0206T)...40 Cardiovascular Stress Tests/Exercise Stress Tests ( )...41 External Cardiovascular Monitoring Services ( )...43 External Mobile Cardiovascular Telemetry (93228, 93229)...43 External Electrocardiographic Recording for More Than 48 Hours up to 21 Days (0295T 0298T)...45 Patient Event Monitors ( )...47 Chapter 6: Pacemaker Systems...49 Permanent Pacemaker Initial Implantation ( )...49 Pacemaker Generator Insertion Only (33212, 33213, 33221)...52 Pacemaker Generator Replacement ( )...53 Pacemaker Generator Upgrade (33214)...54 Pacemaker Removal (33233)...54 Pacemaker Lead (Electrode) Insertion (33216, 33217)...55 Pacemaker Biventricular Lead (Electrode) Placement Into Cardiac Venous System (33224, 33225)...56 Pacemaker Lead (Electrode) Repositioning (33215, 33226)...58 Pacemaker Lead (Electrode) Removal (33234, 33235)...59 Pacemaker Lead (Electrode) Repair (33218, 33220)...60 Pacemaker Relocation of Skin Pocket Pacemaker Generators (33222)...61 Temporary Pacing (33210, 33211)...62 Transcatheter Leadless Pacemaker Insertion or Replacement (0387T)...63 Transcatheter Leadless Pacemaker Removal (0388T)...64 Chapter 7: Implantable Defibrillators...67 ICD Initial Implant (33249)...67 ICD Generator Insertion Only (33240, 33230, 33231)...68 ICD Generator Removal Only (33241)...69 ICD Pacemaker Pulse Generator Replacement ( )...70 ICD Pacemaker Generator Lead (Electrode) Insertion (33216, 33217)...71 ICD Pacemaker Generator Biventricular Lead (Electrode) Placement Into Cardiac Venous System (33224, 33225)...72 iv

4 ICD Pacemaker Generator Lead (Electrode) Repositioning (33215, 33226)...75 ICD Pacemaker Generator Lead Removal (Extraction) (33244)...76 ICD Pacemaker Generator Lead (Electrode) Repair (33218, 33220)...76 ICD Pacemaker Generator Relocation of Skin Pocket (33223)...77 Chapter 8: Subcutaneous Implantable Defibrillator System...81 Subcutaneous Implantable Defibrillator System Implant (33270)...81 Subcutaneous Implantable Defibrillator Generator Insertion Only (33240)...81 Subcutaneous Implantable Defibrillator Generator Removal Only (33241)...82 Subcutaneous Implantable Defibrillator Generator Replacement (33262)...82 Subcutaneous Implantable Defibrillator Lead (Electrode) Insertion (33271)...83 Subcutaneous Implantable Defibrillator Lead (Electrode) Repositioning (33273)...83 Subcutaneous Implantable Defibrillator Lead (Electrode) Removal (33272)...84 Chapter 9: Implantable Loop Recorder (ILR)...85 ILR Implant (33282)...85 ILR Removal (33284)...85 Chapter 10: Percutaneous Closure of Left Atrial Appendage (LAAC)...87 Percutaneous Closure of Left Atrial Appendage (LAAC) (33340)...87 Chapter 11: Testing Device and Leads (Electrodes)...89 Testing ICD Device and Leads (93640, 93641)...89 Testing Subcutaneous Implantable Defibrillator Device and Leads (93644)...90 Chapter 12: Non-Invasive and Invasive Program Stimulation...93 EP Study to Evaluate Therapy (93624)...93 EP Study to Evaluate ICD System (93642)...94 EP Study to Evaluation Subcutaneous Implantable Defibrillator (93644)...94 EP Study to Evaluate Pacemaker (93724)...95 Chapter 13: Electrophysiology Studies...97 Single-Site Studies ( , 93610, 93612, 93618)...97 Esophageal Electrocardiography (93615, 93616)...98 Mapping (Intracardiac) (93609, 93613)...98 Comprehensive EP Studies (93619, 93620)...99 Add-on Codes (93621, 93622, 93623) v

5 Chapter 14: Ablation Procedures Stand-Alone Ablation (93650) (Heart Block) Combined Comprehensive EP Study and Ablation (93653, 93654, 93655, 93656, 93657) Intracardiac Echocardiography (93662) Chapter 15: Tilt-Table Testing Tilt-Table Evaluation (93660) Chapter 16: Cardiovascular Electronic Device Monitoring Pacemaker Device Monitoring ( , 93286, 93288, 93293, 93294, 93296) Pacemaker Programming Device Evaluation ( ) Pacemaker Peri-Procedural Device Evaluation and Programming (93286) Pacemaker Interrogation Device Evaluation (In Person) (93288) Transtelephonic Rhythm Strip Pacemaker Evaluation (93293) Pacemaker Device Interrogation (Remote) (93294, 93296) Implantable Cardioverter-Defibrillator (ICD) Device Monitoring ( , 93287, 93289, 93295, 93296) ICD Programming Device Evaluation ( ) ICD Peri-Procedural Device Evaluation and Programming (93287) ICD Interrogation Device Evaluation (In Person) (93289) ICD Interrogation Device Evaluation (Remote) (93295, 93296) Subcutaneous Implantable Defibrillator System Monitoring (93260, 93261) Subcutaneous Implantable Defibrillator System Programming Device Evaluation (93260) Subcutaneous Implantable Defibrillator System Interrogation Device Evaluation (93261) Subcutaneous Implantable Defi brillator System Interrogation Device Evaluation (Remote) (93295, 93296) Wearable Defibrillator System Device Monitoring (93292, 93745) Wearable Defibrillator Interrogation Device Evaluation (In Person) (93292) Wearable Defibrillator Initial Set-Up and Programming (93745) Implantable Loop Recorder (ILR) Device Monitoring (93285, 93291, 93298, 93299) ILR Programming Device Evaluation (93285) ILR Interrogation Device Evaluation (In Person) (93291) ILR Interrogation Device Evaluation (Remote) (93298, 93299) Implantable Cardiovascular Monitor (ICM) Device Monitoring (93290, 93297, 93299) vi

6 ICM Interrogation Device Evaluation (In Person) (93290) ICM Interrogation Device Evaluation (Remote) (93297, 93299) Transcatheter Leadless Pacemaker Device Monitoring (0389T, 0390T, 0391T) Transcatheter Leadless Pacemaker Programming Device Evaluation (0389T) Transcatheter Leadless Pacemaker Peri-Procedural Device Evaluation (0390T) Transcatheter Leadless Pacemaker Interrogation Device Evaluation (0391T) SECTION 2: Inpatient Procedure Coding Chapter 17: Hospital Inpatient Reimbursement ICD-10 Coding System Common Procedure Coding EP Coding Examples MS-DRG Basics MS-DRG Payments Chapter 18: MS-DRG Logic for CRM Procedures Pacemakers or Cardiac Resynchronization Pacemakers ICD or Cardiac Resynchronization Therapy Defibrillator Electrophysiology Study and Ablation Chapter 19: Pacemaker Implants Chapter 20: Implantable Defibrillators Chapter 21: Cardiac Resynchronization Therapy Chapter 22: Device Testing ICD and Pacemaker Testing Chapter 23: Diagnostic Electrophysiology Studies Chapter 24: Percutaneous Ablation Chapter 25: Leadless Pacemaker Chapter 26: Percutaneous Left Atrial Appendage (LAAC) Closure Chapter 27: Medicare Quality Payment Programs Overview of Medicare Quality Programs Outpatient Department Measures Quality Payment Program Bundled Payments vii

7 Appendices Appendix A: Clinical Case Examples Appendix B: NCD for Implantable Automatic Defibrillators Appendix C: NCD for Cardiac Pacemakers Appendix D: NCD for Cardiac Pacemaker Evaluation Services Appendix E: NCD for Leadless Pacemaker Appendix F: NCD for Percutaneous Left Atrial Appendage Closure (LAAC) viii

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