2009 CPT Codes for Cardiac Device Monitoring

Transcription

1 2009 CPT Codes for Cardiac Device Monitoring December 2008

2 Notices Current Procedural Terminology (CPT ) is copyright 2008 American Medical Association. All Rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. CPT is a trademark of the American Medical Association. These coding suggestions and coverage guidelines do not replace seeking coding advice from the payer and/or your coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for interpretation of the appropriate codes to use for specific procedures. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third party payers as to the correct form of billing or the amount that will be paid to providers of service. Sources used for the material presented include CPT 2009 Professional Edition and CPT 2009 Changes: An Insider s View, both published by the AMA, as well as the Federal Register for November 18, 2008 and November 19,

3 CEUs for Coders A survey will be sent out to all participants a few days after the session. This survey will include information on CEU certificates. AAPC This program has the prior approval of the American Academy of Professional Coders (AAPC) for 2.0 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor. AAPC Index# M A AHIMA This program has been approved for 2 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). 3

4 Topics Background for New Codes Deleted Codes Cardiac Device Systems Key Terms New Codes General Coding Guidelines Questions and More Appendix 1: Crosswalks Appendix 2: and APCs Appendix 3: References 4

5 Background for New Codes 5

6 Background for New Codes For 2009, eleven current CPT codes for cardiac device monitoring are being deleted. They are being replaced by 23 new codes for cardiac device monitoring. The new codes are the result of a joint request by: American College of Cardiology Heart Rhythm Society The revisions reflect the evolution of cardiac devices and cardiac device monitoring in recent years. 6

7 Intention of New Codes The new codes describe newer technologies and patient care practices. They are intended to: better distinguish interrogation from programming provide distinct codes for in-person and remote monitoring identify services performed via monitoring centers and stations capture services related to advanced device functions, eg. monitoring physiologic data provide codes for monitoring services related to newer platforms of earlier devices, eg. biventricular pacemakers and defibrillators 7

8 Coding Approach An entirely new approach to cardiac device monitoring codes was necessary. The new structure enables the codes to: properly value physician work involved in complex data collection and interpretation recognize the technical services of some providers as distinct from the professional services of others differentiate monitoring related to rhythm data from monitoring related to physiologic data distinguish work performed by electrophysiologists from that performed by cardiologists and heart failure specialists 8

9 Deleted Codes 9

10 Deleted Codes For 2009, we ll say farewell to some old friends. These are the 11 current codes for cardiac device monitoring that are being deleted. Old Code Old Code Definition Electronic analysis and/or reprogramming of implantable loop recorder Electronic analysis of dual chamber pacemaker without reprogramming Electronic analysis of dual chamber pacemaker with reprogramming Electronic analysis of dual chamber pacemaker, transtelephonic Electronic analysis of single chamber pacemaker without reprogramming Electronic analysis of single chamber pacemaker with reprogramming Electronic analysis of single chamber pacemaker, transtelephonic 10

11 Deleted Codes Old Code Old Code Definition Electronic analysis of single chamber or wearable cardioverter-defibrillator without reprogramming Electronic analysis of single chamber or wearable cardioverter-defibrillator with reprogramming Electronic analysis of dual chamber cardioverter-defibrillator without reprogramming Electronic analysis of dual chamber cardioverter-defibrillator with reprogramming Although the codes themselves are being deleted, the services are reappearing in a different form as one or more of the new cardiac monitoring codes. 11

12 Cardiac Device Systems 12

13 Cardiac Device Systems The new cardiac monitoring codes encompass five types of cardiac device systems. The first two are implantable therapeutic devices that also store data for monitoring. permanent pacemakers (PPMs) implantable cardioverter-defibrillators (ICDs) Two others are implantable devices that perform monitoring. implantable loop recorders (ILR) implantable cardiovascular monitor (ICM) The last system uses external devices for monitoring. mobile cardiovascular telemetry (MCT) 13

14 Pacemakers Conventional pacemakers treat slow heart rates, e.g. bradycardia, sick sinus syndrome, and heart block. Biventricular pacemakers (CRT-P) treat heart failure. In addition to delivering pacing pulses, pacemaker generators store data on arrhythmias detected and device response which can be downloaded for analysis. The function of the device, eg. battery status and parameters, must also be periodically assessed. A conventional pacemaker system consists of a pulse generator with one or two leads at the right atrium and/or right ventricle. A biventricular pacemaker has two or three leads, with one lead at the left ventricle and the others at the right atrium and/or right ventricle. 14

15 Cardioverter-Defibrillators Conventional ICDs treat rapid heart rates, e.g. ventricular tachycardia and sudden cardiac death. Biventricular ICDs (CRT-D) treat heart failure as well as arrhythmias. In addition to delivering pacing signals and shocks, ICD generators store data on arrhythmias detected and device response which can be downloaded for analysis. The function of the device, eg. battery status and parameters, must also be periodically evaluated. A conventional ICD consists of a pulse generator and one or two leads at the right atrium and/or right ventricle. A biventricular ICD has two or three leads, with one lead at the left ventricle and the others at the right atrium and/or right ventricle. 15

16 Implantable Loop Recorders ILRs continuously monitor heart rhythms via loop memory to detect arrhythmias that may cause syncope for example. The devices do not have implanted leads. They use surface electrodes instead. The recorded data is stored then downloaded non-invasively for analysis. This can be done via local telemetry or remotely to a monitoring service. A stand-alone ILR is implanted into a subcutaneous pocket, usually in the upper chest. It can remain in place recording EKGs for up to 3 years. Recording is triggered automatically by the device when it detects arrhythmias. The patient can also trigger recording during symptomatic events. Example: Reveal DX ILRs can be stand-alone devices or the function can be built into pacemakers or ICDs. 16

17 Implantable CV Monitors ICMs collect physiologic data, such as intrathoracic impedance, to help with on-going management of conditions like heart failure. Data is continuously recorded and stored then downloaded non-invasively for analysis. This can be done via local telemetry or remotely to a monitoring service. ICMs can be stand-alone devices or the function can be built into pacemakers or ICDs. This is a defibrillator with a built-in cardiovascular monitor. It records physiologic data on intrathoracic impedance. Because changes in impedance correlate with fluid build-up, this monitors heart failure status. Example: OptiVol Fluid Trends Report 17

18 Mobile CV Telemetry MCT refers to a system of external leads attached to an external sensor which transmits EKG data continuously to a portable monitor. The monitor records and analyzes the EKG data in real-time and transmits abnormal data automatically to a central office attended by technicians. The technician notifies the physician as appropriate, depending on pre-determined criteria. Note the distinction: Holter TM monitoring is not automatic. In this MCT system, there are three external leads attached to a sensor worn around the patient s neck. The sensor transmits data to the monitor which then transmits it to the service center as needed. MCT transmits by regular land phone when the patient is at home and by an embedded cell phone when the patient is away. Examples: CardioNet MCOT, LifeWatch 18

19 Key Terms 19

20 Key Terms The new cardiac monitoring codes attempt to standardize code descriptions and to use terms consistently. Some terms are familiar from the current codes, but may be used in more specific ways. Other terms are new and involve a precise definition to ensure the codes are applied properly. 20

21 Attended Surveillance Definition Attended surveillance means immediate availability of a technician in a remote location to respond to abnormal rhythms or device alerts as they are transmitted. Other Points This refers to sending transmissions to remote monitoring locations or centers for collection and review. The term attended surveillance appears with the codes for mobile cardiovascular telemetry. CMS also uses the phrase 24 hour attended coverage in relation to Holter monitors and event recorders Medicare National Coverage Determinations Manual, Chapter 1, section B 21

22 Device, Lead Definition The new codes use the term single lead for devices with a lead in one chamber of the heart. Dual lead refers to two chambers of the heart and multiple lead means three or more chambers. Other Points These terms are used with codes for interrogating and programming pacemakers and cardioverter-defibrillators. Multiple lead typically refers to biventricular devices. Note that some biventricular devices have only two leads, one right ventricular and one left ventricular. These devices would be defined as dual lead. 22

23 Interrogation Device Evaluation Definition In interrogation, an instrument retrieves stored data from implanted devices. The data includes heart rhythm, heart rate or physiologic elements, as well as indicators of device function such as leads, sensors, battery status and programmed parameters. The data is then evaluated to determine the device function and patient response. Other Points Interrogation is performed for implanted devices including pacemakers, ICDs, ILRs, and ICMs. The specific data that must be evaluated varies with the type of device. 23

24 Programming Device Evaluation Definition In programming, iterative adjustments are made to the parameters and evaluated. In other words, step-wise progressive changes are made and their effect is assessed, allowing final optimal parameters to be selected and entered. Other Points Programming is performed for implanted devices including pacemakers, ICDs, and ILRs (though not ICMs). The final parameters may ultimately be the same as the original parameters, as long as iterative adjustments are performed. Programming evaluation always includes interrogation. The term programming encompasses reprogramming. 24

25 In-Person and Remote Definition In-person services are delivered face-to-face. Remote services involve data obtained remotely, via phone or Internet transmission. Other than the mode of delivery, the data obtained and analysis performed are the same. Other Points The terms in-person and remote are used with codes for interrogation of pacemakers, ICDs, ILRs, and ICMs. The programming codes don t use these terms, because programming must always be performed in-person. Remote services may be performed multiple times within a given monitoring time period. 25

26 Up to # Days Definition Remote monitoring is delivered over the course of a defined time period, either 30 or 90 days depending on the service. The time period starts with the first monitoring service and continues through 30 or 90 days. A new time period begins on the 31 st or 91 st day. Other Points A 30 day time period is used for ILR and ICM remote interrogation codes. A 90 day time period is used for pacemaker and ICD remote interrogation codes. HRS/EHRA Expert Consensus on the Monitoring of Cardiovascular Implantable Electronic Devices (CIEDs) 26

27 Rhythm-Derived and Physiologic Definition Cardiovascular devices can collect and analyze two different categories of data. The first is ECG rhythm derived. This is obtained from recordings of the heart s electrical activity, eg. heart rhythm, heart rate, ST analysis. The second is physiologic data. This is obtained from internal or external sensors, eg. right ventricular pressure, left atrial pressure, pulmonary artery pressure, impedance, blood pressure. Other Points The same device may be capable of managing both types. Even when handled by the same device, rhythm derived and physiologic data are reported separately. 27

28 Peri-Procedural Definition Therapeutic cardiac rhythm devices are interrogated and programmed prior to surgery, procedures, and tests, to adjust the setting as needed. A second interrogation and programming takes places afterwards, again to adjust the settings as appropriate. Other Points Peri-procedural device evaluation and programming is performed for pacemakers and ICDs. The evaluation and programming in this scenario may be less extensive, but is needed to prevent inappropriate pulses and also to avoid damage to the device. 28

29 New Codes 29

30 New Codes There are 23 new codes for cardiac monitoring services. The new cardiac monitoring codes are all in the Medicine section of CPT, under the Cardiovascular heading. The code number ranges are to 93299, as well as to Most of the new codes are arranged by service, such as interrogation and programming, rather than by the type of device or system. Some new codes reflect only professional services (that were previously reported with the 26 modifier) and some reflect only technical services (that were previously reported with the TC modifier) 30

31 Pacemaker Codes Interrogation : In-Person New Code New Code Definition Interrogation device evaluation (in person) with physician analysis, review and report, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system Old Code Interrogation must include evaluation of programmed parameters, lead(s), battery, capture and sensing function, and heart rhythm is reported once for each in-person interrogation encounter 31

32 Pacemaker Codes Interrogation : In-Person in-person pacemaker interrogation cannot be reported together with pacemaker programming codes or with remote pacemaker interrogation codes (professional or technical) If an in-person interrogation takes place during a remote evaluation time period, only the remote code is reported In-person ILR interrogation is not reported separately with inperson pacemaker interrogation when the loop recording function is built into the pacemaker 32

33 Pacemaker Codes Programming New Code New Code Definition Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; single lead pacemaker system Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; dual lead pacemaker system Old Code Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; multiple lead pacemaker system The codes are differentiated solely by the number of leads 33

34 Pacemaker Codes Programming Codes are reported once for each programming encounter Adjustments are often made to sensor rate response, lower and upper heart rates, AV intervals, pacing voltage and pulse duration, sensing value and diagnostics, but are not required to be considered a programming service Programming must encompass all aspects of interrogation including evaluation of programmed parameters, lead(s), battery, capture and sensing function, and heart rhythm in-person interrogation code cannot be reported on the same day as programming codes , because interrogation is integral to programming Remote interrogation codes can be reported separately with programming codes 34

35 Pacemaker Codes Interrogation : Remote Professional Service Only New Code New Code Definition Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system with interim physician analysis, review(s) and report(s) Old Code is used for reporting professional services only The evaluation must include the same components as an in-person interrogation, and a report must be created covering the entire time period is reported once for the 90 day period; do not report if the monitoring period is less than 30 days in-person interrogation cannot be reported with 93294, but programming performed during the 90 day remote monitoring period can be reported separately 35

36 Pacemaker Codes Interrogation : Remote Technical Service Only New Code New Code Definition Interrogation device evaluation (remote), up to 90 days; single, dual or multiple lead pacemaker system or implantable cardioverterdefibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results Old Code TC TC is used for reporting the technical service only is reported once for the 90 day period; do not report if the monitoring period is less than 30 days Do not report remote technical pacemaker monitoring together with in-person pacemaker interrogation 36

37 Pacemaker Codes Transtelephonic Rhythm Strip Pacemaker Evaluation New Code New Code Definition Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple lead pacemaker system, includes recording with and without magnet application with physician analysis, review and report(s), up to 90 days Old Code is used when a rhythm EKG strip is transmitted by the patient using a surface electrode typically at the wrist to a telephonic monitor for analysis of heart rate and rhythm, and capture and sensing if observed is reported once for the 90 day period, regardless of the number of transmissions Note that an in-person evaluation of a rhythm EKG strip is coded ; these codes have not changed 37

38 Defibrillator Codes Interrogation : In-Person New Code New Code Definition Interrogation device evaluation (in person) with physician analysis, review and report, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead implantable cardioverter-defibrillator system, including analysis of heart rhythm derived data elements Old Code Interrogation must include evaluation of programmed parameters, lead(s), battery, capture and sensing function, presence or absence of therapy for ventricular tachyarrhythmias, and underlying heart rhythm is reported once for each in-person interrogation encounter 38

39 Defibrillator Codes Interrogation : In-Person Analysis of physiologic data is reported separately even when the implantable cardiovascular monitor (ICM) function is built into the defibrillator In-person ILR interrogation is not reported separately with inperson ICD interrogation when loop recording function is built into the ICD in-person ICD interrogation cannot be reported together with ICD programming codes or with remote ICD interrogation codes (professional or technical) If an in-person interrogation takes place during a remote evaluation time period, only the remote code is reported 39

40 Defibrillator Codes Programming New Code New Code Definition Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; single lead implantable cardioverter-defibrillator system Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; dual lead implantable cardioverter-defibrillator system Old Code Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; multiple lead implantable cardioverter-defibrillator system The codes are differentiated solely by the number of leads 40

41 Defibrillator Codes Programming Codes are reported once for each programming encounter Adjustments are often made to sensor rate response, lower and upper heart rates, AV intervals, pacing voltage and pulse duration, and sensing value and diagnostics, as well as ventricular tachycardia detection and therapies, but are not required to be considered a programming service Programming must encompass all components of interrogation, including evaluation of programmed parameters, lead(s), battery, capture and sensing function, presence or absence of therapy for ventricular tachyarrhythmias, and underlying heart rhythm 41

42 Defibrillator Codes Programming in-person interrogation cannot be reported on the same day as programming codes , because interrogation is integral to programming Remote interrogation codes can be reported separately with programming codes 42

43 Defibrillator Codes Interrogation : Remote Professional Service Only New Code New Code Definition Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable cardioverter-defibrillator system with interim physician analysis, review(s) and report(s) Old Code is used for reporting professional services only The evaluation must include the same components as an in-person interrogation, and a report must be created covering the entire time period is reported once for the 90 day period; do not report if the monitoring period is less than 30 days 43

44 Defibrillator Codes Interrogation : Remote Professional Service Only in-person defibrillator interrogation cannot be reported with remote defibrillator interrogation 93295, but defibrillator programming performed during the 90 day remote monitoring period can be reported separately As with in-person interrogation, remote analysis of physiologic data is reported separately even when the implantable cardiovascular monitor (ICM) function is built into the defibrillator 44

45 Defibrillator Codes Interrogation : Remote Technical Service Only New Code New Code Definition Interrogation device evaluation (remote), up to 90 days; single, dual, or multiple lead pacemaker system or implantable cardioverterdefibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results Old Code TC TC is used for reporting the technical service only is reported once for the 90 day period; do not report if the monitoring period is less than 30 days Do not report remote technical defibrillator monitoring together with in-person defibrillator interrogation 45

46 Defibrillator Codes Interrogation of Wearable Defibrillator New Code New Code Definition Interrogation device evaluation (in person) with physician analysis, review and report, includes connection, recording and disconnection per patient encounter; wearable defibrillator system Old Code is for interrogation of wearable, external defibrillator systems Monitoring for wearable defibrillators was previously included with implantable defibrillators but now has been broken out Initial set-up and programming for a wearable defibrillator continues to be coded 93745; use of this code has not changed Example: LifeCor LifeVest TM 46

47 Peri-Procedural Codes Peri-Procedural Device Evaluation and Programming New Code New Code Definition Peri-procedural device evaluation and programming of device system parameters before or after a surgery, procedure or test with physician analysis, review and report; single, dual, or multiple lead pacemaker system Peri-procedural device evaluation and programming of device system parameters before or after a surgery, procedure or test with physician analysis, review and report; single, dual, or multiple lead implantable cardioverter-defibrillator system Old Code NA NA The codes are differentiated between pacemaker and defibrillator 47

48 Peri-Procedural Codes Peri-Procedural Device Evaluation and Programming Pre-operatively, the pacemaker and defibrillator devices are adjusted to settings appropriate to the surgery or other procedure or test, as needed After the surgery, procedure or test, the pacemaker and defibrillator devices are again evaluated and programmed to appropriate post-procedural settings, as needed If the same physician performs both the pre-operative and post-operative service, the physician reports the code twice If one physician performs the pre-operative service and another physician performs the post-operative service, each submits the code once 48

49 Peri-Procedural Codes Peri-Procedural Device Evaluation and Programming Peri-procedural codes and cannot be reported together with in-person pacemaker interrogation code or in-person defibrillator interrogation code Peri-procedural codes and also cannot be reported together with the pacemaker programming codes or the defibrillator programming codes Peri-procedural codes and cannot be reported on the same day by the same physician performing insertion or surgical revision of a pacemaker or defibrillator lead or generator 49

50 ILR Codes Interrogation : In-Person New Code New Code Definition Interrogation device evaluation (in person) with physician analysis, review and report, includes connection, recording and disconnection per patient encounter; implantable loop recorder system, including heart rhythm derived data analysis Old Code Interrogation must include evaluation of programmed parameters, and the heart rate and rhythm during recorded episodes from both the patient-initiated events and devicedetected events is reported once for each in-person interrogation encounter cannot be reported at the same time as surgical placement of the implantable loop recorder

51 ILR Codes Interrogation : In-Person in-person ILR interrogation cannot be reported together with the ILR programming code or with the remote ILR interrogation codes (professional or technical) If an in-person ILR interrogation takes place during a remote evaluation time period, only the remote code is reported in-person ILR interrogation cannot be reported together with the in-person pacemaker interrogation code or in-person defibrillator interrogation code also cannot be reported together with in-person interrogation of implantable cardiovascular monitor 51

52 ILR Codes Programming New Code New Code Definition Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; implantable loop recorder system Old Code is reported once for each programming encounter cannot be reported at the same time as for implantation of the ILR, because implantation includes initial programming ILR programming cannot be reported together with to pacemaker or defibrillator programming 52

53 ILR Codes Programming Adjustments are often made to the bradycardia and tachycardia detection criteria, but are not required to be considered a programming service Programming must encompass all components of interrogation, including evaluation of programmed parameters, and the heart rate and rhythm during recorded episodes from both the patient-initiated events and device-detected events in-person ILR interrogation cannot be reported on the same day as ILR programming code 93285, because interrogation is integral to programming Remote interrogation codes can be reported separately with programming codes 53

54 ILR Codes Interrogation : Remote Professional Service Only New Code New Code Definition Interrogation device evaluation(s) (remote), up to 30 days; implantable loop recorder system, including analysis of recorded heart rhythm data, physician analysis, review(s) and report(s) Old Code NA is used for reporting professional services only The evaluation must include the same components as an in-person interrogation, and a report must be created covering the entire time period is reported once for the 30 day period; do not report if the monitoring period is less than 10 days 54

55 ILR Codes Interrogation : Remote Professional Service Only in-person ILR interrogation cannot be reported with remote ILR interrogation 93298, but ILR programming performed during the 30 day remote monitoring period can be reported separately remote ILR interrogation also cannot be reported together with remote interrogation of implantable cardiovascular monitor (ICM) also cannot be reported at the same time as surgical placement of the implantable loop recorder

56 ILR Codes Interrogation : Remote Technical Service Only New Code New Code Definition Interrogation device evaluation (remote), up to 30 days; implantable cardiovascular monitor system or implantable loop recorder system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results Old Code NA is used for reporting the technical service only is reported once for the 30 day period; do not report if the monitoring period is less than 10 days Do not report remote technical ILR monitoring together with in-person ILR interrogation 56

57 ICM Codes Interrogation : In-Person New Code New Code Definition Interrogation device evaluation (in person) with physician analysis, review and report, includes connection, recording and disconnection per patient encounter; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors Old Code NA Interrogation must include evaluation of programmed parameters and analysis of at least one physiologic cardiovascular data element, eg. intrathoracic impedance is reported once for each in-person interrogation encounter 57

58 ICM Codes Interrogation : In-Person in-person ICD interrogation for analysis of heart rhythm data is reported separately from for analysis of physiologic data, even when both functions are built into the same defibrillator in-person ICM interrogation cannot be reported together with the remote ICM interrogation codes (professional or technical) If an in-person ICM interrogation takes place during a remote evaluation time period, only the remote code is reported 58

59 ICM Codes Interrogation : Remote Professional Service Only New Code New Code Definition Interrogation device evaluation(s), (remote), up to 30 days; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors, physician analysis, review(s), and report(s) Old Code NA is used for reporting professional services only The evaluation must include the same components as an in-person interrogation, and a report must be created covering the entire time period 59

60 ICM Codes Interrogation : Remote Professional Service Only is reported once for the 30 day period; do not report if the monitoring period is less than 10 days in-person ICM interrogation cannot be reported together with remote ICM interrogation code remote ICM interrogation also cannot be reported together with remote interrogation of ILR remote analysis of heart rhythm data is reported separately even when the implantable cardiovascular monitor function is built into the defibrillator 60

61 ICM Codes Interrogation : Remote Technical Service Only New Code New Code Definition Interrogation device evaluation(s), (remote), up to 30 days; implantable cardiovascular monitor system or implantable loop recorder system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results Old Code NA is used for reporting the technical service only is reported once for the 30 day period; do not report if the monitoring period is less than 10 days Do not report remote technical ICM monitoring together with in-person ICM interrogation remote technical ICM or ILR monitoring is also not reported with remote pacemaker or ICD interrogation 61

62 MCT Codes MCT : Remote Professional Service Only New Code New Code Definition Wearable mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; physician review and interpretation with report Old Code NA is used for reporting professional services only is reported once for the 30 day period 62

63 MCT Codes MCT : Remote Technical Service Only New Code New Code Definition Wearable mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; technical support for connection and patient instructions for use, attended surveillance, analysis and physician prescribed transmission of daily and emergent data reports Old Code NA is used for reporting the technical service only is reported once for the 30 day period 63

64 General Coding Guidelines 64

65 General Coding Guidelines Surgical Services Codes for device interrogation and programming cannot be reported together with surgical codes for insertion or revision of pacemakers, defibrillators and loop recorders, when performed on the same day by the same physician Note: intra-operative DFTs remain separately codable Physiologic and Rhythm Monitoring Codes for physiologic monitoring are always reported separately from codes for rhythm monitoring, even when the same device is performing both functions 65

66 Interrogation In-Person Interrogation In-person interrogation services are reported individually, ie. once per service Remote Interrogation of Pacemakers and ICDs Remote interrogation of pacemakers and ICDs is reported once per 90 days, regardless of the number of evaluations performed during that time period Do not report remote interrogation of pacemakers and ICDs if the monitoring period is less than 30 days 66

67 Interrogation Remote Interrogation of ILRs and ICMs Remote interrogation of ILRs and ICMs is reported once per 30 days, regardless of the number of evaluations performed during that time period Do not report remote interrogation of ILRs and ICMs if the monitoring period is less than 10 days 67

68 Interrogation In-Person and Remote Interrogation in Same Time Period The same guidelines apply to all devices that have both in-person and remote monitoring codes, ie. pacemakers, ICDs, ILRs and ICMs A physician cannot report both in-person and remote interrogation of the same device during the same period If an in-person interrogation takes place during the same time period as remote interrogation, the physician submits only the remote code for professional services A service center can report its technical services for remote interrogation during the same time period in which a physician performs in-person device evaluation 68

69 Programming Programming of Pacemakers, ICDs and ILRs Programming services are reported individually, ie. once per service Programming and In-Person Interrogation Physicians cannot report programming and in-person interrogation of the same device on the same date Programming and Remote Interrogation in Same Time Period Programming can be reported separately even when it takes place during the period of remote interrogation 69

70 Questions and More 70

71 Healthcare Economics Information Multiple resources are always available to you: Our website: At this site, you will find: 2009 Cardiac Device Evaluation Code Look-Up (website search) You will also find these files: New CPT Codes for Cardiac Device Monitoring: Side-by-Side Comparison CPT Codes for Cardiac Device Monitoring 71

72 Healthcare Economics Information You can also obtain a printed copy of these files from either your Medtronic sales representative or your CRDM Regional Economic Manager (REM) You can find out who your REM is by contacting your Medtronic sales representative Call our CRDM Coding Hotline at (option 1) with your coding questions us with any coding, coverage and reimbursement questions at: rs.healthcareeconomics@medtronic.com 72

73 Questions 73

74 Appendix 1: Crosswalks 74

75 Crosswalks: Old to New Codes In becoming acclimated to the new 2009 codes, it s useful to have a reference cross-walking the old codes to the new codes. Current cardiac monitoring codes address only pacemakers, defibrillators and implantable loop recorders. There are no crosswalks for peri-procedural, implantable CV monitors, and mobile CV telemetry simply because there are no current codes for these services. Because many old codes crosswalk to several new codes, it s important to note the distinctions between the new codes to ensure that the correct code is selected. 75

76 Pacemaker Old Code Old Code Definition Electronic analysis of dual chamber pacemaker without reprogramming Electronic analysis of dual chamber pacemaker with reprogramming New 2009 Code Interrogation device evaluation, in person, single, dual, or multiple lead pacemaker Interrogation device evaluation(s), remote, up to 90 days, single, dual, or multiple lead pacemaker, physician Programming device evaluation, dual lead pacemaker New Code Brief Definition Interrogation device evaluation(s), remote, up to 90 days, single, dual, or multiple lead pacemaker, technician Programming device evaluation, multiple lead pacemaker 76

77 Pacemaker Old Code Old Code Definition Electronic analysis of single chamber pacemaker without reprogramming Electronic analysis of single chamber pacemaker with reprogramming New 2009 Code Interrogation device evaluation, in person, single, dual, or multiple lead pacemaker Interrogation device evaluation(s), remote, up to 90 days, single, dual, or multiple lead pacemaker, physician New Code Brief Definition Interrogation device evaluation(s), remote, up to 90 days, single, dual, or multiple lead pacemaker, technician Programming device evaluation, single lead pacemaker 77

78 Pacemaker Old Code Old Code Definition Electronic analysis of dual chamber pacemaker, transtelephonic Electronic analysis of single chamber pacemaker, transtelephonic New 2009 Code New Code Brief Definition Transtelephonic rhythm strip pacemaker evaluation(s), single, dual, or multiple lead pacemaker system, includes recording with and without magnet application with physician analysis, review and report(s), up to 90 days 78

79 Defibrillator Old Code Old Code Definition Electronic analysis of single chamber or wearable cardioverterdefibrillator without reprogramming New 2009 Code Interrogation device evaluation, in person, single, dual, or multiple lead defibrillator Interrogation device evaluation(s), remote, up to 90 days, single, dual, or multiple lead defibrillator, physician Interrogation device evaluation(s), remote, up to 90 days, single, dual, or multiple lead defibrillator, technician New Code Brief Definition Interrogation device evaluation, in person, single, wearable defibrillator Electronic analysis of Programming device evaluation, single lead single chamber or defibrillator wearable cardioverterdefibrillator with reprogramming 79

80 Defibrillator Old Code Old Code Definition Electronic analysis of dual chamber cardioverterdefibrillator without reprogramming Electronic analysis of dual chamber cardioverterdefibrillator with reprogramming New 2009 Code Interrogation device evaluation, in person, single, dual, or multiple lead defibrillator Interrogation device evaluation(s), remote, up to 90 days, single, dual, or multiple lead defibrillator, physician Programming device evaluation, dual lead defibrillator New Code Brief Definition Interrogation device evaluation(s), remote, up to 90 days, single, dual, or multiple lead defibrillator, technician Programming device evaluation, multiple lead defibrillator 80

81 Implantable Loop Recorder Old Code Old Code Definition Electronic analysis and/or reprogramming of implantable loop recorder New 2009 Code Programming device evaluation, ILR Interrogation device evaluation, in person, ILR Interrogation device evaluation(s), remote, up to 30 days, ILR, physician New Code Brief Definition Interrogation device evaluation(s), remote, up to 30 days, ILR, technician 81

82 Revised Codes In addition to the 11 deleted codes and the 23 new codes, the definitions of 15 codes are being revised. The revised codes are , for Holter monitoring and wearable loop recorders. The revisions are minor and consist mostly of adding the term wearable to the existing definitions. This helps to differentiate external Holter monitoring from monitoring related to implantable devices. 82

83 Appendix 2: and APCs 83

84 Medicare reimburses physicians under the RBRVS prospective payment system. Other payers may also use this system or a variation. Each code is assigned Relative Value Units () for physician work, practice expense and malpractice The codes for some services can be split into global, technical component (-TC), and professional component (-26) Some services can only be reported by physicians in the facility setting 84

85 APCs Medicare reimburses hospitals for outpatient services under the APC prospective payment system. Other payers may also use this system or a variation. Hospitals report the CPT cardiac device monitoring codes for outpatient services, eg. in the hospital clinic. Codes for major services are classified into groups based on comparable clinical nature and resources, and each group is assigned a relative weight Some codes are packaged and are not separately payable with other primary services Codes representing physician only services are not billable by hospitals 85

86 Pacemaker Codes Physician CPT Mod Brief Description Work Practice Expense Non Facility Practice Expense Facility Programming, single lead NA NA TC Programming, single lead NA NA Programming, single lead Programming, dual lead NA NA TC Programming, dual lead Malpractice Total Non- Facility Total Facility NA NA Programming, dual lead Programming, multiple lead NA NA TC Programming, multiple lead NA NA Programming, multiple lead All pacemaker programming codes can be split into global, technical component (-TC), and professional component (-26) In the facility setting, physicians can report only the professional component (-26) 86

87 Pacemaker Codes Physician CPT Mod Brief Description Work Practice Expense Non Facility Practice Expense Facility Interrogation, in person NA NA TC Malpractice Total Non- Facility Total Facility Interrogation, in person NA NA Interrogation, in person In-person pacemaker interrogation can also be split in global, technical component (-TC), and professional component (-26) In the facility setting, physicians can report only the professional component (-26) 87

88 Pacemaker Codes Physician CPT Mod Brief Description Work Practice Expense Non Facility Practice Expense Facility Malpractice Total Non- Facility Interrogation, remote, physician Total Facility Interrogation, remote, technician NA NA 1.02 Remote pacemaker interrogation with physician analysis is a professional only code by definition; physicians can report this service in either the non-facility or facility setting Remote pacemaker interrogation with technician review is a technical only code by definition; physicians can report this service in the non-facility setting 88

89 Pacemaker Codes Physician CPT Mod Brief Description Work Practice Expense Non Facility Practice Expense Facility Malpractice Total Non- Facility Total Facility Transtelephonic rhythm strip eval NA NA TC Transtelephonic rhythm strip eval NA NA Transtelephonic rhythm strip eval The code for transtelephonic rhythm strip evaluation can be split into global, technical component (-TC), and professional component (-26) In the facility setting, physicians can report only the professional component (-26) 89

90 Pacemaker Codes Hospital Outpatient APCs CPT Brief Definition Status APC Weight Programming, single lead S 0690 Level I Electronic Analysis of Devices Programming, dual lead S 0690 Level I Electronic Analysis of Devices Programming, multiple lead S 0690 Level I Electronic Analysis of Devices Interrogation, in person S 0690 Level I Electronic Analysis of Devices Interrogation, remote, physician M Interrogation, remote, technician S 0689 Level II Electronic Analysis of Devices Transtelephonic rhythm strip eval S 0689 Level II Electronic Analysis of Devices The only service hospitals can t report is remote pacemaker interrogation with physician analysis; this professional service is status M, non-billable under APCs Other hospital pacemaker device monitoring services are status S, separately paid under APCs without discounting 90

91 Defibrillator Codes Physician CPT Mod Brief Description Work Practice Expense Non Facility Practice Expense Facility Programming, single lead NA NA TC Programming, single lead NA NA Programming, single lead Programming, dual lead NA NA TC Programming, dual lead Malpractice Total Non- Facility Total Facility NA NA Programming, dual lead Programming, multiple lead NA NA TC Programming, multiple lead NA NA Programming, multiple lead All defibrillator programming codes can be split into global, technical component (-TC), and professional component (-26) In the facility setting, physicians can report only the professional component (-26) 91

92 Defibrillator Codes Physician CPT Mod Brief Description Work Practice Expense Non Facility Practice Expense Facility Interrogation, in person NA NA TC Malpractice Total Non- Facility Total Facility Interrogation, in person NA NA Interrogation, in person In-person defibrillator interrogation can also be split in global, technical component (-TC), and professional component (-26) In the facility setting, physicians can report only the professional component (-26) 92

93 Defibrillator Codes Physician CPT Mod Brief Description Work Practice Expense Non Facility Practice Expense Facility Malpractice Total Non- Facility Interrogation, remote, physician Total Facility Interrogation, remote, technician NA NA 1.84 Remote defibrillator interrogation with physician analysis is a professional only code by definition; physicians can report this service in either the non-facility or facility setting Remote defibrillator interrogation with technician review is a technical only code by definition; physicians can report this service in the non-facility setting 93

94 Defibrillator Codes Physician CPT Mod Brief Description Work Practice Expense Non Facility Practice Expense Facility Malpractice Total Non- Facility Total Facility Interrogation, in person, wearable NA NA TC Interrogation, in person, wearable NA NA Interrogation, in person, wearable The code for in-person interrogation of a wearable defibrillator can be split into global, technical component (-TC), and professional component (-26) In the facility setting, physicians can report only the professional component (-26) 94