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 55101 1-800-252-1578 www.medlearnmedia.com
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...25 2018 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...31 2018 Medicare OPPS Payment Updates...32 iii
Important Device-Related OPPS Updates...32 Payments for ASCs...35 2018 Medicare ASC Payment Updates...36 Chapter 5: Diagnostic Cardiac Testing...37 Electrocardiograms (93000 93010)...37 Rhythm Strips (93040 93042)...38 64-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 (93015 93018)...41 External Cardiovascular Monitoring Services (93224 93227)...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 (93268 93272)...47 Chapter 6: Pacemaker Systems...49 Permanent Pacemaker Initial Implantation (33206 33208)...49 Pacemaker Generator Insertion Only (33212, 33213, 33221)...52 Pacemaker Generator Replacement (33227 33229)...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 (33262 33264)...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
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 (93600 93603, 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)...101 v
Chapter 14: Ablation Procedures...105 Stand-Alone Ablation (93650) (Heart Block)...105 Combined Comprehensive EP Study and Ablation (93653, 93654, 93655, 93656, 93657)...106 Intracardiac Echocardiography (93662)...113 Chapter 15: Tilt-Table Testing...115 Tilt-Table Evaluation (93660)...115 Chapter 16: Cardiovascular Electronic Device Monitoring...117 Pacemaker Device Monitoring (93279 93281, 93286, 93288, 93293, 93294, 93296)...118 Pacemaker Programming Device Evaluation (93279 93281)...118 Pacemaker Peri-Procedural Device Evaluation and Programming (93286)...119 Pacemaker Interrogation Device Evaluation (In Person) (93288)...120 Transtelephonic Rhythm Strip Pacemaker Evaluation (93293)...121 Pacemaker Device Interrogation (Remote) (93294, 93296)...122 Implantable Cardioverter-Defibrillator (ICD) Device Monitoring (93282 93284, 93287, 93289, 93295, 93296)...124 ICD Programming Device Evaluation (93282 93284)...124 ICD Peri-Procedural Device Evaluation and Programming (93287)...125 ICD Interrogation Device Evaluation (In Person) (93289)...126 ICD Interrogation Device Evaluation (Remote) (93295, 93296)...127 Subcutaneous Implantable Defibrillator System Monitoring (93260, 93261)...129 Subcutaneous Implantable Defibrillator System Programming Device Evaluation (93260)...129 Subcutaneous Implantable Defibrillator System Interrogation Device Evaluation (93261)...130 Subcutaneous Implantable Defi brillator System Interrogation Device Evaluation (Remote) (93295, 93296)...130 Wearable Defibrillator System Device Monitoring (93292, 93745)...131 Wearable Defibrillator Interrogation Device Evaluation (In Person) (93292)...131 Wearable Defibrillator Initial Set-Up and Programming (93745)...131 Implantable Loop Recorder (ILR) Device Monitoring (93285, 93291, 93298, 93299)...132 ILR Programming Device Evaluation (93285)...132 ILR Interrogation Device Evaluation (In Person) (93291)...133 ILR Interrogation Device Evaluation (Remote) (93298, 93299)...134 Implantable Cardiovascular Monitor (ICM) Device Monitoring (93290, 93297, 93299)...135 vi
ICM Interrogation Device Evaluation (In Person) (93290)...136 ICM Interrogation Device Evaluation (Remote) (93297, 93299)...136 Transcatheter Leadless Pacemaker Device Monitoring (0389T, 0390T, 0391T)...138 Transcatheter Leadless Pacemaker Programming Device Evaluation (0389T)...139 Transcatheter Leadless Pacemaker Peri-Procedural Device Evaluation (0390T)...139 Transcatheter Leadless Pacemaker Interrogation Device Evaluation (0391T)...139 SECTION 2: Inpatient Procedure Coding Chapter 17: Hospital Inpatient Reimbursement...143 ICD-10 Coding System...145 Common Procedure Coding EP Coding Examples...150 MS-DRG Basics...151 MS-DRG Payments...152 Chapter 18: MS-DRG Logic for CRM Procedures...155 Pacemakers or Cardiac Resynchronization Pacemakers...155 ICD or Cardiac Resynchronization Therapy Defibrillator...157 Electrophysiology Study and Ablation...158 Chapter 19: Pacemaker Implants...159 Chapter 20: Implantable Defibrillators...167 Chapter 21: Cardiac Resynchronization Therapy...171 Chapter 22: Device Testing...175 ICD and Pacemaker Testing...175 Chapter 23: Diagnostic Electrophysiology Studies...177 Chapter 24: Percutaneous Ablation...179 Chapter 25: Leadless Pacemaker...181 Chapter 26: Percutaneous Left Atrial Appendage (LAAC) Closure...183 Chapter 27: Medicare Quality Payment Programs...185 Overview of Medicare Quality Programs...185 Outpatient Department Measures...186 Quality Payment Program...188 Bundled Payments...192 vii
Appendices Appendix A: Clinical Case Examples...197 Appendix B: NCD for Implantable Automatic Defibrillators...215 Appendix C: NCD for Cardiac Pacemakers...221 Appendix D: NCD for Cardiac Pacemaker Evaluation Services...225 Appendix E: NCD for Leadless Pacemaker...227 Appendix F: NCD for Percutaneous Left Atrial Appendage Closure (LAAC)...231 viii