Cardiac Rhythm Management Coder 2017 An easy-to-use tool for coding and reimbursement compliance Prepared and Published By: MedLearn Publishing, A Division of Panacea Healthcare Solutions, Inc. 287 East Sixth Street, Suite 400 St. Paul, MN 55101 1-800-252-1578 www.panaceainc.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 Diagnostic EP Testing...6 Intracardiac Mapping...6 Ablation...6 Cardiovascular Implantable Electronic Device (CIED)...7 Pacemaker...7 Cardiac Resynchronization Therapy Pacemaker (CRT-P)...8 Implantable Cardioverter-Defibrillator (ICD)...8 Cardiac Resynchronization Therapy Defibrillator (CRT-D)...9 Implantable Cardiovascular Monitor (ICM)...10 Implantable Loop Recorder (ILR)...10 Chapter 2: Indications and Coverage for Cardiac Rhythm Management Devices...11 National Coverage Determinations (NCDs)...11 ICD National Coverage...11 Q0 Modifier Requirement...12 Device Follow-Up National Coverage...14 Local Coverage Determinations (LCDs)...16 SECTION 1: Outpatient Procedure Coding Chapter 3: HCPCS/CPT Procedural Coding...21 HCPCS Level I...21 HCPCS Level II...21 Level II C Codes...21 Procedure-to-Procedure (PTP) Edits...22 New Modifiers for Distinct Procedures...23 2017 Medicare Physician Fee Schedule Updates Related to CRM Procedures...24 Physician Documentation Tips for EP Procedures...26 Chapter 4: Hospital OPPS and ASC Payments...29 Hospital Outpatient PPS...29 2017 Medicare OPPS Payment Updates...30 Important Device-Related OPPS Updates...30 Payments for ASCs...33 Medicare ASC Payment Updates...33 Chapter 5: Pacemaker Systems...35 Permanent Pacemaker Initial Implantation (33206 33208)...35 Pacemaker Generator Insertion Only (33212, 33213, 33221)...38 Pacemaker Generator Replacement (33227 33229)...39 Pacemaker Generator Upgrade (33214)...40 Pacemaker Removal (33233)...40 Pacemaker Lead (Electrode) Insertion (33216, 33217)...41 Pacemaker Biventricular Lead (Electrode) Placement Into Cardiac Venous System (33224, 33225)...42 iii
Pacemaker Lead (Electrode) Repositioning (33215, 33226)...44 Pacemaker Lead (Electrode) Removal (33234, 33235)...45 Pacemaker Lead (Electrode) Repair (33218, 33220)...46 Pacemaker Relocation of Skin Pocket Pacemaker Generators (33222)...47 Temporary Pacing (33210, 33211)...48 Transcatheter Leadless Pacemaker Insertion or Replacement (0387T)...49 Transcatheter Leadless Pacemaker Removal (0388T)...50 Chapter 6: Implantable Defibrillators...53 ICD Initial Implant (33249)...53 ICD Generator Insertion Only (33240, 33230, 33231)...54 ICD Generator Removal Only (33241)...55 ICD Pacemaker Pulse Generator Replacement (33262 33264)...56 ICD Pacemaker Generator Lead (Electrode) Insertion (33216, 33217)...57 ICD Pacemaker Generator Biventricular Lead (Electrode) Placement Into Cardiac Venous System (33224, 33225)...58 ICD Pacemaker Generator Lead (Electrode) Repositioning (33215, 33226)...61 ICD Pacemaker Generator Lead Removal (Extraction) (33244)...62 ICD Pacemaker Generator Lead (Electrode) Repair (33218, 33220)...62 ICD Pacemaker Generator Relocation of Skin Pocket (33223)...63 Chapter 7: Subcutaneous Implantable Defibrillator System...67 Subcutaneous Implantable Defibrillator System Implant (33270)...67 Subcutaneous Implantable Defibrillator Generator Insertion Only (33240)...67 Subcutaneous Implantable Defibrillator Generator Removal Only (33241)...68 Subcutaneous Implantable Defibrillator Generator Replacement (33262)...68 Insertion (33271)...69 Repositioning (33273)...69 Removal (33272)...70 Chapter 8: Implantable Loop Recorder (ILR)...71 ILR Implant (33282)...71 ILR Removal (33284)...71 Chapter 9: Left Atrial Hemodynamic Monitor...73 Left Atrial Hemodynamic Monitor (0293T, 0294T)...73 Chapter 10: Testing Device and Leads (Electrodes)...75 Testing ICD Device and Leads (93640, 93641)...75 Testing Subcutaneous Implantable Defibrillator Device and Leads (93644)...76 Chapter 11: Non-Invasive and Invasive Program Stimulation...79 EP Study to Evaluate Therapy (93624)...79 EP Study to Evaluate ICD System (93642)...80 iv
EP Study to Evaluation Subcutaneous Implantable Defibrillator (93644)...80 EP Study to Evaluate Pacemaker (93724)...81 Chapter 12: Electrophysiology Studies...83 Single-Site Studies (93600 93603, 93610, 93612, 93618)...83 Esophageal Electrocardiography (93615, 93616)...84 Mapping (Intracardiac) (93609, 93613)...85 Comprehensive EP Studies (93619, 93620)...85 Add-on Codes (93621, 93622, 93623)...87 Chapter 13: Ablation Procedures...91 Stand-Alone Ablation (93650) (Heart Block)...91 Combined Comprehensive EP Study and Ablation (93653, 93654, 93655, 93656, 93657)...92 Intracardiac Echocardiography (93662)...99 Chapter 14: Tilt-Table Testing...101 Tilt-Table Evaluation (93660)...101 Chapter 15: Cardiovascular Electronic Device Monitoring...103 Pacemaker Device Monitoring (93279 93281, 93286, 93288, 93293, 93294, 93296)...104 Pacemaker Programming Device Evaluation (93279 93281)...104 Pacemaker Peri-Procedural Device Evaluation and Programming (93286)...105 Pacemaker Interrogation Device Evaluation (In Person) (93288)...106 Transtelephonic Rhythm Strip Pacemaker Evaluation (93293)...107 Pacemaker Device Interrogation (Remote) (93294, 93296)...108 Implantable Cardioverter-Defibrillator (ICD) Device Monitoring (93282 93284, 93287, 93289, 93295, 93296)...110 ICD Programming Device Evaluation (93282 93284)...110 ICD Peri-Procedural Device Evaluation and Programming (93287)...111 ICD Interrogation Device Evaluation (In Person) (93289)...112 ICD Interrogation Device Evaluation (Remote) (93295, 93296)...113 Subcutaneous Implantable Defibrillator System Monitoring (93260, 93261)...115 Subcutaneous Implantable Defibrillator System Programming Device Evaluation (93260)...115 Subcutaneous Implantable Defibrillator System Interrogation Device Evaluation (93261)...116 Wearable Defibrillator System Device Monitoring (93292, 93745)...116 Wearable Defibrillator Interrogation Device Evaluation (In Person) (93292)...116 Wearable Defibrillator Initial Set-Up and Programming (93745)...117 Implantable Loop Recorder (ILR) Device Monitoring (93285, 93291, 93298, 93299)...117 ILR Programming Device Evaluation (93285)...118 ILR Interrogation Device Evaluation (In Person) (93291)...119 ILR Interrogation Device Evaluation (Remote) (93298, 93299)...119 v
Implantable Cardiovascular Monitor (ICM) Device Monitoring (93290, 93297, 93299)...121 ICM Interrogation Device Evaluation (In Person) (93290)...121 ICM Interrogation Device Evaluation (Remote) (93297, 93299)...122 Mobile Cardiovascular Telemetry (MCT) Device Monitoring (93228, 93229)...124 Transcatheter Leadless Pacemaker Device Monitoring (0389T, 0390T, 0391T)...125 Transcatheter Leadless Pacemaker Programming Device Evaluation (0389T)...125 Transcatheter Leadless Pacemaker Peri-Procedural Device Evaluation (0390T)...125 Transcatheter Leadless Pacemaker Interrogation Device Evaluation (0391T)...125 SECTION 2: Inpatient Procedure Coding Chapter 16: Hospital Inpatient Reimbursement...129 ICD-10 Coding System...131 Common Procedure Coding EP Coding Examples...136 MS-DRG Basics...137 MS-DRG Payments...138 Chapter 17: MS-DRG Logic for CRM Procedures...141 Pacemakers or Cardiac Resynchronization Pacemakers...141 ICD or Cardiac Resynchronization Therapy Defibrillator...143 Electrophysiology Study and Ablation...144 Chapter 18: Pacemaker Implants...145 Chapter 19: Implantable Defibrillators...153 Chapter 20: Cardiac Resynchronization Therapy...157 Chapter 21: Device Testing...161 ICD and Pacemaker Testing...161 Chapter 22: Diagnostic Electrophysiology Studies...163 Chapter 23: Percutaneous Ablation...165 Chapter 24: Medicare Quality Payment Programs...167 Overview of Medicare Quality Programs...167 Outpatient Department Measures...168 Quality Payment Program...170 Bundled Payments...174 Appendices Appendix A: Clinical Case Examples...179 Appendix B: NCD for Implantable Automatic Defibrillators...197 Appendix C: NCD for Cardiac Pacemakers...203 Appendix D: NCD for Cardiac Pacemaker Evaluation Services...207 vi