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Codman Neuro Reimbursement Guide

Codman Neuro Reimbursement Services 1-800-609-1108

Codman Neuro is pleased to provide a service designed to meet your needs, the Codman Neuro Reimbursement Hotline. Reimbursement Principles, Inc., a full-service reimbursement-consulting group specializing in medical device reimbursement, staffs the hotline. With over 10 years serving the healthcare community, Reimbursement Principles supports hospitals and physicians by providing assistance with reimbursement and billing information Hotline details: (800) 609-1108 Hours of Operation: Monday through Friday, 8:00 am to 5:00 pm MST (10:00 am to 7:00 pm EST) We trust you will find this service and guide useful. These are examples of the Codman Neuro commitment to providing quality products and services to our customers. 2017 The information contained in this document is provided for informational purposes only and represents no statement, promise or guarantee by Codman & Shurtleff, Inc. concerning levels of reimbursement, payment or charge. Similarly, all CPT® (AMA), ICD-10, and HCPCS codes are supplied for informational purposes only and represent no statement, promise, or guarantee by Codman & Shurtleff, Inc. that these codes will be appropriate or that reimbursement will be made. It is not intended to increase or maximize reimbursement by any payer. We strongly recommend that you consult your payer organization with regard to its reimbursement policies. Current Procedural Terminology© 2016 American Medical Association. All rights reserved.

©DePuy Synthes 2017. All rights reserved. DSUS/COD/0215/0271(2) 1/17

January 2017 The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Codman & Shurtleff, Inc. concerning levels of reimbursement, payment, or charge. Similarly, all CPT® (AMA), ICD-10, HCPCS codes are supplied for informational purposes only and represent no statement, promise, or guarantee by Codman & Shurtleff, Inc. that these codes will be appropriate or that reimbursement will be made. It is not intended to increase or maximize reimbursement by any payer. We strongly recommend that you consult your payer organization with regard to its reimbursement policies. Current Procedural Terminology© 2016 American Medical Association. All rights reserved.

CONTENTS ICD-10-CM Diagnosis Coding for Hospital and Physician Services 4 Hospital Inpatient Coding and Payment 5 Hospital Inpatient Reimbursement 7 Humanitarian Use Device (HUD) and Humanitarian Use Device Exemption (HDE) 11 Hospital Inpatient Case Example – Vascular Reconstruction Device 12 Hospital Outpatient Coding and Payment 13 Physician Professional Coding and Payment 19 Physician Payment Examples 24 Modifiers 26 Documentation 27 Codman Neuro Products and C Codes (Pass-Through Codes) 28 References 29

Disclaimer: The information contained in this guide is provided to assist you in understanding the reimbursement process. It is intended to assist providers in accurately obtaining reimbursement for healthcare services. The information is broad-based and intended to address a wide range of reimbursement scenarios that you may encounter. It references many different procedures and types of devices. Such generic references do not mean or suggest that Codman Neuro has a specific product approved for each procedure discussed. Please refer to the Instructions for Use (IFU) for a complete description of indications and contraindications for each medical device used. Any case study examples are provided only to illustrate a possible reimbursement scenario. It is not intended as direction on how to conduct or code for a procedure. Individual procedures and corresponding codes will vary based on the physician’s medical judgment and circumstances of the case. It is important to research coverage and payment for procedures on a payer-specific basis as coverage policies and guidelines vary by payer. Payment rates were current at time of printing.

©DePuy Synthes 2017. All rights reserved. DSUS/COD/0215/0271(2) 1/17

January 2017 4 The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Codman & Shurtleff, Inc. concerning levels of reimbursement, payment, or charge. Similarly, all CPT® (AMA), ICD-10, HCPCS codes are supplied for informational purposes only and represent no statement, promise, or guarantee by Codman & Shurtleff, Inc. that these codes will be appropriate or that reimbursement will be made. It is not intended to increase or maximize reimbursement by any payer. We strongly recommend that you consult your payer organization with regard to its reimbursement policies. Current Procedural Terminology© 2016 American Medical Association. All rights reserved. ©DePuy Synthes 2017. All rights reserved. DSUS/COD/0215/0271(2) 1/17

ICD-10-CM DIAGNOSIS CODING FOR HOSPITAL AND PHYSICIAN SERVICES

The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes entered on hospital and physician claims are important in conveying information about the patient’s condition to payers. All healthcare providers must report the principal diagnosis using the appropriate ICD-10-CM code, as well as any secondary diagnoses. Payers use this information to evaluate the medical necessity for the episode of care and the appropriateness of the treatment the patient received. Diagnosis codes should be reported to the highest level of specificity available – a code is invalid if it has not been coded to the full number of digits required for that code. Table 1 includes ICD-10-CM diagnosis codes commonly used to report neurovascular conditions: TABLE 1 ICD-10-CM Diagnosis Codes – Neurovascular Conditions ICD-10-CM Code1 Description (See current ICD-10-CM book for complete descriptions)

A52.05 Other cerebrovascular syphilis Syphilitic cerebral aneurysm (ruptured) (non-ruptured) Syphilitic cerebral thrombosis

I60.00 – I60.9

Nontraumatic subarachnoid hemorrhage Ruptured cerebral aneurysm Excludes: sequelae of subarachnoid hemorrhage (I69.0-) syphilitic ruptured cerebral aneurysm (A52.05) berry aneurysm, nonruptured (I67.1)

I61.0 – I61.9 Nontraumatic intracerebral hemorrhage Excludes: sequelae of intracerebral hemorrhage (I69.1-)

I62.1 Nontraumatic extradural hemorrhage Nontraumatic epidural hemorrhage

I62.00 – I62.03

Nontraumatic subdural hemorrhage Excludes: sequelae of intracranial hemorrhage (I69.2)

I62.9 Nontraumatic intracranial hemorrhage, unspecified I67.1 Cerebral aneurysm, nonruptured

Cerebral aneurysm NOS Cerebral arteriovenous fistula, acquired Internal carotid artery aneurysm, intracranial portion Internal carotid artery aneurysm, NOS Excludes: congenital cerebral aneurysm, nonruptured (Q28.-) ruptured cerebral aneurysm (I60.7)

I72.0 Aneurysm of carotid artery Aneurysm of common carotid artery Aneurysm of external carotid artery Aneurysm of internal carotid artery, extracranial portion Excludes1: aneurysm of internal carotid artery, intracranial portion (I67.1) aneurysm of internal carotid artery NOS (I67.1)

Q28.2

Arteriovenous malformation of cerebral vessels Arteriovenous malformation of brain NOS Congenital arteriovenous cerebral aneurysm (nonruptured)


TABLE 1 ICD-10-CM Diagnosis Codes – Neurovascular Conditions ICD-10-CM Code1 Description (See current ICD-10-CM book for complete descriptions)

Q28.3 Other malformations of cerebral vessels Congenital cerebral aneurysm (nonruptured) Congenital malformation of cerebral vessels NOS Developmental venous anomaly

HOSPITAL INPATIENT CODING AND PAYMENT

Medicare uses ICD-10-CM & PCS codes to identify diagnoses and procedures in the hospital inpatient setting. Hospitals must report the principal diagnosis using the appropriate ICD-10-CM code, as well as any secondary diagnoses – some of which may be considered CCs or MCCs for MS-DRG assignment. The principal diagnosis is defined in the Uniform Hospital Discharge Data Set (UHDDS) as “that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.” The circumstances of inpatient admission always govern the selection of principal diagnosis.2 For patient admissions involving procedures, hospitals must also report ICD-10-PCS procedure code(s) for the surgical and other procedures, up to six procedures on a claim. A minimum of one diagnosis code is required on all claims, and it is possible to report up to eighteen. Medicare may require additional clinical information specific to each patient to determine coverage and payment for the reported procedure. Medicare recognizes certain ICD-10-PCS procedure codes used in the inpatient setting to report neurovascular procedures. The following table lists some of the most commonly used codes for neurovascular diagnostic and therapeutic procedures: TABLE 2 Common ICD-10-PCS Procedure Codes – Neurovascular Procedures ICD-10-PCS Code1 Description (See current ICD-10-PCS book for complete descriptions) B34[3,4,5,6,7,8]ZZ[3,Z] Ultrasonography of Carotid Arteries B34RZZ[3,Z] Ultrasonography of Intracranial Arteries 03JY[0,3,4,X]ZZ Inspection of Upper Arteries 03L[G,H,J,K,L,M,N,P,Q,R,S,T]3DZ

Occlusion of Head & Neck Arteries, Percutaneous Approach

03C[G,H,J,K,L,M,N,P,Q,R,S,T]3ZZ

Extirpation of Head & Neck Arteries, Percutaneous Approach

03V[G,H,J,K,L,M,N,P,Q,R,S]3[B,C,D,Z]Z

Restriction of Head & Neck Arteries, Percutaneous Approach

B30[6,7,8][0,1,Y,Z]Z Plain Radiograph of Internal Carotid Arteries B31[6,7,8][0,1,Y]10 Fluoroscopy of Internal Carotid Arteries 3E053[0,1,2,3,4,6,7.F,G, H,K,N,P,R,T,X,V,W]

Percutaneous introduction of a therapeutic, diagnostic, nutritional, physiological, or prophylactic substance into peripheral artery


REVENUE CODES Revenue codes allow hospitals to categorize services provided by revenue center for cost reporting. For Medicare, revenue codes must be included for each service on a CMS 1450 (UB-04) claim form. Sample revenue codes that hospital facilities may use to track costs for services associated with neurovascular, nonsurgical procedures are listed in the following table: TABLE 3 Common Revenue Codes Revenue Code 3 Description 0278 Medical/Surgical Supplies and Devices – Other Implants 0323 Radiology - Diagnostic – Arteriography 0360 Operating Room Services - General Classification 0624 Medical/Surgical Supplies - FDA Investigational Device


HOSPITAL INPATIENT REIMBURSEMENT Medicare beneficiaries who are admitted into hospital inpatient settings typically have coverage through Medicare Part A. Medicare reimburses inpatient hospital services under the Inpatient Prospective Payment System (IPPS), which bases payment on Medicare Severity Diagnosis-Related Groups (MS-DRGs). The MS-DRG payment system groups similar diagnoses and procedures into a single payment level, and reimburses the hospital according to the extent of resources typically required to treat patients with similar diagnoses undergoing similar treatments. All services and supplies provided during the inpatient admission are bundled into a single MS-DRG reimbursement rate, regardless of the length of the inpatient stay, the intensity of treatment, or the number of procedures performed for the specific individual. Hospitals will receive one global MS-DRG payment rate per patient admission, and the MS-DRG assignment is primarily determined by the patient’s principal diagnosis and/or principal procedure performed.

COMPLICATIONS AND COMORBIDITIES (CCS) AND MAJOR COMPLICATIONS AND COMORBIDITIES (MCCS)

In 2007, Medicare revised the Inpatient Prospective Payment System to better reflect severity levels of inpatient treatments. Hospitals performing procedures for Medicare patients receive payment under the MS-DRG assignment and neurovascular MS-DRGs are distinguished between encounters with or without the presence of MCCs or CCs. MCCs better recognize hospital resource use based on secondary diagnoses. These conditions generally correspond to longer and more complicated inpatient stays due to a need for services such as intensive monitoring, expensive and technically complex procedures, and/or extensive nursing care. Secondary conditions documented in a patient’s medical record may impact the reimbursement a hospital receives. The following two tables provide common cardiovascular diagnosis codes, and diagnoses that are frequently comorbidities in neurovascular patients, which have been identified as CCs or MCCs and may, therefore, affect MS-DRG assignment.


TABLE 4 Partial List of ICD-10-CM Codes – Complications and Comorbidities (CC)4 ICD-10-CM Diagnosis Code1 Description (See current ICD-10-CM book for complete descriptions)

I10 Essential (primary) hypertension

I11.0, I11.9 Hypertensive heart disease with (I11.0) or without (I11.9) heart failure E87.0 Hyperosmolarity and hypernatremia I12.0, I12.9 Hypertensive chronic kidney disease with

A) stage 5 or end stage renal disease (I12.0) or B) stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney

disease (I12.9) I13.0, I13.10 Hypertensive heart and chronic kidney disease

A) without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease (I13.10)

B) with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease (I13.0)

I13.11, I13.2 Hypertensive heart and chronic kidney disease A) without heart failure, with stage 5 chronic kidney disease, or end stage renal disease

(I13.11) B) with heart failure and with stage 5 chronic kidney disease, or end stage renal

disease(I13.2) I20.0, I24.0, I24.1, I24.8, I24.9

Unstable angina (I20.0), Acute coronary thrombosis not resulting in myocardial infarction (I24.0), Dressler’s syndrome (I24.1), Other forms of acute ischemic heart disease (I24.8), Acute ischemic heart disease, unspecified (I24.9)

I27.0 Primary pulmonary hypertension I47.1, I49.2 Supraventricular tachycardia (I47.1), Junctional premature depolarization (I49.2) I47.0, I47.2 Re-entry ventricular arrhythmia (I47.0), Ventricular tachycardia (I47.2) I48.1, I48.3, I48.4, I48.92

Persistent atrial fibrillation (I48.1), Typical atrial flutter (I48.3), Atypical atrial flutter (I48.4), Unspecified atrial flutter (I48.92)

I50.1 Left ventricular failure I50.20, I50.22, I50.30, I50.32 I50.40, I50.42

Unspecified or chronic (congestive) systolic, diastolic, or combined systolic and diastolic heart failure

G45.0, G45.8 Vertebro-basilar artery syndrome (G45.0), Other transient cerebral ischemic attacks and related syndromes (G45.8)

G45.8, G45.9 Other transient cerebral ischemic attacks and related syndromes (G45.8), Transient cerebral ischemic attack, unspecified (G45.9)

I67.89 Other cerebrovascular disease I67.89 Other cerebrovascular disease I74.5, I74.8, I74.9 Embolism and thrombosis of iliac artery (I74.5), other artery (I74.8), or unspecified artery

(I74.9) I77.2 Rupture of artery J96.10, J96.11, J96.12

Chronic respiratory failure A) unspecified whether with hypoxia or hypercapnia (J96.10), B) with hypoxia (J96.11) C) with hypercapnia (96.12)

N18.4, N18.5 Chronic kidney disease, stage 4 (severe) (N18.4) or 5 (N18.5) N39.0 Urinary tract infection, site not specified R17 Unspecified jaundice


TABLE 4 Partial List of ICD-10-CM Codes – Complications and Comorbidities (CC)4 ICD-10-CM Diagnosis Code1 Description (See current ICD-10-CM book for complete descriptions)

T82.310A – T82.339

Mechanical complication of other vascular device, implant, and graft

T82.7XXA, T82.7XXD, T82.7XXS

Infection and inflammatory reaction due to other cardiac device, implant and graft

T82.8[1,2,3,4,5,6,9]8A

Other complications due to other vascular device, implant, and graft

Z68.1, Z68.41-Z65.45

Body Mass Index less than 19 (Z68.1), or 40 and over, adult

TABLE 5 Partial List of ICD-10-CM Codes – Major Complications & Comorbidities (MCC)5 ICD-10-CM Code1 Description (See current ICD-10-CM book for complete descriptions)

E08.00 – E08.11, E08.641, E09.00 – E09.11, E13.00 – E13.11, E13.641

Secondary diabetes mellitus with ketoacidosis, hyperosmolarity, or other coma

E10.10 – E10.11, E10.69, E11.00 – E11.01, 11.65, E11.69, E13.00– E13.12

Diabetes mellitus with ketoacidosis, hyperosmolarity, or other coma

I25.01 – I25.4 ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction I126.01 – I126.99 Pulmonary embolism with/without acute cor pulmonale I49.01, I49.02 Ventricular fibrillation (I49.01) or flutter (I49.02) I46.2 – I46.9 Cardiac arrest I50.21, I50.22 Acute (I50.21) or chronic (I50.22) systolic heart failure I50.31, I50.32 Acute (I50.31) or chronic (I50.32) diastolic heart failure I50.41, I50.43 Acute (I50.41) or chronic (I50.43) combined systolic and diastolic heart failure I63.02 - I63.29 Cerebral infarction due to occlusion and stenosis of precerebral arteries I71.00 – I71.9 Aortic aneurysm and dissection; thoracic, abdominal, or thoracoabdominal I77.71 – I77.79 Dissection of artery: carotid, iliac, renal, vertebral, or other artery L89.0[0,1,2][3,4], L89.1[0,1,2,3,4,5][3,4], L89.2[0,1,2][3,4], L89.3[0,1,2][3,4], L89.4[3,4], L89.5[0,1,2][3,4], L89.6[0,1,2][3,4], L89.8[1,9][3,4], L89.9[3,4]

Pressure ulcer, stage III or stage IV

R57.0 Cardiogenic shock


Table 6 below lists common MS-DRGs which may be assigned when conducting neurovascular procedures in the inpatient setting: TABLE 6 Common MS-DRGs for Neurovascular Procedures MS-DRG

Description 2017 Relative Weight6

2017 National Average Payment7

020 Intracranial vascular procedures with principal diagnosis of hemorrhage with MCC

9.7053 $52,825

021 Intracranial vascular procedures with principal diagnosis of hemorrhage with CC

7.2910 $39,684

022 Intracranial vascular procedures with principal diagnosis of hemorrhage without CC/MCC

4.6095 $25,089

023 Craniotomy with major device implant/acute complex CNS principal diagnosis with MCC or chemo implant

5.3762 $29,262

024 Craniotomy with major device implant/acute complex CNS principal diagnosis without MCC

4.0114 $21,834

025 Craniotomy with and endovascular intracranial procedures with MCC

4.2413 $23,085

026 Craniotomy and endovascular intracranial procedures with CC 2.9723 $16,178 027 Craniotomy and endovascular intracranial procedures without

CC/MCC 2.3761 $12,933


HUMANITARIAN USE DEVICE (HUD) AND HUMANITARIAN USE DEVICE EXEMPTION (HDE)

Certain types of aneurysms may be treated with devices that are considered to be humanitarian use devices (HUDs). HUDs are devices that help in conditions affecting a small number of persons. The Federal Food, Drug and Cosmetic Act defines a HUD as a device that is intended to benefit patients in the treatment and diagnosis of diseases or conditions that affect, or are manifested in, not more than 8,000 individuals in the United States per year.i

A Humanitarian Device Exemption (HDE) authorizes marketing of an HUD. HUDs that are granted an HDE can only be used in facilities that have an established institutional review board (IRB). An IRB is a committee whose function is to ensure the protection of the rights and welfare of the human subjects by reviewing potential research that will be conducted in the facility, and, must follow FDA regulations when studies of FDA regulated products are reviewed and approved.

Medicare covers HDEs if they are considered reasonable and necessary, and if all other applicable Medicare coverage requirements are fulfilled. Additionally, for Medicare patients, the hospital should contact the office of the Medical Director of Health Policy (or the department responsible for health technology assessments) at their Medicare Part A Contractor to secure approval. The process may involve providing details about the specific device (i.e., product description and Instructions for Use (IFU)). The clinical situation(s) in which it will be used, and IRB approval documents once secured. In addition, the Medicare Contractor may require:

• The Humanitarian Use Device Number • A copy of the FDA approval letter • A copy of the physician training certificate for the device, if necessary • ICD-10-CM and CPT codes that will be used to bill for the procedure

All claims for this procedure must not only be coded appropriately, but must include adequate supportive documentation in the patient’s medical record. Documentation should reflect each patient’s clinical condition and medical justification for the procedure. The Instructions for Use (IFU) includes a complete description of indications and contraindications for each medical device used in percutaneous embolization of an intracranial aneurysm.

An approved HDE authorizes marketing of the HUD. However, an HUD may only be used in facilities that have established a local institutional review board (IRB) to supervise clinical testing of devices and after an IRB has approved the use of the device to treat or diagnose the specific disease. The labeling for an HUD must state that the device is a humanitarian use device and that, although the device is authorized by Federal Law, the effectiveness of the device for the specific indication has not been demonstrated.

I”On December 13, 2016, Section 3052 of the 21st Century Cures Act (Pub. L. No. 114-255) changed the population estimate required to qualify for Humanitarian Use Device (HUD) designation from "fewer than 4,000" and "not more than 8,000." Accordingly, a HUD is now defined as a medical device intended to benefit patients in the treatment or diagnosis of a disease or condition that affects or is manifested in not more than 8,000 individuals in the United States per year. The full text of the 21st Century Cures Act is available at:https://www.congress.gov/114/bills/hr34/BILLS-114hr34eah.pdf. Source: http://www.fda.gov/ForIndustry/DevelopingProductsforRareDiseasesConditions/DesignatingHumanitarianUseDevicesHUDS/default.htm


HOSPITAL INPATIENT CASE EXAMPLE – VASCULAR RECONSTRUCTION DEVICE

Aneurysm Repair Using Vascular Reconstruction Devicei

The patient has been referred for a suspected aneurysm located in the anterior circulation and has acute systolic heart failure. Arteriography is performed on cerebral arteries and reveals a wide neck aneurysm of 9.8 mm, unruptured. Endovascular repair is performed by the placement of the vascular reconstruction device (VRD). The VRD facilitates and helps to secure the placement of coils that are used to permanently occlude the aneurysm. The patient tolerates the procedures well. ICD-10-CM Diagnosis Codes and Descriptions1

ICD-10-PCS Procedure Codes and Descriptions1

MS-DRG Code and Description

Relative Weight6 2017 National Average Payment7

I67.1

Cerebral aneurysm, nonruptured

I50.21

Acute systolic heart failure

03VG3DZ

Restriction of Intracranial Artery with Intraluminal Device, Percutaneous Approach

B31GYZZ

Fluoroscopy of Bilateral Vertebral Arteries using Other Contrast

025

Craniotomy and endovascular intracranial procedures with MCC

4.2413

$23,085

An approved HDE authorized marketing of the HUD. However, an HUD may only be used in facilities that have established a local institutional review board (IRB) to supervise clinical testing of devices and after an IRB has approved the use of the device to treat or diagnose the specific disease. The labeling for an HUD must state that the device is a humanitarian use device and that, although the device is authorized by Federal Law, the effectiveness of the device for the specific indication has not been demonstrated. I Vascular Reconstruction Devices are humanitarian use devices (HUDs) and are provided under a humanitarian device exemption (HDE) granted by the FDA.


HOSPITAL OUTPATIENT CODING AND PAYMENT Medicare beneficiaries who receive services in the hospital outpatient setting typically have coverage through Medicare Part B. Medicare reimburses outpatient hospital services under the Outpatient Prospective Payment System (OPPS), which bases payment on Ambulatory Payment Classification (APC). Current Procedural Terminology (CPT®)8 and Healthcare Common Procedure Coding System (HCPCS)9 codes map to APCs, which assign a Medicare hospital outpatient payment rate for the service. Depending upon the services provided, hospitals may receive payment for more than one APC per patient encounter.

STATUS INDICATORS

OPPS payment status indicators (SIs) indicate whether a service represented by an HCPCS or CPT code is payable under the OPPS or another payment system, and also whether particular OPPS policies apply to the code (eg, multiple procedure discounts or other payment reductions, full separate payment, packaged with another procedure, or restricted to inpatient setting). A total of twenty-six (26) SIs are listed in the calendar year 2017 OPPS Final Rule.

HOSPITAL SERVICES CODING

Coding for the interventional neuroradiology service is changing rapidly and requires accounting for each significant element of the entire procedure. In some circumstances, component coding is appropriate and in others comprehensive codes are used. Appropriate insurance payment for the spectrum of outpatient hospital services involved with the treatment of an endovascular aneurysm requires careful documentation in the medical chart and accurate coding of each discrete procedure or consultation. Below are the components that must be documented in the procedural record and identified for insurance billing purposes; which depending on the procedure may have its own CPT Procedure code:

• Diagnostic catheterizations • Diagnostic angiography • Endovascular occlusion • Angiographic radiologic services • Follow-up (post-occlusion) angiography

As applicable, document and bill, when appropriate, for:

• Transcatheter infusions (thrombolytic or nonthrombolytic) and associated radiologic services


HOSPITAL OUTPATIENT SERVICES COMMON CODING AND REIMBURSMENT

Current Procedural Terminology (CPT®) is copyright 2016 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. Applicable FARS/DFARS restrictions apply to government use. CPT® is a registered trademark of the American Medical Association.

CPT and Description Status Indicator

Item / Code / Service

2017 OPPS National Average Payment10

Temporary Balloon Occlusion 61623 Endovascular temporary balloon arterial occlusion, head or neck (extracranial/intracranial), including selective catheterization of vessel to be occluded, positioning and inflation of occlusion balloon, concomitant neurological monitoring, and radiologic supervision and interpretation of all angiography required for balloon occlusion and to exclude vascular injury post occlusion

J1

Hospital Part B services paid through a comprehensive APC

$9,752.43

Transcatheter Permanent Occlusion 61624 Transcatheter permanent occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method; central nervous system (intracranial, spinal cord)

C Inpatient Procedure

Not paid under OPPS. Admit patient. Bill as inpatient.

61626 Transcatheter permanent occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method; noncentral nervous system, head or neck (extracranial, brachiocephalic branch)

J1

Hospital Part B services paid through a comprehensive APC

$9,752.43

Transcatheter Infusion Therapy

37211 Transcatheter therapy arterial infusion for thrombolysis other than coronary or intracranial, any method, including radiological supervision and interpretation, initial treatment day

T

Significant Procedure, Multiple Procedure Reduction Applies

$3,924.28


HOSPITAL OUTPATIENT SERVICES COMMON CODING AND REIMBURSMENT (CONT)




Transcatheter Infusion Therapy (cont.)

37212 Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day

T


$2,360.60

37213 Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection position change, or exchange, when performed;

T


$684.13

37214 Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed; cessation of thrombolysis including removal or catheter and vessel closure by any method

T


$684.13

Cerebral endovascular therapeutic Interventions 61645 Percutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis, intracranial, any method, including diagnostic angiography, fluoroscopic guidance, catheter placement, and intraprocedural pharmacological thrombolytic injection(s)



61650 Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; initial vascular territory








61651 Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; each additional vascular territory (List separately in addition to code for primary procedure)



Vascular Catheterization

36215 Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family

N Item or services package into APC rates

Paid under OPPS; payment packaged into payment for other services. No separate payment.

36216 Selective catheter placement, arterial system; initial second order, thoracic or brachiocephalic branch, within a vascular family



36217 Selective catheter placement, arterial system; initial third order or more selective thoracic or brachiocephalic branch, within a vascular family

N Item or services packaged into APC rates


36218 Selective catheter placement, arterial system; additional second order, third order and beyond, thoracic or brachiocephalic branch, within a vascular family (list in addition to code for initial second or third order vessel as appropriate)

N Item or services packaged into APC rates


36221 Non-selective catheter placement, thoracic aorta, with angiography of the extracranial carotid, vertebral, and/or intracranial vessels, unilateral or bilateral, and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

Q2 T-Packaged Code

Paid under OPPS; packaged payment if billed on same date as a service with an SI of T






Vascular Catheterization (cont.) 36222 Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral extracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

Q2 T-Packaged Code


36223 Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography or the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed

Q2 T-Packaged Code


36224 Selective catheter placement, internal carotid artery, unilateral, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed

Q2 T-Packaged Code


36225 Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

Q2 T-Packaged Code


36226 Selective catheter placement, vertebral artery. Unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

Q2 T-Packaged Code







Vascular Catheterization (cont.) 36227 Selective catheter placement, external carotid artery, unilateral, with angiography of the ipsilateral external carotid circulation and all associated radiological supervision and interpretation (list separately in addition to code for primary procedure)

N Item or service package into APC rates


36228 Selective catheter placement, each intracranial branch of the internal carotid or vertebral arteries, unilateral, with angiography of the selected vessel circulation and all associated radiological supervision and interpretation (eg, middle cerebral artery, posterior inferior cerebellar artery) (list separately in addition to code for primary procedure)

N Item or service packaged into APC rates


Radiologic Services 75774 Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation (list separately in addition to code for procedure)



75894 Transcatheter therapy, embolization, any method, radiological supervision and interpretation



Follow-Up Angiography (Post-Occlusion or Other Transcatheter Therapy)

75898 Angiography through existing catheter for follow-up study for transcatheter therapy, embolization, or infusion, other than for thrombolysis

Q2 T-Packaged Code


A complete list of SIs can be found in Addendum D1 of the CY 2017 OPPS Final Rule10


PHYSICIAN PROFESSIONAL CODING AND PAYMENT Medicare Part B pays for physician services based upon the Medicare Physician Fee Schedule (MPFS). Physician and other clinicians bill for their services using Current Procedural Terminology (CPT®)8 and Healthcare Common Procedure Coding System (HCPCS)9 codes. The Fee schedule amounts are calculated according to the Resource-Based Relative Value Scale (RBRVS), which determines payment according to the relative resource costs needed to provide each service, quantified as relative value units (RVUs). The relative value for each code is divided into three components: physician work, practice expense, and professional liability insurance. Each of these components is modified by a geographic adjustment (GPCI) to reflect the variances in costs for differing localities. Payments are calculated by multiplying the geographically adjusted total relative values (resource costs) of service by a conversion factor (CF) which is defined each year in the Final Rule. [(Work RVU x Work GPCI) + (PE RVU x PE GPCI) + (MP RVU x MP GPCI)] x CF = Payment The 2017 conversion factor is $35.888711. PHYSICIAN SERVICES CODING Coding for the interventional neuroradiology service is changing rapidly and requires accounting for each element of the entire procedure. In some circumstances, component coding is appropriate and in other comprehensive codes are used. Appropriate insurance payment for the spectrum of physician services invoiced with the treatment of endovascular aneurysms requires careful documentation in the medical chart and accurate coding each discrete procedure or consultation. Below are the components that must be documented in the procedural record and identified for insurance billing purposes, which depending on the procedure may have its own CPT Procedure code:

• Diagnostic catheterizations

• Diagnostic angiography

• Endovascular occlusion

• Angiographic radiological supervision and interpretation (S&I)

• Follow-up (post-occlusion) angiography As applicable, document and bill for when appropriate:

• Transcatheter infusions (thrombolytic or nonthrombolytic) and associated radiological S&I

• Related evaluation and management (E&M) services also apply as supported by medical necessity


PHYSICIAN SERVICES COMMON CODNG AND REIMBURSEMENT: MEDICARE PHYSICIAN FEE SCHEDULE RELATIVE VALUE UNITS (RVUS) Current Procedural Terminology (CPT®) is copyright 2016 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. Applicable FARS/DFARS restrictions apply to government use. CPT® is a registered trademark of the American Medical Association.

CPT and Description 2017 RVUs11

2017 Estimated Medicare National Average Payment11

Temporary Balloon Occlusion 61623 Endovascular temporary balloon arterial occlusion, head or neck (extracranial/intracranial), including selective catheterization of vessel to be occluded, positioning and inflation of occlusion balloon, concomitant neurological monitoring, and radiologic supervision and interpretation of all angiography required for balloon occlusion and to exclude vascular injury post occlusion

16.62 $596.47

Transcatheter Permanent Occlusion 61624 Transcatheter permanent occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation, percutaneous, any method; central nervous system (intracranial, spinal cord)

33.43 $1,199.76

61626 Transcatheter permanent occlusion or embolization (eg, tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method; noncentral nervous system, head or neck (extracranial, brachiocephalic branch)

25.03 $898.29

Transcatheter Infusion Therapy 37211 Transcatheter therapy, arterial infusion for thrombolysis other than coronary, or intracranial,any method, including radiological supervision and interpretation , initial treatment day

11.26 $404.11

37212 Transcatheter therapy, venous infusion for thrombolysis, and method, including radiological supervision and interpretation, initial treatment day

9.82 $352.43


PHYSICIAN SERVICES COMMON CODNG AND REIMBURSEMENT: MEDICARE PHYSICIAN FEE SCHEDULE RELATIVE VALUE UNITS (RVUS) (CONT)



Transcatheter Infusion Therapy (cont.) 37213 Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change or exchange, when performed;

6.83 $245.12

37214 Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed; cessation of thrombolysis including removal of catheter and vessel closure by any method

3.59 $128.84

Cerebral endovascular therapeutic Interventions 61645 Percutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis, intracranial, any method, including diagnostic angiography, fluoroscopic guidance, catheter placement, and intraprocedural pharmacological thrombolytic injection(s)

22.77 $817.19

61650 Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; initial vascular territory

15.57 $558.79

61651 Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; each additional vascular territory (List separately in addition to code for primary procedure)

6.62 $237.58

Vascular Catheterization 36215 Selective catheter placement, arterial system; each first order, thoracic or brachiocephalic branch, within a vascular family

6.81 $244.40

36216 Selective catheter placement, arterial system; initial second order, thoracic or brachiocephalic branch, within a vascular family

7.90 $283.52





36217 Selective catheter placement, arterial system; initial third order, or more selective thoracic or brachiocephalic branch, with in a vascular family

9.40 $337.35

36218 Selective catheter placement, arterial system; additional second order, third order and beyond, thoracic or brachiocephalic branch, within a vascular family (list in addition to code for initial second or third order vessel as appropriate)

1.51 $54.19

36221 Non-Selective catheter placement, thoracic aorta, with angiography of the extracranial carotid, vertebral, and/or intracranial vessels, unilateral or bilateral, and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed.

5.88 $211.03

36222 Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral extracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

8.22 $295.01

36223 Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, incudes angiography of the extracranial carotid and cervicocerebral arch, when performed

9.08 $325.87

36224 Selective catheter placement, internal carotid artery, unilateral, with angiography of the ipsilateral intracranial carotid circulation and al associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed

10.32 $370.37

36225 Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

9.04 $324.43





Vascular Catheterization (cont.) 36226 Selective catheter placement, external carotid artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

10.18 $365.35

36227 Selective catheter placement, external carotid artery, unilateral, with angiography of the ipsilateral external carotid circulation and all associated radiological supervision and interpretation (list separately in addition to code for primary procedure)

3.38 $121.30

36228 Selective catheter placement, each intracranial branch of the internal carotid or vertebral arteries, unilateral, with angiography of the selected vessel circulation and all associated radiological supervision and interpretation (eg, middle cerebral artery, posterior inferior cerebellar artery) (list separately in addition to code for primary procedure)

6.92 $248.35

Radiologic Services Additional Vessels 75774 -26 Angiography selective, each additional vessel studied after basic examination, radiological S&I (list separately in addition to code for primary procedure)

0.5 $17.94

75894 -26 Transcatheter therapy, embolization, any method, radiological supervision and interpretation

1.94 $69.62

Follow-Up Angiography (Post-Occlusion or Other Transcatheter Therapy)

75898-26 X (# of units) Angiography through existing catheter for follow-up study for transcatheter therapy, embolization, or infusion, other than for thrombolysis

2.46 $88.29


PHYSICIAN PAYMENT EXAMPLES11 Example 1 Treatment of a Wide Neck Aneurysm Using a Vascular Reconstruction Devicei and Coils A previous diagnostic cerebral angiogram confirmed this patient has an intracranial saccular basilar aneurysm (8 mm in size), which has been determined to have a wide neck suitable for use with a vascular reconstruction device (VRD) followed by percutaneous placement of detachable coils. Left common femoral access is established and the catheter is advanced to the right basilar artery. Heparin is administered throughout the procedure. A VRD is deployed and through its interstices, micro-coils of varying dimensions are introduced through a micro-catheter into the basilar artery aneurysm. At the conclusion of the procedure, a follow-up angiogram confirms total occlusion of the aneurysm.

CPT and Description

2017 Estimated Medicare National Average Payment

Multiple Procedure Discount

2017 Estimated Medicare Total Payment

61624 Transcatheter permanent occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method; central nervous system (intracranial, spinal cord)

$1,199.76 None $1,199.76

36226 Selective catheter placement, vertebral artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

$365.35 50% $182.68

75894-26 Transcatheter therapy, embolization, any method, radiological supervision and interpretation

$69.62 None $69.62

75898-2612 Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis

$88.29 None $88.29

Total Estimated Payment $1,540.35

An approved HDE authorizes marketing of the HUD. However, an HUD may only be used in facilities that have established a local institutional review board (IRB) to supervise clinical testing of devices and after an IRB has approved the use of the device to treat or diagnose the specific disease. The labeling for an HUD must state that the device is a humanitarian use device and that, although the device is authorized by Federal Law, the effectiveness of the device for the specific indication has not been demonstrated. I Vascular Reconstruction Devices are humanitarian use devices (HUDs) and are provided under a humanitarian device exemption (HDE) granted by the FDA.


PHYSICIAN PAYMENT EXAMPLES11

Example 2 Cerebral AVM Occlusion Using Liquid Embolic System

The right common femoral artery is punctured under radiological supervision for access into the left and right vertebral arteries. Radiological imaging from the proximal vertebral indicates that the distal intradural left vertebral artery is normal and the catheter is repositioned. However, there is a reflux of contrast into the distal portion of the right vertebral artery and opacification of the right side posterior fossa indicates an arterial venous malformation (AVM). Under radiological supervision, a micro-catheter was placed in the right posterior fossa AVM through the large artery originating from the right vertebral artery just proximal to the vertebrobasilar junction. Use of the liquid embolic system is indicated for a desired presurgical devascularization. The glue was mixed with ethiodized oil and tantalum powder and injected through the micro-catheter. A follow-up angiogram demonstrated a significant decrease in the size of the arterial venous malformation to a residual of 2 by 2.5 cm receiving its blood supply predominately from a large arterial branch form the distal right vertebral artery. No evidence of missing branches throughout the posterior fossa.

CPT and Description

2017 Estimated Medicare National Average Payment

Multiple Procedure Discount

2017 Estimated Medicare Total Payment

6162413 Transcatheter permanent occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method; central nervous system (intracranial, spinal cord)

$1,199.76 None $1,199.76

36226-50 Selective catheter placement, vertebral artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed

$365.35

50% of 150% (billed for bilateral)

$274.01

75894-26 Transcatheter therapy, embolization, any method, radiological supervision and interpretation

$69.62 None $69.62

75898-26 Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis

$88.29 None $88.29

Total Estimated Payment $1,631.68


MODIFIERS When submitting a particular physician service on a claim, it is sometimes necessary to include modifiers with the CPT code. A modifier provides a way to indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition of code. Modifiers also enable healthcare professional to effectively respond to payment policy requirements established by other entities. Some modifiers apply to either physician or hospital outpatient claims; some may only be relevant for one or the other. A complete list of modifiers is included in the HCPCS9

and CPT8 coding books. In the table below is a list of some of the CPT and HCPCS modifiers which may be common to procedures associated with Codman Neuro products. SAMPLE CPT/HCPCS MODIFIERS Modifier Description 22 Increased Procedural Service: When the work required to provide a service is

substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient’s condition, physical and mental effort required). Note: This modifier should not be appended to an E/M service.

26 Professional Component: Certain procedures are a combination of a physician or other qualified health care professional component and a technical component. When the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.

50 Bilateral Procedures: Unless otherwise identified in the listings, bilateral procedures that are performed at the same operative session should be identified by adding modifier 50 to the appropriate five digit code.

51 Multiple Procedures: When multiple procedures, other than E/M services, Physical Medicine and Rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. The additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). Note: This modifier should not be appended to designated “add-on” codes (see Appendix D of the current CPT Manual).

59 Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate it should be used rather than modifier 59. Only if no more descriptive modifier is available and the use of the modifier 59 best explains the circumstances should modifier 59 be used. Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.


DOCUMENTATION Medicare and other payers may request additional documentation to support the medical necessity of a particular procedure. This documentation may play a significant role in any review of a claim that a carrier might conduct. The clinical documentation provided should describe why the procedure was performed, what specifically was done, and the expected treatment outcome or benefit to be gained from this procedure. Any report or cover letter provided to Medicare and other payers should be clear and direct. If necessary, additional documentation in the form of chart notes, patient medical history, etc. can be submitted with a claim to provide additional support or clarification.


CODMAN NEURO PRODUCTS AND C CODES (PASS-THROUGH CODES) Many hospitals look to manufacturers for coding advice specific to that manufacturer’s products. This is especially true when it comes to “product codes” also known as C Codes. In general, most Codman Neuro products are used in the inpatient hospital setting and do not have C Codes. However, because similar products, such as a guide catheter, are used in the outpatient hospital setting, there are a few Codman Neuro products that do have C Codes. The following information is a list of C codes that are associated with some Codman Neuro products. These codes are generic in description and not brand-name specific and may be used for any neurovascular product matching the description.

C1887 Catheter, guiding (may include infusion/perfusion capability)

C1751 Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)

C1769 Guide wire

C1874 Stent, coated/covered, with delivery system For additional information regarding C Codes, refer to the “List of Device Category Codes for Present or Previous Pass-Through Payment and Related Definitions” that can be obtained from www.cms.gov. Contact the Codman Neuro Reimbursement Hotline at 800-609-1108 for information regarding C Codes for Codman Neuro products.

http://www.cms.gov/


REFERENCES 1 2017 ICD-10-CM & PCS Code Set https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-CM-

and-GEMs.html & https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-PCS-and-GEMs.html 2 The UHDDS definitions are used by acute care short-term hospitals to report inpatient data elements in

a standardized manner. These data elements and their definitions can be found in the July 31, 1985, Federal Register (Vol. 50, No. 147), pp. 31038 - 40

3 Medicare Claims Processing Manual, Chapter 25 – Completing and Processing the Form CMS-1450 Data Set, §75.4 – Form Locator 42.

4 Centers for Medicare and Medicaid Services, FY17 Final Rule and Correction Notice Tables, Table 6J Complete CC List; https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2017-IPPS-Final-Rule-Home-Page-Items/FY2017-IPPS-Final-Rule-Regulations.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending

5 Centers for Medicare and Medicaid Services, FY17 Final Rule and Correction Notice Tables, Table 6I Complete Major CC List; https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2017-IPPS-Final-Rule-Home-Page-Items/FY2017-IPPS-Final-Rule-Regulations.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending

6 Centers for Medicare and Medicaid Services, FY17 Final Rule and Correction Notice Tables, Table 5 (Final Rule and Correction Notice); https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2017-IPPS-Final-Rule-Home-Page-Items/FY2017-IPPS-Final-Rule-Regulations.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending

7 Inpatient national reimbursement levels are based on the Medicare Inpatient Prospective System as published in the 08/22/16 Federal Register (Medicare Program: Changes to the Hospital Inpatient Prospective Payment Systems . . . Fiscal Year 2017 Rates; Final Rule), the 10/5/16 and 10/31/16 Federal Register Correction Notices. National payment estimates are determined using the book DRG Expert, 2017 Edition, Appendix D, “The national average payment for each DRG is calculated by multiplying each specific MS-DRG relative weight by the national average hospital Medicare base rate. The national average hospital Medicare base rate is the average of the sum of the full update labor-related and nonlabor-related amounts published in the FY 2017 Correction Notice dated October 3, 2016, Table 1A. National Adjusted Operating Standardized Amounts; Labor/Nonlabor (if wage index greater than 1) and Table 1B. National Adjusted Operating Standardized Amounts; Labor/Nonlabor (if wage index less than or equal to 1). This information is provided as a benchmark reference only. There is no official publication of the average hospital base rate; therefore the national average payments provided in this table are approximate.”

8 Current Procedural Terminology (CPT 2017), Professional Edition, American Medical Association, ©2016. CPT is a registered trademark of the American Medical Association.

9 Healthcare Common Procedure Coding System (HCPCS) Level II National Codes are developed by CMS and available in book form from several different publishers.

10 Outpatient Hospital national reimbursement levels are based on the Medicare Outpatient Prospective Payment System and Ambulatory Surgery Center Payment System as published the November 14, 2016 Federal Register (Medicare Program: Hospital Outpatient Prospective Payment System and Ambulatory Surgical Payment System . . . Final Rule) and January 2017 Addedum updates.

11 Physician national reimbursement levels are based on the Medicare Physician Fee Schedule as published in the Medicare Program: Revisions to Payment Policies, etc; Final Rule. Federal Register, November 15, 2016, the Correction Notice dated November 11, 2016, and the January 9, 2016 RVUA file update. .

https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-CM-and-GEMs.html

https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-CM-and-GEMs.html

https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-PCS-and-GEMs.html

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2017-IPPS-Final-Rule-Home-Page-Items/FY2017-IPPS-Final-Rule-Regulations.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending







12 This code may be reported for each intraprocedural angiogram performed during central nervous

system embolizations, as well as for completion. Documentation would need to include the number of intraoperative angiograms performed. Review correct coding edits carefully.

13 Embolization procedures should only be reported once per operative field, even if several vessels are occluded.


Notes


Notes

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©DePuy Synthes 2017. All rights reserved. DSUS/COD/0215/0271(2) 1/17 The third party trademarks used herein are the trademarks of their respective owners.

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