2016 HEMODIALYSIS CATHETERS CODING AND REIMBURSEMENT GUIDE
Contents Overview of Central Venous Access Catheters for Hemodialysis
2
Procedures Using Hemodialysis Catheters
2
Physician Reimbursement for Hemodialysis Catheters
3
Hospital Outpatient Reimbursement for Hemodialysis Catheters Under Ambulatory Payment Classification (APC)
8
Ambulatory Surgery Center Payment for Hemodialysis Catheters
10
Hospital Inpatient DRGs for Hemodialysis Catheters
12
Common Diagnosis (Dx) Codes for Hemodialysis Catheters
13
Overview of Central Venous Access Catheters for Hemodialysis Since 1983, Medicare has paid dialysis facilities a predetermined, bundled rate intended to cover a specific bundle of services provided to patients in a given dialysis treatment. However, payment for procedures involving the hemodialysis catheter are separately payable outside the outpatient dialysis services bundle. Covidien produces a variety of catheters used to perform hemodialysis in patients with renal failure.1 These catheters are Central Venous Access Catheters, intended to be inserted via a central vein – typically, the jugular, subclavian, brachiocephalic or femoral veins. Once inserted, the internal tip of the catheter is advanced into the superior or inferior vena cava or into the right atrium of the heart. To be used for hemodialysis, the catheters have two lumens with two caps that hang outside the body.
Procedures Using Hemodialysis Catheters Current Procedural Technology (CPT)® codes are used by physicians for all sites of service, and by hospitals and Ambulatory Surgical Centers (ASC) for outpatient procedures. Summary of Codes: There are seven different types of procedures that can be performed using central venous access devices: (1) Insert; (2) Replace; (3) Remove; (4) Repair; (5) Remove Obstruction; (6) Reposition; or (7) Evaluate Catheter Each procedure has a specific set of CPT® codes as shown in the table below. Different CPT® codes are used depending on several factors:2 Non-Tunneled (acute, short term use) or Tunneled (chronic, long-term use) Use of Single Catheter vs. Two-Catheter System Patient’s Age (< 5, age 5 and older) CATHETER TYPE
Non-tunneled
Tunneled
COVIDIEN PRODUCT
Acute
Chronic
2 Catheter TandemSystem, Tunneled Cath™
2
INSERT
REPLACE (VIA SAME ACCESS)
36555 (5years)
36580
36557 (5 years)
36581
36565 (any age)
36581 (x2)
REMOVE
REPAIR
REPOSITION
EVALUATE
Declotting: 36593
E/M code 36575 36589
36589 (x2)
REMOVE OBSTRUCTION
36575 (x2)
Outside Catheter: 36597 36595, 75901 & & 36010-36012 76000 Inside Catheter: 36596, 79502 & 36010-36012
36598
Physician Reimbursement for Hemodialysis Catheters National Average Medicare reimbursement for physician services related to Covidien hemodialysis catheters is provided in this section. These amounts will vary based on the physician’s specific Medicare locality. Reimbursement is subject to the following payment rules: Global Days During a global period, services related to the initial dialysis catheter procedure are not separately payable, as follows: 0 day global: related services same day as the procedure are not separately paid; services on following days are paid separately 10 day global: related services on the same day and for 10 days after are not separately paid Multiple Procedure Discounting When two or more procedures are performed during the same encounter, the higher-valued codes pay at 100% and other codes pay at 50% of the rate. Discounting applies to codes marked “Y”. Codes marked “N” always pay at 100%. Non-Facility and Facility Payment Codes have different payments depending on the setting in which the procedure was performed. Non-Facility refers to physician payment when procedures are performed in the office setting Facility refers to physician payment when procedures are performed in a hospital or an ASC Generally, Non-Facility payments are higher since the physician incurs all costs in the office whereas the hospital/ASC incurs costs in the Facility.
Medicare National Average Payments for Physicians3 Insertion of Catheter: Different CPT® codes are assigned depending on several factors: whether the catheter is non-tunneled (ie. for acute, shortterm use) or tunneled (ie. for chronic, long-term use); whether the catheter is centrally inserted or peripherally inserted (as noted, Covidien dialysis catheters are centrally-inserted); the patient’s age; and whether the system uses two catheters.
PROCEDURE
Catheter Insertion
3
GLOBAL DAYS
CODE AND DESCRIPTION
MULT PROC DISCOUNTING
NONFACILITY
FACILITY
CY2016 PAYMENT
CY2016 PAYMENT
36555, Insertion of non-tunneled centrally inserted central venous catheter, younger than 5 years of age
0
N
$262
$122
36556, Insertion of non-tunneled centrally inserted central venous catheter, age 5 years or older
0
N
$238
$124
36557, Insertion of tunneled centrally inserted central venous catheter, younger than 5 years of age
10
Y
$1,029
$341
36558, Insertion of tunneled centrally inserted central venous catheter, age 5 years or older
10
Y
$799
$287
36565, Insertion of tunneled centrally inserted central venous access device, requiring 2 catheters via 2 separate access sites, without subcutaneous port or pump (e.g. Tesio type catheter)
10
Y
$995
$364
Medicare National Average Payments for Physicians3 Replacement of Catheter4 Via Separate Venous Access: If replacement involves removing an existing dialysis catheter and inserting a new dialysis catheter via separate venous access, two codes may be assigned: (1) insertion of the new catheter (see Insertion Table above), and (2) removal of the old catheter (see Removal Table below). Both codes can be billed together and no modifier is required. Via Same Venous Access: Codes below are assigned when replacement involves removing the existing dialysis catheter and inserting the new dialysis catheter through the same venous access site, eg. over-the-wire. Codes differ depending on whether the catheter is non-tunneled or tunneled.
PROCEDURE
Catheter Replacement, Same Venous Access
CODE AND DESCRIPTION
GLOBAL DAYS
MULT PROC DISCOUNTING
NONFACILITY
FACILITY
CY2016 PAYMENT
CY2016 PAYMENT
36580, Replacement, complete, of a non-tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access
0
N
$219
$69
36581, Replacement, complete, of a tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access
10
Y
$785
$204
Removal of Catheter Dialysis catheters are removed both during replacement, and also when a patient receiving acute, short-term therapy no longer requires dialysis. Non-tunneled catheters are known to have been removed by health care practitioners without surgery and there is no procedure code for this. An E&M office visit code can be billed as appropriate for the visit during which the removal took place. Removal of tunneled catheters, however, requires surgical dissection to release the catheter.
PROCEDURE
Catheter Removal
4
CODE AND DESCRIPTION
GLOBAL DAYS
MULT PROC DISCOUNTING
NONFACILITY
FACILITY
CY2016 PAYMENT
CY2016 PAYMENT
No code for removal of non-tunneled catheter
Payable under E/M code for visit, as applicable
36589, Removal of tunneled central venous catheter, without subcutaneous port or pump
10
Y
$169
$142
Medicare National Average Payments for Physicians3 Imaging Guidance for Insertion, Replacement and Removal Two additional codes can be billed for imaging guidance. These codes must be billed with either a catheter insertion, replacement, or removal code. The code depends on the type of imaging used. If both ultrasound guidance and fluoroscopic guidance are performed, both 76937 and 77001 can be assigned together with the dialysis catheter code.
PROCEDURE
Imaging Guidance
CODE AND DESCRIPTION
GLOBAL DAYS
MULT PROC DISCOUNTING
NONFACILITY
FACILITY
CY2016 PAYMENT
CY2016 PAYMENT
+76937, Ultrasound guidance for vascular access requiring US evaluation of potential access sites, documentation of selected vessel patency, concurrent real-time US visualization of vascular needle entry, with permanent recording & reporting
NA
N
$31
-
+76937-26, US guidance for vascular access, professional component
NA
N
-
$14
+77001, Fluoroscopic guidance for central venous access device placement, replacement, or removal (includes fluoroscopic guidance for vascular access & catheter manipulation, any necessary contrast injections through access site or catheter w/related venography, radiologic S&I and interpretation and radiographic documentation of final catheter position)
NA
N
$70
-
+77001-26, Fluoroscopic guidance, CVAD, professional component
NA
N
-
$19
* In the office, if the physician owns the equipment, radiology codes are billed without modifiers and the physician receives payment for both technical & professional components. In the facility, the hospital or ASC owns the equipment and the physician bills with modifier -26 to receive payment for the professional component only.
Repair of Catheter Some catheters can be repaired, for example by replacing a damaged segment or component. There is just one code for repair. For repair of a two catheter system, bill the procedure with frequency of “2” if both catheters are repaired.
PROCEDURE
Catheter Repair
5
CODE AND DESCRIPTION
36575, Repair of tunneled or non-tunneled central venous access catheter, without subcutaneous port or pump, central or peripheral insertion site
GLOBAL DAYS
0
MULT PROC DISCOUNTING
Y
NONFACILITY
FACILITY
CY2016 PAYMENT
CY2016 PAYMENT
$170
$36
Medicare National Average Payments for Physicians3 Removal of Obstruction from Catheter There are three basic ways to remove clots and thrombus, fibrin sheaths and other obstructive material from dialysis catheters: (1) declotting by injection, (2) removing external obstruction, or (3) removing internal obstruction.
PROCEDURE
GLOBAL DAYS
CODE AND DESCRIPTION
MULT PROC DISCOUNTING
NONFACILITY
FACILITY
CY2016 PAYMENT
CY2016 PAYMENT
Declotting catheter by injecting thrombolytic agent (e.g. Urokinase or tPA) into the catheter 36593, Declotting by thrombolytic agent of implanted vascular access device or catheter
NA
N
$31
-
Note: Code 36593 is not payable to the physician when performed in a hospital or ambulatory surgery center, because the service is typically performed by a facility-employed nurse. Removing obstruction from around the outside of catheter (e.g. stripping a fibrin sheath off a catheter with a snare) Three codes are needed to describe the procedure: (1) 36595 to remove obstruction; (2) 75901 for associated imaging; and (3) 36010-36012,depending on the vein, for placing the snare.
Removal of Obstruction from Catheter
36595, Mechanical removal of pericatheter obstructive material (eg. fibrin sheath) from CVAD via separate venous access
0
Y
$597
$191
75901, Mechanical removal of pericatheter obstructive material (eg. fibrin sheath) from central venous access device via separate venous access, radiological supervision and interpretation
NA
N
$179
-
*75901-26, Radiological Supervision and Interpretation (S&I), Professional Component
NA
N
-
$24
36010-36012, Introduction of catheter, vein
NA
Y
$512-$878
$127-$181
Removing obstruction from inside of catheter (e.g., using an intraluminal brush): Three codes are needed to describe the procedure: (1) 36596 to remove obstruction; (2) 75902 for associated imaging; and (3) 36010-36012,depending on the vein, for placing the brush. 36596, Mechanical removal of intraluminal (intracatheter) obstructive material from central venous access device through device lumen
0
Y
$136
$46
75902, Mechanical removal of intraluminal (intracatheter) obstructive material from central venous access device through device lumen. radiological supervision and interpretation
NA
N
$72
-
*75902-26, Radiological S&I, Professional Component
NA
N
-
$19
36010-36012, Introduction of catheter, vein
NA
Y
$512-$878
$127-$181
* In the office, if the physician owns the equipment, radiology codes are billed without modifiers and the physician receives payment for both technical & professional components. In the facility, the hospital or ASC owns the equipment and the physician bills with modifier -26 to receive payment for the professional component only.
6
Medicare National Average Payments for Physicians3 Repositioning Catheter The catheter can be moved back to its proper location if it has migrated out of position. This is done under fluoroscopic guidance.
PROCEDURE
Repositioning Catheter
GLOBAL DAYS
CODE AND DESCRIPTION
MULT PROC DISCOUNTING
NONFACILITY
FACILITY
CY2016 PAYMENT
CY2016 PAYMENT
36597, Repositioning of previously placed central venous catheter under fluoroscopic guidance
0
Y
$129
$63
76000, Fluoroscopy, up to 1 hour physician time
NA
N
$47
-
*76000-26, Fluoroscopy, up to 1 hour physician time, professional component
NA
N
-
$8
* In the office, if the physician owns the equipment, radiology codes are billed without modifiers and the physician receives payment for both technical & professional components. In the facility, the hospital or ASC owns the equipment and the physician bills with modifier -26 to receive payment for the professional component only.
Catheter Evaluation When a catheter is not functioning properly, it is injected with contrast & imaged to identify obstruction/malposition.
PROCEDURE
Catheter Evaluation
GLOBAL DAYS
CODE AND DESCRIPTION
36598, Contrast injections for radiologic evaluation of existing central venous access device, including fluoroscopy, image documentation and report
0
MULT PROC DISCOUNTING
NA
NONFACILITY
FACILITY
CY2016 PAYMENT
CY2016 PAYMENT
$112
$38
Note: Code 36598 is payable when it is the only service the physician performed. However, when any additional service payable to the physician is performed on the same date, the catheter evaluation is bundled into the other service and code 36598 is not paid separately.5
HCPCS Device Codes For procedures performed in the office where the physician incurs the cost of the catheter, the physician can bill the HCPCS code for the catheter in addition to the CPT® code for the procedure of placing it. However, many payers include payment for the device in the payment for the CPT® procedure code and do not pay separately for the catheter itself. HCPCS
A4300
7
CODE DESCRIPTION
Implantable access catheter (e.g., venous, arterial, epidural subarachnoid, or peritoneal etc), external access
COMMENT
Can be used for all dialysis catheters.
Hospital Outpatient Reimbursement for Hemodialysis Catheters Under Ambulatory Payment Classification (APC) Under Medicare’s methodology for hospital outpatient payment, each procedural CPT® code is assigned to a specific Ambulatory Payment Classification (APC) with a flat payment rate. Depending on the procedures performed, multiple APCs can be assigned for each case.
Medicare Average Payments for Hospital Outpatient PROCEDURE
Catheter Insertion
Replacement, Same Venous Access Catheter Removal Imaging Guidance Repair
8
CODE AND DESCRIPTION
STATUS INDICATOR6
MULT PROC DISCOUNTING7
CY2016 PAYMENT
APC
36555, Insertion of non-tunneled catheter, younger than 5 years of age
T
Y
5181
$862
36556, Insertion of non-tunneled catheter, age 5 years or older
T
Y
5181
$862
36557, Insertion of tunneled catheter, younger than 5 years of age
T
Y
5182
$2,247
36558, Insertion of tunneled catheter, age 5 years or older
T
Y
5182
$2,247
36565, Insertion of tunneled centrally inserted central venous access device, 2 catheters
T
Y
5182
$2,247
36580, Replacement, non-tunneled catheter
T
Y
5181
$862
36581, Replacement, tunneled catheter
T
Y
5182
$2,247
Note: When replacement is performed via separate venous access, both catheter insertion (see above) and catheter removal (see below) are coded. However, payment is made for catheter insertion only. No code for removal of non-tunneled catheter
Payable under E/M code for clinic visit, as applicable
36589, Removal of tunneled catheter
Q2
Y
+76937, Ultrasound guidance for vascular access
N
-
-
+77001, Fluoroscopic guidance for central venous access device (CVAD)
N
-
-
36575, Repair of tunneled or non-tunneled catheter
T
Y
5391
5391
$482
$482
Medicare Average Payments for Hospital Outpatient PROCEDURE
STATUS INDICATOR6
CODE AND DESCRIPTION
MULT PROC DISCOUNTING7
CY2016 PAYMENT
APC
Declotting catheter by injection 36593, Declotting by thrombolytic agent of catheter
T
Y
5291
$199
36595, Mech. removal, pericatheter obstructive material (eg. fibrin sheath)
T
Y
5182
$2,247
75901, Radiological S&I
N
-
-
36010-36012, Introduction of catheter, vein
N
-
-
36596, Mech. removal of intraluminal (intracatheter) obstructive material
T
Y
75902, Radiological S&I
N
-
-
36010-36012, Introduction of catheter, vein
N
-
-
36597, Repositioning of previously placed catheter
T
Y
5181
$862
76000, Fluoroscopy
S
N
5523
$191
36598, Contrast injections for radiologic evaluation of existing (CVAD)
T
Y
5291
$199
Removing obstruction from around outside of catheter
Removal of Obstruction from Catheter
Removing obstruction from inside of catheter
Repositioning Catheter Evaluation
5181
$862
HCPCS Device Codes In addition to the CPT® code for the procedure, hospitals bill the HCPCS code for the catheter itself, as well as guidewires and introducer sheaths. However, payment for the catheter and the other items is included in the payment for the CPT® procedure code and the HCPCS codes are not separately paid. HCPCS
CODE DESCRIPTION
COVIDIEN PRODUCT
C1750
Catheter, hemodialysis/peritoneal, long-term
Chronic
C1752
Catheter, hemodialysis/peritoneal, short-term
Acute
C1769
Guidewire
C1892
Introducer Sheath
NA
Medicare Billing For Medicare, C-codes are typically used. HCPCS
A4300
CODE DESCRIPTION
Implantable access catheter (e.g., venous, arterial, epidural subarachnoid, or peritoneal etc), external access
COMMENT
Code can be used for all dialysis catheters.
Non-Medicare Billing Some non-Medicare payers accept C-codes but more commonly, hospitals submit the regular HCPCS code. Many payers include payment for the device in the payment for the CPT® procedure code and do not pay separately for the catheter itself.
9
Ambulatory Surgery Center Payment for Hemodialysis Catheters Medicare payment for procedures performed in an ambulatory surgery center is adapted from hospital outpatient APCs and physician office payments. Medicare only pays for surgical procedures performed in the ASC. Imaging services are usually not separately paid. Generally, there is no separate payment for devices because their payment is included in the payment for the procedure.
Medicare Average Payments for ASC PROCEDURE
Catheter Insertion
Catheter Replacement, Same Venous Access
Catheter Removal
Imaging Guidance
10
CODE AND DESCRIPTION
PAYMENT INDICATOR8
MULT PROC DISCOUNTING7
CY2016 PAYMENT
36555, Insertion of non-tunneled catheter, younger than 5 years of age
A2
Y
$482
36556, Insertion of non-tunneled catheter, age 5 years or older
A2
Y
$482
36557, Insertion of tunneled catheter, younger than 5 years of age
A2
Y
$1,256
36558, Insertion of tunneled catheter, age 5 years or older
A2
Y
$1,256
36565, Insertion of tunneled centrally inserted central venous access device, 2 catheters
A2
Y
$1,256
36580, Replacement, non-tunneled catheter
A2
Y
$482
36581, Replacement, tunneled catheter
A2
Y
$1,256
Note: When performed via separate venous access, payment is made for catheter insertion plus, as appropriate, catheter removal. No code for removal of non-tunneled catheter
Not payable in an ASC
36589, Removal of tunneled catheter
A2
N
$269
Note: Because ASCs do not have clinics for non-surgical services, removal of non-tunneled catheters is not recognized in ASC. +76937, Ultrasound guidance for vascular access
N1
-
-
+77001, Fluoroscopic guidance for central venous access device (CVAD)
N1
-
-
Medicare Average Payments for ASC PAYMENT INDICATOR8
MULT PROC DISCOUNTING7
CY2016 PAYMENT
A2
Y
$269
P3
Y
$30
36595, Mechanical removal of pericatheter obstructive material (eg. fibrin sheath)
P3
Y
$453
75901, Radiological S&I
N1
-
-
36010-36012, Introduction of catheter, vein
N1
-
-
36596, Mechanical removal of intraluminal (intracatheter) obstructive material
G2
Y
$482
75902, Radiological S&I
N1
-
-
36010-36012, Introduction of catheter, vein
N1
-
-
36597, Repositioning of previously placed catheter
G2
Y
$482
76000, Fluoroscopy
Z3
N
$38
P3
Y
$83
PROCEDURE
Catheter Repair
CODE AND DESCRIPTION
36575, Repair of tunneled or non-tunneled catheter Declotting catheter by injection 36593, Declotting by thrombolytic agent of catheter Removing obstruction from around outside of catheter
Removal of Obstruction from Catheter
Removing obstruction from inside of catheter
Repositioning Catheter
Catheter Evaluation 36598, Contrast injections for radiologic evaluation of existing CVAD
HCPCS Codes As instructed by Centers for Medicare and Medicaid Services (CMS), ASCs generally do not use Healthcare Common Procedure Coding System (HCPCS) device code when billing Medicare.
11
Hospital Inpatient DRGs for Hemodialysis Catheters Under Medicare’s Diagnosis-Related Groups (DRG) system for hospital inpatient payment, each inpatient stay is assigned to one of about 750 surgical or medical DRGs based on diagnoses and procedures. Each DRG has a flat payment rate. ICD-10-PCS Procedure Codes Procedures with dialysis catheters are typically performed in the outpatient setting. However, some patients who are already hospitalized may need a dialysis catheter. When insertion is performed as inpatient, the ICD-10-PCS procedure code depends on the anatomic site where the internal tip of the dialysis catheter rests.10 ICD-10-PCS PROCEDURE CODE
CODE DESCRIPTION
COMMENT
02HV33Z
Insertion of infusion device into superior vena cava, percutaneous approach
This code is used for centrally and peripherally inserted catheters, both non-tunneled and tunneled, when the tip rests in the superior vena cava or the cavoatrial junction.
02H633Z
Insertion of infusion device into right atrium, percutaneous approach
This code is used for centrally and peripherally inserted catheters, both tunneled and non-tunneled, when the tip rests in the right atrium.
Medicare Average Payments for Hospital Inpatient Because 02HV33Z and 02H633Z are not considered significant procedures for DRG assignment, non-surgical DRGs are assigned according to the principal diagnosis. Common ICD-10-CM diagnosis codes are listed at the end of this Guide. DRG
DRG TITLE8
FY 2016 PAYMENT
PRINCIPAL DIAGNOSIS: N18.6, I12.0, I13.11, N17.0-N17.9
682
Renal Failure W MCC
$8,909
683
Renal Failure W CC
$5,555
Renal Failure WO CC/MCC
$3,704
684
PRINCIPAL DIAGNOSIS: I13.2
291
Heart Failure and Shock W MCC
$8,746
292
Heart Failure and Shock W CC
$5,733
Heart Failure and Shock WO CC/MCC
$3,979
293
PRINCIPAL DIAGNOSIS: T80.218A, T80.219A, T82.4-XA, T82.8-8A
314
Other Circulatory System Diagnoses W MCC
$11,419
315
Other Circulatory System Diagnoses W CC
$5,742
Other Circulatory System Diagnoses WO CC/MCC
$3,838
316
PRINCIPAL DIAGNOSIS: E10.22, E11.22
698
Other Kidney and Urinary Tract Diagnoses W MCC
$9,169
699
Other Kidney and Urinary Tract Diagnoses W CC
$6,051
700
Other Kidney and Urinary Tract Diagnoses WO CC/MCC
$4,231
12
Common Diagnosis (Dx) Codes for Hemodialysis Catheters Hemodialysis catheters are used to treat renal failure. In most patients, the renal failure is chronic and referred to as chronic kidney disease (CKD) with end stage renal disease (ESRD). ESRD is frequently due to hypertension or diabetes, and the diagnosis code assignments reflect this. ICD-10-CM DX CODE
CODE DESCRIPTION
COMMENT
END STAGE RENAL DISEASE
N18.6
End stage renal disease
Includes Stage V chronic kidney disease that requires dialysis.
NOTE: This diagnosis is designated as an MCC but there are exceptions: N18.6 does not count as an MCC when sequenced as the principal diagnosis N18.6 does not count as an MCC when assigned as a secondary diagnosis with the principal diagnosis codes below for diabetes or acute renal failure. Otherwise, code N18.6 for ESRD does count as an MCC and a DRG W MCC will be assigned when code N18.6 is used as a secondary dx. END STAGE RENAL DISEASE DUE TO DIABETES
E10.22
Type 1 diabetes mellitus with diabetic chronic kidney disease
E11.22
Type 2 diabetes mellitus with diabetic chronic kidney disease
The diabetes code is sequenced first, followed by N18.6.
END STAGE RENAL DISEASE DUE TO OR WITH HYPERTENSION
I12.0
Hypertensive CKD with stage 5 chronic kidney disease or ESRD
The hypertension code is sequenced first, followed by N18.6.
END STAGE RENAL DISEASE DUE TO OR WITH HYPERTENSION WITH HEART DISEASE
I13.11
Hypertensive heart and CKD without heart failure, with stage 5 chronic kidney disease, or ESRD
I13.2
Hypertensive heart and CKD with heart failure and with stage 5 chronic kidney disease, or ESRD
The hypertension code is sequenced first, followed by N18.6.
ACUTE RENAL FAILURE
Although ESRD is a chronic disease, hemodialysis catheters may also be placed to treat acute renal failure. N17.0 N17.9
Acute kidney failure
Codes N17.0-N17.9 may be used together with N18.6 if the patient has both acute renal failure and ESRD.
COMPLICATIONS OF DIALYSIS CATHETERS
When complications arise, hemodialysis catheters may be replaced, removed, or repaired. There are specific codes for catheter complications. The underlying ESRD is coded as well. T82.41XA
Breakdown (mechanical) of vascular dialysis catheter
T82.42XA
Displacement of vascular dialysis catheter
T82.43XA
Leakage of vascular dialysis catheter
T82.49XA
Other mechanical complication of vascular dialysis catheter
T82.818A
Embolism of vascular prosthetic devices, implants and grafts
T82.828A
Fibrosis of vascular prosthetic devices, implants and grafts
T82.838A
Hemorrhage of vascular prosthetic devices, implants and grafts
T82.848A
Pain from vascular prosthetic devices, implants and grafts
T82.858A
Stenosis of vascular prosthetic devices, implants and grafts
T82.868A
Thrombosis of vascular prosthetic devices, implants and grafts
T82.898A
Other specified complication of vascular prosthetic devices, implants and grafts
T80.218A
Other infection due to central venous catheter
T80.219A
Unspecified infection due to central venous catheter
T80.211A
Bloodstream infection due to central venous catheter
T80.212A
Local infection due to central venous catheter
13
An additional code can be used with T80.21-A to show the type of infection. “Local” infection refers to infection at the catheter entrance or exit site, or in the subcutaneous tunnel.
Notes: 1. Renal failure can also be treated with peritoneal dialysis. There are special catheters for peritoneal dialysis but they are not addressed in this Guide. 2. Another factor in CPT® coding is central vs. peripheral insertion (PICC). However, since Covidien’s dialysis catheters are centrally inserted, these are the only codes provided. 3. All Medicare Physician Fee Schedules calculated using CF $35.8043 effective January 8, 2016 - December 31, 2016. The new CF is reflected in the January PFS update available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html 4. Partial replacement uses code 36578 but this is only for catheters connected to ports and pumps. Covidien does not manufacture ports or pumps. 5. Medicare National Physician Fee Schedule Relative Value File. Code 36598 is designated as status T: “There are RVUS and payment amounts for these services, but they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other services payable under the physician fee schedule are billed on the same date by the same provider, these services are bundled into the physician services for which payment is made. 6. Status Indicators determine payment methodology when multiple APCs are assigned to a case: S- always paid at 100% of the rate; T - paid at 50% of the rate when submitted with a higher-valued T procedure; N - no separate payment made because procedure is packaged with another primary procedure; Q2 - not separately payable when submitted with a status T procedure. 7. Multiple Procedure Discounting: When two or more procedures are performed during the same encounter, the higher-valued code pays at 100% of the rate and the other codes pay at 50% of the rate. This discounting applies to codes marked “Y”. Codes marked “N” always pay at 100%. 8. Payment Indicators determine payment methodology for CPT® codes billed in the ASC: A2 = surgical procedure, payment based on hospital outpatient rate adjusted for ASC; G2 = non office-based surgical procedure, payment based on hospital outpatient rate adjusted for ASC; N1 = packaged service, no separate payment ; P3 = office-based procedure, payment based on physician fee schedule; Z3 = radiology service paid separately when provided integral to a procedure, payment based on physician fee schedule. 9. Most DRGs above are tiered as W MCC, W CC, and WO CC/MCC. MCCs are major complications/ comorbidities. CCs are other complications/comorbidities. Assignment to a DRG W MCC or W CC occurs if any of the secondary diagnoses assigned to the patient are designated as MCCs or CCs, according to fixed DRG logic. If none of the secondary diagnosis codes for the case are designated as an MCC or a CC, a DRG WO CC/MCC is assigned. 10. Coding Clinic, 4th Q 2015, p.26-30
The information contained in this guide is for educational purposes only and is not intended to serve as reimbursement advice. The information herein is taken from the materials published by the Centers for Medicare and Medicaid Services and the American Medical Association and may be helpful to providers in staying up to date on coding and billing of services. This information is subject to change, and cannot guarantee coverage or reimbursement. Medtronic makes no other representations as to selecting codes for procedures or compliance with any other billing protocols or prerequisites. As with all claims, providers are responsible for exercising their independent clinical judgment in selecting the codes that most accurately reflect the patient’s condition and procedures performed for a patient and to consult with each patient’s health plan for appropriate reporting of each procedure. Providers should refer to current, complete, and authoritative publications such as AMA HCPCS Level II Code publication or insurer policies for selecting codes based on the care rendered to an individual patient, and may wish to contact individual carriers, fiscal intermediaries, or other third-party payers as needed CPT © 2015 American Medical Association. All rights reserved. CPT © is a registered trademark of the American Medical Association. © 2016 Medtronic. All rights reserved. Medtronic, Medtronic logo and Further, Together are trademarks of Medtronic. All other brands are trademarks of a Medtronic company.
For more information, contact the Medtronic Reimbursement Hotline: 877-278-7482.
Renal Care Solutions 15 Hampshire Street Mansfield, MA 02048 USA T: (800) 962-9888
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