Coding for Electrophysiology & Cardiac Rhythm Management

Coding for Electrophysiology & Cardiac Rhythm Management COMMON CODING SCENARIOS EFFECTIVE JANUARY 1, 2014 Contents Page Introduction 03 Electrophys...
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Coding for Electrophysiology & Cardiac Rhythm Management COMMON CODING SCENARIOS EFFECTIVE JANUARY 1, 2014

Contents Page Introduction 03 Electrophysiology Services

04

Electrophysiology Evaluations

04

Electrophysiology Ablation Procedures

04

Pacemaker Procedures

05

Pacemaker System Implants

05

Pacemaker Generator Replacements

05

Device Upgrades

06

Other Procedures

06

ICD Procedures

07

Defibrillator System Implant

07

Defibrillator Generator Replacements

08

Device Upgrades

09

Other Procedures

09

Device Monitoring Services

10

Pacemaker Monitoring

10

ICD Monitoring

11

Implantable Loop Recorder Evaluations

12

Implantable Cardiac Monitor Evaluations

12

Reference Tables

13

APC Descriptors

13

ICD-9-CM Descriptors

13

MS-DRG Descriptors

14

Introduction This guide provides hospital coding information for electrophysiology and cardiac rhythm management procedures. In addition, St. Jude Medical offers a reimbursement hotline, which provides live coding and billing information from dedicated reimbursement specialists. Hotline support is available from 8:00 a.m. to 5:00 p.m. Central Time, Monday through Friday at (855) 569-6430. Hotline reimbursement assistance is provided subject to the disclaimers set forth below. The guide contains case scenarios which are intended to serve as examples only. They are not intended to be representative of all possible reporting scenarios. The hospital and physician should always select the code or codes that most accurately describe the procedures actually performed and fully comply with the insurer requirements in submitting claims. This document and the information contained herein is for general information purposes only and is not intended and does not constitute legal, reimbursement, coding, business or other advice. Furthermore, it is not intended to increase or maximize payment by any payer. Nothing in this document should be construed as a guarantee by St. Jude Medical regarding levels of reimbursement, payment or charge, or that reimbursement or other payment will be received. Similarly, nothing in this document should be viewed as instructions for selecting any particular code. The ultimate responsibility for coding and obtaining payment/reimbursement remains with the customer. This includes the responsibility for accuracy and veracity of all coding and claims submitted to third party payers. Also note that the information presented herein represents only one of many potential scenarios, based on the assumptions, variables and data presented. In addition, the customer should note that laws, regulations and coverage and coding policies are complex and are updated frequently, and therefore the customer should check with its local carriers or intermediaries often and should consult with legal counsel or a financial, coding or reimbursement specialist for any coding, reimbursement or billing questions or any related issues.

3

Electrophysiology Services Electrophysiology Evaluations Procedure Description

APC Assignment

Possible ICD-9-CM

Possible MS-DRG Assignments

93620

0085

37.26

250 251

CPT Code

APC Assignment

Possible ICD-9-CM

Possible MS-DRG Assignments

CPT Code

Example 1: Pacing and recording at high right atria, bundle of His, and right ventricular locations. Comprehensive EP evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording. His bundle recording.

Electrophysiology Ablation Procedures Procedure Description

Example 1: Pacing and recording at high right atrium, bundle of His and right ventricular locations. Left atrial evaluation performed via coronary sinus catheter with recordings and pacing performed. Isuprel infused; arrhythmia induced; 3D mapping performed. Ablation catheter utilized to perform SVT ablation across the abnormal circuit. Repeat EP study performed. Comprehensive EP evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording. His bundle recording. Intracardiac catheter ablation of arrhythmogenic focus; for treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathways, accessory atrioventricular connections or other atrial foci, singly or in combination Intracardiac electrophysiologic 3-dimensional mapping

37.26 93653

8000 37.34

+93613

packaged

250 251

37.27

Example 2: Localized EP study performed with localized mapping in the region of the AV node. Testing with Isuprel infusion. AV node localized, mapped and ablated. Single chamber ventricular pacemaker implanted, tested and programmed. Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of completer heart block, with or without temporary pacemaker placement Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular

93650

33207

0085

0089

37.34 37.71 37.80 37.81 37.82

242 243 244

4

Pacemaker Procedures Pacemaker System Implants Procedure Description

CPT Code

APC Assignment

Possible ICD-9-CM

Possible MS-DRG Assignments

0089

37.71 37.80 37.81 37.82

242 243 244

37.72 37.83 99.62

242 243 244

Example 1: Initial implant of a pacemaker system with single ventricular lead Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular

33207

Example 2: Initial implant of dual chamber pacemaker system with cardioversion Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular

33208

0655

Cardioversion, elective, electrical conversion of 244 arrhythmia; external

92960

0679

CPT Code

APC Assignment

Possible ICD-9-CM

Possible MS-DRG Assignments

33227

0090

37.86

258 259 260

33228

0654

37.80 37.87

258 259 260

Pacemaker Generator Replacements Procedure Description Example 1: Replacement of single chamber pacemaker pulse generator Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system Example 2: Replacement of dual chamber pacemaker pulse generator Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system

Example 3: Replacement of dual chamber pacemaker pulse generator, including capping of existing atrial lead and insertion of new atrial lead Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial

33206

0089

37.76 37.80 37.85 37.86

Removal of permanent pacemaker pulse generator only

33233

0105

37.89

260 261 262

5

Pacemaker Procedures (Continued) Device Upgrades Procedure Description

CPT Code

APC Assignment

Possible ICD-9-CM

Possible MS-DRG Assignments

Example 1: Upgrade from single chamber pacemaker system with ventricular lead to a dual chamber pacemaker system, including addition of right atrial lead Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator)

33214

0655

37.73 37.87

242 243 244

Example 2: Single chamber pacemaker upgrade to CRT-P, with insertion of right atrial lead and insertion of left ventricular lead with coronary sinus venogram Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator)

33214

Insertion of pacing electrode, cardiac venous system, 244 for left ventricular pacing, at time of insertion of pacing cardioverterdefibrillator or pacemaker pulse generator (including upgrade to dual chamber system and pocket revision)

+33225

0655 00.50 00.52 00.53

242 243 244

222 223 224 225 226 227

0655

Example 3: Upgrade from dual chamber pacemaker system to dual chamber ICD system, with replacement of ventricular lead Removal of permanent pacemaker pulse generator only

33233

0105

37.89

Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber

33249

0108

00.51 00.52 00.54

CPT Code

APC Assignment

Possible ICD-9-CM

Possible MS-DRG Assignments

33234

0105

37.77

260 261 262

0136

37.79

260 261 262

Other Procedures Procedure Description Example 1: Extraction of single pacemaker electrode Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular

Example 1: Relocation of pacemaker pocket from right to left side of pacemaker pocket Relocation of skin pocket for pacemaker

33222

6

ICD Procedures Defibrillator System Implant Procedure Description

CPT Code

APC Assignment

Possible ICD-9-CM

Possible MS-DRG Assignments

Example 1: Patient with a history of ventricular tachycardia is evaluated for defibrillator implant. Right ventricular pacing with induction of arrhythmia is successful in inducing the arrhythmia. Patient is cardioverted, after which right ventricular defibrillating lead and defibrillator are placed in the right ventricular apex under fluoroscopic guidance. Defibrillation testing is performed. Intraventricular pacing

93612-59*

0084

Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber

33249

0108

Electrophsiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; with testing of single or dual chamber pacing cardioverter-defibillator pulse generator.

93641

packaged

37.29

37.94

222 223 224 225 226 227

Example 2: Initial CRT-D system implant, with coronary sinus venography and defibrillator threshold testing at time of implant. Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber

33249

Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverterdefibrillator or pacemaker pulse generator (including upgrade to dual chamber system and pocket revision)

+33225

Electrophsiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; with testing of single or dual chamber pacing cardioverter-defibillator pulse generator.

93641

0108

00.51 00.52 00.54

packaged

not coded

222 223 224 225 226 227

*-59 modifier indicates Distinct Procedural Service

7

ICD Procedures (Continued) Defibrillator Generator Replacements Procedure Description

CPT Code

APC Assignment

Possible ICD-9-CM

Possible MS-DRG Assignments

Example 1: Replacement of single chamber ICD pulse generator with defibrillator threshold testing at time of implant. Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverterdefibrillator pulse generator; single lead system Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator

33262

0107

37.89

245 93641

packaged

not coded

Example 2: Replacement of CRT-D pulse generator with defibrillator threshold testing at time of implant. Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverterdefibrillator pulse generator; multiple lead system Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator

33264

0107

00.54

245 93641

packaged

not coded

8

ICD Procedures (Continued) Device Upgrades Procedure Description

CPT Code

APC Assignment

Possible ICD-9-CM

Possible MS-DRG Assignments

Example 1: Dual chamber ICD to CRT-D upgrade, including capping existing atrial and ventricular leads, implant of new atrial and ventricular leads, with coronary sinus venogram to guide left ventricular lead implant, with defibrillator threshold testing at time of implant. Removal of pacing cardioverter-defibrillator pulse generator only

33241

Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber

33249

0105

37.89

0108

00.51 00.52 00.54

Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverterdefibrillator or pacemaker pulse generator (including upgrade to dual chamber system and pocket revision)

+33225

Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator

93641

packaged

not coded

CPT Code

APC Assignment

Possible ICD-9-CM

222 223 224 225 226 227

Other Procedures Procedure Description

Possible MS-DRG Assignments

Example 1: Extraction and replacement of single chamber cardioverter-defibrillator lead, with threshold testing of ICD system. Removal of single or dual chamber pacing cardioverterdefibrillator electrode(s); by transvenous extraction

33244

0105

Insertion of a single transvenous electrode, permanent pacemaker or cardioverter-defibrillator

33216

0106

37.76 37.95 37.97

Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator

93641

packaged

not coded

260 261 262 265

Example 2: Insertion of left ventricular transvenous pacing lead only, inserted into previously implanted CRT-D. Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or pacing cardioverter-defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator)

33224

0655

00.52

265

9

Device Monitoring Services The following examples present coding appropriate for collection of the global fee. Modifier -26 should be applied when providing professional services only and modifier – TC when providing technical services only. For remote interrogations, distinct CPT codes are used to represent the professional and technical components of the service and the -26 and –TC modifiers do not apply. Pacemaker Monitoring Procedure Description

APC Assignment

Possible ICD-9-CM

Possible MS-DRG Assignments

0690

89.45

NA

93288

0690

89.45

NA

93294

NA NA

NA

CPT Code

Example 1: Device programming evaluation Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; single lead pacemaker system

93279

Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; dual lead pacemaker system

93280

Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; multiple lead pacemaker system

93281

Example 2: Device Interrogation (in person) Interrogation device evaluation (in person) with physician analysis, review and report, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system Example 3: Device Interrogation (remote) Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system with interim physician analysis, review(s) and report(s) Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system or implantable cardioverterdefibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results

93296

0690

10

Device Monitoring Services (Continued) ICD Monitoring Procedure Description

APC Assignment

Possible ICD-9-CM

Possible MS-DRG Assignments

0690

89.49

NA

93289

0690

89.49

NA

93295

NA NA

NA

CPT Code

Example 1: Device Programming Programming device evaluation (in person) with iterative adjustments of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; single lead implantable cardioverter defibrillator system

93282

Programming device evaluation (in person) with iterative adjustments of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; dual lead cardioverter defibrillator system

93283

Programming device evaluation (in person) with iterative adjustments of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; multiple lead cardioverter defibrillator system

93284

Example 2: Device Interrogation (in person) Interrogation device evaluation (in person) with physician analysis, review and report, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead implantable cardioverterdefibrillator system, including analysis of heart rhythm derived data elements Example 3: Device Interrogation (remote) Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable cardioverter defibrillator system with interim physician analysis, review(s) and report(s) Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results

93296

0690

11

Device Monitoring Services (Continued) Implantable Loop Recorder Evaluations Procedure Description

CPT Code

APC Assignment

Possible ICD-9-CM

Possible MS-DRG Assignments

Programming device evaluation (in person) with iterative adjustments of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; implantable loop recorder system

93285

0690

89.59

NA

93291

0690

89.59

NA

93298

NA NA

NA

Device Programming

Device Interrogation (in person) Interrogation device evaluation (in person) with physician analysis, review and report, includes connection, recording and disconnection per patient encounter; implantable loop recorder system, including heart rhythm derived data analysis Device Interrogation (remote) Interrogation device evaluation(s), (remote) up to 30 days; implantable loop recorder system, including analysis of recorded heart rhythm data, physician analysis, review(s) and report(s) Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system or implantable loop recorder system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results

93299

0690

CPT Code

APC Assignment

Possible ICD-9-CM

Possible MS-DRG Assignments

93290

0035

89.59

NA

Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors, physician analysis, review(s) and report(s)

93297

NA

Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system or implantable loop recorder system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results

NA

NA

93299

Implantable Cardiac Monitor Evaluations Procedure Description Device Interrogation (in person) Interrogation device evaluation (in person) with physician analysis, review and report, includes connection, recording and disconnection per patient encounter; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors Device Interrogation (remote)

0690

12

Reference Tables APC Descriptors APC

Brief Descriptor

0035

Vascular puncture and minor diagnostic procedures

0080

Diagnostic cardiac catheterization

0084

Level I electrophysiologic procedures

0085

Level II electrophysiologic procedures

0086

Level III electrophysiologic procedures

0089

Insertion/replacement of permanent pacemaker and electrodes

0090

Level I insertion/replacement of permanent pacemaker

0105

Repair/revision/removal of pacemakers AICDs or vascular devices

0106

Insertion/replacement of pacemaker leads and/or electrodes

0107

Insertion of cardioverter-defibrillator pulse generator

0108

Insertion/replacement/repair of AICD leads, generator, and pacing electrodes

0136

Level IV skin repair

0655

Insertion/replacement/conversion of a permanent dual chamber pacemaker

0690

Level I electronic analysis of devices

8000

Cardiac electrophysiologic evaluation and ablation composite

ICD-9-CM Descriptors ICD-9-CM

Descriptor

00.50

Implantation of cardiac resynchronization pacemaker without mention of defibrillation, total system [CRT-P]

00.51

Implantation of cardiac resynchronization defibrillator, total system [CRT-D]

00.52

Implantation or replacement of transvenous lead [electrode] into left ventricular coronary venous system

00.53

Implantation or replacement of cardiac resynchronization pacemaker pulse generator only [CRT-P]

00.54

Implantation or replacement of cardiac resynchronization defibrillator pulse generator device only [CRT-D]

37.70

Initial insertion of lead [electrode], not otherwise specified

37.71

Initial insertion of transvenous lead [electrode] into ventricle

37.72

Initial insertion of transvenous leads [electrodes] into atrium and ventricle

37.73

Initial insertion of transvenous lead [electrode] into atrium

37.74

Insertion or replacement of epicardial lead [electrode] into epicardium

37.75

Revision of lead [electrode]

37.76

Replacement of transvenous atrial and/or ventricular lead(s) [electrode]

37.77

Removal of lead(s) [electrode] without replacement

37.78

Insertion of temporary transvenous pacemaker system

89.45

Artificial pacemaker rate check

89.46

Artificial pacemaker artifact wave form check

89.47

Artificial pacemaker electrode impedance check

89.48

Artificial pacemaker voltage or amperage threshold check

89.49

Automatic implantable cardioverter/defibrillator (AICD) check

89.59

Other nonoperative cardiac and vascular measurements

13

Reference Tables (Continued) MS-DRG Descriptors MS-DRG

Descriptor

222

Cardiac defibrillator implant with cardiac catheterization with acute MI/HF/Shock w MCC

223

Cardiac defibrillator implant with cardiac catheterization with acute MI/HF/Shock w/o MCC

224

Cardiac defibrillator implant with cardiac catheterization without acute MI/HF/Shock w MCC

225

Cardiac defibrillator implant with cardiac catheterization without acute MI/HF/Shock w/o MCC

226

Cardiac defibrillator implant without cardiac catheterization w MCC

227

Cardiac defibrillator implant without cardiac catheterization w/o MCC

242

Permanent cardiac pacemaker implant w MCC

243

Permanent cardiac pacemaker implant w CC

244

Permanent cardiac pacemaker implant w/o CC/ MCC

245

AICD generator procedure

250

Percutaneous cardiovascular procedure without coronary artery stent w MCC

251

Percutaneous cardiovascular procedure without coronary artery stent w/o MCC

258

Cardiac pacemaker replacement w MCC

259

Cardiac pacemaker replacement w/o MCC

260

Cardiac pacemaker revision except device replacement w MCC

261

Cardiac pacemaker revision except device replacement w CC

262

Cardiac pacemaker revision except device replacement w/o CC/MCC

265

ICD lead procedures

MCC – major complications and cormorbidities; CC – complications and comorbidities

14

Please check the applicable user’s manuals for the FDA approved/cleared indications for use.

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Rx Only Brief Summary: Prior to using these devices, please review the Instructions for Use for a complete listing of indications, contraindications, warnings, precautions, potential adverse events and directions for use. Unless otherwise noted, ™ indicates that the name is a trademark of, or licensed to, St. Jude Medical or one of its subsidiaries. ST. JUDE MEDICAL and the nine-squares symbol are trademarks and service marks of St. Jude Medical, Inc. and its related companies. © 2014 St. Jude Medical, Inc. All Rights Reserved. US-2000315 A EN (03/14)