Philips 85900P User Manual Reimbursement Information 2016 Coronary IVUS Coding Guide 16 4 182 SM
User Manual: Philips 85900P Reimbursement information Philips Volcano - Eagle Eye Platinum Digital IVUS catheter85900P
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Coronary Intravascular Ultrasound (IVUS) 2016 Coding and Medicare Payment Guide All coding, coverage, billing and payment information provided herein by Volcano Corporation is gathered from third-party sources and is subject to change. The information is intended to serve as a general reference guide and does not constitute reimbursement or legal advice. For all coding, coverage and reimbursement matters or questions about the information contained in this material, Volcano recommends that you consult with your payers, certified coders, reimbursement specialists and/or legal counsel. Volcano does not guarantee that the use of any particular codes will result in coverage or payment at any specific level. Coverage for these procedures may vary by Payer. Volcano recommends that providers verify coverage prior to date of service. This information may include some codes for procedures for which Volcano currently offers no cleared or approved products. In those instances, such codes have been included solely in the interest of providing users with comprehensive coding information and are not intended to promote the use of any products. The selection of a code must reflect the procedure(s) documented in the medical record. Providers are responsible for determining medical necessity, the proper place of service, and for submitting accurate claims. Payment amounts set forth herein are 2016 Medicare national averages; local Medicare payment amounts and private payer rates will vary. Page 2 1 Hospital Inpatient 1.1 Hospitals are reimbursed by Medicare for inpatient procedures and services under the Inpatient Prospective Payment System (IPPS), which utilizes the Medicare Severity Diagnosis Related Group (MS-DRG) system. Hospital Inpatient Diagnosis Codes Not an all-inclusive list. Refer to ICD-10-CM 2016: The Complete Official Codebook for additional codes. Depending on procedure performed, multiple codes may be reported. ICD-10-CM 1 DESCRIPTOR I21.0-I21.4 ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction I22.0-I22.9 Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction I23.8-I23.8 Certain current complications following ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction (within the 28 day period) I24.0-I24.9 Other acute ischemic heart disease I25.1-I25.9 Chronic ischemic heart disease 1.2 Hospital Inpatient Procedure Codes Not an all-inclusive list. Refer to ICD-10-PCS 2016: The Complete Official Codebook. Multiple codes may be reported. ICD-10-PCS2 B240ZZ3 Ultrasonography of single coronary artery, intravascular B241ZZ3 Ultrasonography of multiple coronary arteries, intravascular 1.3 Hospital Inpatient Diagnosis Related Groups For cardiac primary interventional procedures; assignment varies based on patient condition. DRG Page 3 DESCRIPTOR DESCRIPTOR3, 4 PAYMENT 231 Coronary bypass with PTCA with MCC 232 Coronary bypass with PTCA without MCC $34,117.00 246 Percutaneous cardiovascular procedure with drug-eluting stent with MCC or 4+ vessels/stents $19,186.86 247 Perc cardiovasc proc with drug-eluting stent without MCC $12,581.23 248 Perc cardiovasc proc with non-drug-eluting stent with MCC or 4+ ves/stents $18,125.19 249 Perc cardiovasc proc with non-drug-eluting stent without MCC $11,301.67 250 Perc cardiovasc proc without coronary artery stent with MCC $15,928.04 251 Perc cardiovasc proc without coronary artery stent without MCC $9,957.16 286 Circulatory disorders except AMI, with card cath with MCC $12,857.57 287 Circulatory disorders except AMI, with card cath without MCC $6,827.06 $46,090.04 See page 2 for important information about the uses and limitations of this guide and page 6 for all third party sources. 2 Hospital Outpatient 2.1 Hospitals are reimbursed by Medicare for outpatient procedures and services under the Outpatient Prospective Payment System (OPPS), which utilizes the Ambulatory Payment Classification (APC) system. Hospital Outpatient Procedure Codes - IVUS DESCRIPTOR APC / STATUS INDICATOR6 PAYMENT +92978 Intravascular ultrasound (coronary vessel or graft) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; initial vessel (list separately in addition to code for primary procedure) Status: N 0 +92979 Intravascular ultrasound (coronary vessel or graft) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; each additional vessel (list separately in addition to code for primary procedure) Status: N 0 CPT CORONARY IVUS 2.2 HCPCS Supply Code In the outpatient setting, when devices are used in combination with device-related procedures, hospitals report C codes. While the supply codes are not paid separately from the procedure, the assignment of charges and reporting these supply codes identify device-related costs. This information is important for future rate-setting by Medicare. Private payers’ policies vary if they accept the use of these C codes. HCPCS DESCRIPTOR APC / STATUS INDICATOR6 PAYMENT CORONARY IVUS CATHETER C1753 Page 4 Catheter, intravascular ultrasound Status: N 0 See page 2 for important information about the uses and limitations of this guide and page 6 for all third party sources. 3 Physician 3.1 Physicians services are paid by Medicare based on the Physician Fee Schedule. Physician Procedure Codes - Inpatient, Outpatient and Office IN HOSPITAL FACILITY 7 IN OFFICE NON-FACILITY8 DESCRIPTOR PAYMENT RVU9 PAYMENT GLOBAL RVU10 +92978-2611 Intravascular ultrasound (coronary vessel or graft) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; initial vessel (list separately in addition to code for primary procedure) $99.54 2.78 $99.54 2.78 +92979-2611 Intravascular ultrasound (coronary vessel or graft) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; each additional vessel (list separately in addition to code for primary procedure) $79.49 2.22 $79.49 2.22 CPT CORONARY IVUS Page 5 See page 2 for important information about the uses and limitations of this guide and page 6 for all third party sources. Highlights For complete guidance, refer to CPT, Medicare and private payer edits and rules. INTRAVASCULAR ULTRASOUND »» CPT codes 92978 and 92979 are add-on codes. An add-on code is always performed in conjunction with another primary service. CPT Assistant December 2014, Volume 24, Issue 12, pages 6-10) »» Intravascular ultrasound services include all transducer manipulations and repositioning within the specific vessel being examined, both before and after therapeutic intervention (eg, stent placement.) CPT Changes: An Insider's View 2000 -Medicine Cardiovascular »» 92978 may be reported with the following codes: 92975, 92920, 92924,92928, 92933, 92937, 92941, 92943, 93454-93461, 93563, 93564 CPT Copyright © 2016 American Medical Association »» Use 92979 in conjunction with 92978. CPT Copyright © 2016 American Medical Association THIRD-PARTY SOURCES »» Medicare Physician Fee Schedule 2016 Final Rule (CMS-1631-FC) Federal Register Vol 80 No. 220, November 16, 2015 Update January 5, 2016 »» Medicare Inpatient Prospective Payment System 2016 Final Rule (CMS-1632-F) Federal Register Vol 80 No. 158, August 17, 2015 »» Medicare Outpatient Prospective Payment System 2016 Final Rule (CMS-1633-FC) Federal register Vol 80 No.219, November 13, 2015 Update December 14, 2015 »» 2016 CPT Professional Edition »» 2016 CPT Changes, An Insider’s View »» CPT Assistant »» 2016 ICD-10-CM and ICD-10-PCS 1 Refer to ICD-10-CM 2016: The Complete Official Codebook for a complete list of codes and specific character codes 2 Refer to ICD-10-PCS 2016: The Complete Official Codebook for a complete list of codes and specific character codes 3 CC: Complications and Comorbidities 4 MCC: Major Complications and Comorbidities 5 Payment rates assume full update amount for hospitals which have submitted quality data and that hospitals have a wage index greater than 1. Actual payment rates will vary by locality. Payment rates are Medicare national, unadjusted rates. Actual payment rates will vary by locality. 6 Status Indicator N; No separate APC payment. Packaged into payment for other services. 7 Procedures performed by the physician in the hospital setting are reimbursed at the facility rate. Payment rates are Medicare national, unadjusted rates. Actual payment rates will vary by locality. 8 Procedures performed in the physician office are reimbursed at the Medicare non-facility rate. Payment rates are Medicare national, unadjusted rates. Actual payment rates will vary by locality. 9 RVU-Relative Value Units assigned under the Physician Fee Schedule. For each CPT code, RVUs are assigned to account for the relative resource costs used to provide the service. 10 11 No RVUs have been established for the technical or global service in the office setting. Medicare local carriers price the code. Carriers will establish RVUs and payment amounts for these services, generally on an individual case basis following review of documentation such as an operative report. Modifier 26 - Professional Component: Certain procedures are a combination of a physician component and a technical component. When the physician component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. CPT® Copyright 2016 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors, and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. For further information about Volcano and its products, please visit www.volcanocorp.com. Volcano and the Volcano Logo are registered trademarks of Volcano Corporation. Page 6 601-0103.141/002
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