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CRV-431307-AA OCT2016 Page 1 of 62
ContentsIntroductionImportant—Please Note (print page 2)
Description of Payment Methods (print page 3)
Rhythm Management Procedures (print page range: 4-18)
Interventional Cardiology Select Coronary Interventions (print page range: 19-29)
Peripheral Interventions (print page range: 30-45)
AppendicesAppendix A: APC Reference Table (print page 46)Appendix B: Category Codes (C-Codes) Reference Guide 2016 (print page range: 47-48)
Appendix C: ICD-10-PCS Reference Table (print page range: 49-61)
This document is formatted to print in a landscape orientation on letter (8.5 x 11) or legal (8.5 x 14) paper.
Procedural Payment GuideFY2017 Hospital Inpatient, CY2016 Hospital Outpatient and Physician Reimbursement Information
2016 Procedural Payment Guide
CRV-431307-AA OCT2016 Page 2 of 62
IMPORTANT—Please Note:This Procedural Payment Guide for rhythm management, interventional cardiology and peripheral intervention procedures provides coding and reimbursement information for physicians and healthcare facilities.The codes included in this guide are intended to represent typical rhythm management, cardiology and peripheral intervention procedures where there is: 1) at least one product approved by the U.S. Food and Drug Administration (FDA) for use in the listed procedure; and 2) specific procedural coding guidance provided by a recognized coding or reimbursement authority such as the American Medical Association (AMA) or the Centers for Medicare and Medicaid Services (CMS). This guide is in no way intended to promote the off-label use of medical devices.
Please note that while these materials are intended to provide coding information for a range of cardiology, rhythm, and vascular peripheral intervention procedures, the FDA- approved/cleared labeling for all products may not be consistent with all uses described in these materials. Some payers, including some Medicare contractors, may treat a procedure which is not specifically covered by a product’s FDA-approved labeling as a non-covered service.
The Medicare reimbursement amounts shown are currently published national average payments. Actual reimbursement will vary for each provider and institution for a variety of reasons including geographic differences in labor and non-labor costs, hospital teaching status, proportion of low-income patients, coverage, and/or payment rules. Please feel free to contact the Boston Scientific reimbursement department at 1-800-CARDIAC if you have any questions about the information in these materials. You can also find reimbursement updates on our website:
www.bostonscientific.com/reimbursement
DisclaimerPlease note: this coding information may include codes for procedures for which Boston Scientific 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 Boston Scientific products for which they are not cleared or approved.
Health economics and reimbursement information provided by Boston Scientific Corporation is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is provided for illustrative purposes only and does not constitute reimbursement or legal advice. Boston Scientific encourages providers to submit accurate and appropriate claims for services. It is always the provider's responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges, and modifiers for services that are rendered. Boston Scientific recommends that you consult with your payers, reimbursement specialists and/or legal counsel regarding coding, coverage and reimbursement matters. Boston Scientific does not promote the use of its products outside their FDA-approved label.
Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
CPT® DisclaimerCPT® Copyright 2015 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.
Boston Scientific does not promote the use of its products outside their FDA-approved label.
2016 Procedural Payment Guide
CRV-431307-AA OCT2016 Page 3 of 62
Physician Billing and Payment: Medicare and most other insurers typically reimburse physicians based on fee schedules tied to Current Procedural Terminology1 (CPT®) codes. CPT codes are published by the AMA and used to report medical services and procedures performed by or under the direction of physicians. Physician payment for procedures performed in an outpatient or inpatient hospital or Ambulatory Surgical Center (ASC) setting is described as an in-facility fee payment (listed as In-Hospital in document) while payment for procedures performed in the physician office is described as an in-office payment. In-facility payments reflect modifier -26 as applicable.
Hospital Outpatient Billing and Payment: Medicare reimburses hospitals for outpatient stays (typically stays that do not span 2 midnights) under Ambulatory Payment Classification (APC) groups. Medicare assigns an APC to a procedure based on the billed CPT/HCPCS (Healthcare Common Procedural Coding System) code. (Note that private insurers may require other procedure codes for outpatient payment.) While it is possible that separate APC payments may be deemed appropriate where more than one procedure is done during the same outpatient visit, many APCs are subject to reduced payment when multiple procedures are performed on the same day. Comprehensive APCs (J1 status indicator) can impact total payment received for outpatient services.
Hospitals report device category codes (C-codes) on claims when such devices are used in conjunction with procedure(s) billed and paid for under the OPPS. This reporting provides claims data used annually to update the OPPS payment rates. Although separate payment is not typically available for C-Codes, denials may result if applicable C- Codes are not included with associated procedure codes CMS has an established cost center for “Implantable Devices Charged to Patients”, available for cost reporting periods since May 1, 2009. As CMS uses data from this cost center to establish OPPS payments, it is important for providers to document device costs in this cost center to help ensure appropriate payment amounts.
Hospital Inpatient Billing and Payment: Medicare reimburses hospital inpatient procedures based on the Medicare Severity Diagnosis Related Group (MS-DRG). The MS-DRG is a system of classifying patients based on their diagnoses and the procedures performed during their hospital stay. MS-DRGs closely calibrate payment to the severity of a patient’s illness. One single MS-DRG payment is intended to cover all hospital costs associated with treating an individual during his or her hospital stay, with the exception of “professional” (e.g., physician) charges associated with performing medical procedures. Private payers may also use MS-DRG-based systems or other payer-specific system to pay hospitals for providing inpatient services.
ICD-10-PCS: Potential procedure codes are included within this guide. Due to the number of potential codes within the ICD-10-PCS system, the codes included in this document do not fully account for all procedure code options. Some codes outlined in this guide include an " _" symbol. For example, 027_34Z is listed as a potential code for reporting a coronary drug-eluting stent procedure. In this example, the "_" character could be 0, 1, 2 or 3, depending on the number of sites treated. The "_" symbol is not a recognized character within the ICD-10-PCS system.
ASC Billing and Payment: Many elective procedures are performed outside of the hospital in Medicare certified facilities also known as Ambulatory Surgical Centers (ASCs). Not all procedures that Medicare covers in the hospital setting are eligible for payment in an ASC. Medicare has a list of all services (as defined by CPT/HCPCs codes), generally non-surgical, that it covers when offered in an ASC. ASC allowed procedures can be found at http://www.cms.hhs.gov/ASCPayment/. Payments made to ASCs from private insurers depend on the contract the facility has with the payer.
CRV-431307-AA OCT2016 Page 4 of 62
+ Signifies Add-on CodeASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU7
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment MS-DRG Payment6
Rhythm Management Device Implant Procedures go to ICD-10-PCS list33206 $479 NA 7.39 $7,664 APC 5223 $9,273 02H63JZ
13.38 0JH604Z MS-DRG 244 without CC/MCC $12,7590JH605Z MS-DRG 243 with CC $15,708
MS-DRG 242 with MCC $22,07033207 $511 8.05 02HK3JZ
14.27 02HK0JZ0JH605Z0JH604Z
33208 $554 8.77 02H63JZ15.46 02HK0JZ
02HK3JZ0JH606Z
33212 $346 5.26 $5,787 APC 5222 $6,697 0JH604Z9.67 MS-DRG 259 without MCC $11,871
MS-DRG 258 with MCC $18,10133213 $362 5.53 $7,664 APC 5223 $9,273 0JH606Z
10.09
33221 $387 5.80 $12,616 APC 5224 $16,914 0JH607Z10.81
33214 $508 7.84 $7,664 APC 5223 $9,273 0JH636Z14.19 0JPT0PZ MS-DRG 244 without CC/MCC $12,759
02H63JZ MS-DRG 243 with CC $15,708
02HK3KZ MS-DRG 242 with MCC $22,070
33215 $322 4.92 $482 APC 5181 $8638.98 MS-DRG 262 without CC/MCC
$9,552
MS-DRG 261 with CC $11,680MS-DRG 260 with MCC $22,445
Insertion of pacemaker pulse generator only; with existing multiple leads
Rhythm Management 2016 Procedural Payment Guide
Permanent cardiac pacemaker implant
Cardiac pacemaker replacement
Permanent cardiac pacemaker implant
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular
Insertion of pacemaker pulse generator only; with existing single lead
Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode
Cardiac pacemaker revision except device implant
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 generation)
HOSPITALOUTPATIENT4
HOSPITALINPATIENT6
go to APC listInsertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial
Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular
*PHYSICIAN²
02WA3MZ
Insertion of pacemaker pulse generator only; with existing dual leads
CRV-431307-AA OCT2016 Page 5 of 62
+ Signifies Add-on CodeASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU7
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment MS-DRG Payment6
Rhythm Management 2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
HOSPITALOUTPATIENT4
HOSPITALINPATIENT6*PHYSICIAN²
Rhythm Management Device Implant Procedures continued go to ICD-10-PCS list33216 $397 NA 5.87 $5,787 APC 5222 $6,697 02H63JZ
11.09 02H63KZ MS-DRG 262 without CC/MCC $9,55202H73JZ MS-DRG 261 with CC $11,68002HK3JZ MS-DRG 260 with MCC $22,44502HL3JZ02HK3KZ ICD lead procedures02H73KZ MS-DRG 265 $19,15102HL3KZ
33217 $390 5.84 02H63KZ10.88
33218 $416 6.07 $1,392 APC 5221 $2,490 02WA3MZ11.61 02WA0MZ MS-DRG 262 without CC/MCC
$9,552
MS-DRG 261 with CC $11,680MS-DRG 260 with MCC $22,445
33220 $417 6.15 $1,392 APC 5221 $2,490 02WA0MZ11.63 02WA3MZ MS-DRG 262 without CC/MCC
$9,552
MS-DRG 261 with CC $11,68033222 $362 5.10 $789 APC 5054 $1,411 0JWT0PZ MS-DRG 260 with MCC $22,445
10.1133223 $436 6.55
12.1833224 $536 9.04 $7,664 APC 5223 $9,273 02H43JZ ICD lead procedures
14.96 02H43KZ MS-DRG 265 $19,15102HL0JZ02HL0KZ
Repair of single transvenous electrode, permanent pacemaker or pacing cardioverter-defibrillator
Insertion of 2 transvenous electrodes, permanent pacemaker or cardioverter-defribrillator
Insertion of a single transvenous electrode, permanent pacemaker or cardioverter-defibrillator
Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator)
Relocation of skin pocket for pacemaker
Cardiac pacemaker revision except device replacement
Cardiac pacemaker revision except device replacement
go to APC list
Repair of 2 transvenous electrodes for permanent pacemaker or pacing cardioverter-defibrillator
Relocation of skin pocket for implantable-defibrillator
Cardiac pacemaker revision except device implant
CRV-431307-AA OCT2016 Page 6 of 62
+ Signifies Add-on CodeASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU7
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment MS-DRG Payment6
Rhythm Management 2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
HOSPITALOUTPATIENT4
HOSPITALINPATIENT6*PHYSICIAN²
26 Rhythm Management Device Implant Procedures continued go to ICD-10-PCS list+33225 $487 NA 8.33 $0 02H43JZ
3322526 13.59 02H43KZ33225 02HL0JZ MS-DRG 222 with MCC $50,148
02HL0KZ MS-DRG 223 without MCC $38,837
MS-DRG 224 with MCC $45,238MS-DRG 225 without MCC $34,119
MS-DRG 226 with MCC $41,118MS-DRG 227 without MCC $32,539
MS-DRG 242 with MCC $22,070MS-DRG 243 with CC $15,708MS-DRG 244 without CC/MCC $12,759
33226 $514 8.68 $1,257 APC 5182 $2,24714.34
MS-DRG 262 without CC/MCC $9,552MS-DRG 261 with CC $11,680
33233 $252 3.39 $5,787 APC 5222 $6,697 0JPT0PZ MS-DRG 260 with MCC $22,4457.02
33227 $364 5.50 $5,787 0JH604Z10.17 0JPT0PZ
33228 $380 5.77 $7,664 APC 5223 $9,273 0JPT0PZ10.60 0JH606Z
33229 $400 6.04 $12,616 APC 5224 $16,914 0JPT09Z11.17 0JH607Z
Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) (List separately in addition to code for primary procedure)
Status N, items and services packaged into primary procedure APC
rate. No separate payment
02WA3MZ Cardiac pacemaker revision except device replacement
Permanent cardiac pacemaker implant
go to APC list
Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generaor; multiple lead system
Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system
Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator)
Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system
Removal of permanent pacemaker pulse generator only
Cardiac defibrillator implant without cardiac catheteraization
Cardiac defibrillator implant with cardiac catheterization with acute MI/HF/Shock
Cardiac defibrillator implant with cardiac catheterization without acute MI/HF/Shock
CRV-431307-AA OCT2016 Page 7 of 62
+ Signifies Add-on CodeASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU7
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment MS-DRG Payment6
Rhythm Management 2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
HOSPITALOUTPATIENT4
HOSPITALINPATIENT6*PHYSICIAN²
Rhythm Management Device Implant Procedures continued go to ICD-10-PCS list33234 $516 NA 7.91 $1,392 APC 5221 $2,490 02PA0MZ
14.40 02PA3MZMS-DRG 262 without CC/MCC $9,552
33235 $673 10.15 MS-DRG 261 with CC $11,68018.78 MS-DRG 260 with MCC $22,445
33240 $393 6.05 $19,581 APC 5231 $21,930 0JH608Z10.96 MS-DRG 245 $28,475
33230 $412 6.3211.51
33231 $429 6.59 $26,658 APC 5232 $30,49011.98
33241 $236 3.29 $1,286 APC 5221 $2,490 0JPT0PZ6.60
MS-DRG 262 without CC/MCC $9,552MS-DRG 261 with CC $11,680MS-DRG 260 with MCC $22,445
33262 $400 6.06 $19,581 APC 5231 $21,930 0JH608Z AICD Generator Procedures11.16 0JPT0PZ MS-DRG 245 with MCC $28,475
33263 $416 6.3311.60
33264 $433 6.60 $26,658 APC 5232 $30,49012.09
33244 $904 13.99 APC 5221 $2,490 02PA3MZ25.23
MS-DRG 262 without CC/MCC $9,552MS-DRG 261 with CC $11,680MS-DRG 260 with MCC $22,445
go to APC list
Insertion of implantable defibrillator pulse generator only; with existing multiple leads
Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular
Insertion of implantable defibrillator pulse generator only; with existing single lead
Insertion of implantable defibrillator pulse generator only; with existing dual leads
Removal of transvenous pacemaker electrode(s); dual lead system
Cardiac pacemaker revision except device replacement
AICD Generator Procedures
Not covered for ASC
payment
Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system
Removal of implantable defibrillator pulse generator only
Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system
Removal of single or dual chamber implantable defibrillator electrode(s); by transvenous extraction
Cardiac pacemaker revision except device replacement
Cardiac pacemaker revision except device replacement
Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system
CRV-431307-AA OCT2016 Page 8 of 62
+ Signifies Add-on CodeASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU7
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment MS-DRG Payment6
Rhythm Management 2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
HOSPITALOUTPATIENT4
HOSPITALINPATIENT6*PHYSICIAN²
Rhythm Management Device Implant Procedures continued go to ICD-10-PCS list
33249 $963 NA 15.17 $26,658 APC 5232 $30,490 02H63KZ26.89 02HK3KZ
0JH608Z MS-DRG 222 with MCC $50,14802HK0KZ MS-DRG 223 without MCC $38,83702HL0KZ02H43KZ
33270 $614 9.10 0JH608Z17.15 0JH60PZ MS-DRG 224 with MCC $45,238
MS-DRG 225 without MCC $34,119
MS-DRG 226 with MCC $41,118MS-DRG 227 without MCC $32,539
33271 $517 7.50 $5,787 APC 5222 $6,697 0JH60PZ ICD lead procedures14.44 MS-DRG 265 $19,151
33272 $365 5.42 NA APC 5221 $2,490 0JPT0PZ10.19
33273 $418 6.50 $1,392 0JWT0PZ11.68
WATCHMAN TM Left Atrial Appendage Closure (LAAC) Procedure0281T NA 0.00 NA 02L73DK
0.00 MS-DRG 273 with MCC $21,497 MS-DRG 274 without MCC $15,091
WATCHMAN is a registered or unregistered trademark of Boston Scientific Corporation
Percutaneous transcatheter closure of the left atrial appendage with implant, including fluoroscopy, transseptal puncture, catheter placement(s) left atrial angiography, left atrial appendage angiography, radiological supervision and interpretation
Cardiac defibrillator implant with cardiac catheterization without acute MI/HF/Shock
Percutaneous Intracardiac Procedures
go to APC list
Removal of subcutaneous implantable defibrillator electrode
Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode including defibrillation threshold evaluation, induction of arrhythmia evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed
Insertion of subcutaneous implantable defibrillator electrode
Reposition of previously implanted subcutaneous implantable defibrillator electrode
NAInpatient Only
Procedure
CarrierPriced
Cardiac defibrillator implant with cardiac catheterization with acute MI/HF/Shock
Insertion or replacement of permanent implantable defibrillator system with transvenous lead(s), single or dual chamber
Cardiac defibrillator implant without cardiac catheterization
CRV-431307-AA OCT2016 Page 9 of 62
+ Signifies Add-on CodeASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU7
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment MS-DRG Payment6
Rhythm Management 2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
HOSPITALOUTPATIENT4
HOSPITALINPATIENT6*PHYSICIAN²
26 Rhythm Management Device Evaluation Codes go to ICD-10-PCS list93279 $33 $50 0.65 APC 5741 $34 4B02XSZ
9327926 1.40
93280 $39 $58 0.779328026 1.63
93281 $46 $69 0.909328126 1.92
93282 $43 $63 0.85 4B02XTZ9328226 1.77
93283 $58 $82 1.159328326 2.30
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 analysis, review and report by a physician or other qualified health care professional; multiple lead pacemaker system
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 analysis, review and report by a physician or other qualified health care professional; dual lead transvenous implantable defibrillator system
ICD-10-PCS procedure code does not impact MS-DRGgo to APC list
Not covered for ASC
payment
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 analysis, review and report by a physician or other qualified health care professional; single lead pacemaker system
ICD-10-PCS procedure code does not impact MS-DRG
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 analysis, review and report by a physician or other qualified health care professional; dual lead pacemaker system
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 analysis, review and report by a physician or other qualified health care professional; single lead transvenous implantable defibrillator system
CRV-431307-AA OCT2016 Page 10 of 62
+ Signifies Add-on CodeASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU7
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment MS-DRG Payment6
Rhythm Management 2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
HOSPITALOUTPATIENT4
HOSPITALINPATIENT6*PHYSICIAN²
Rhythm Management Device Evaluation Codes continued go to ICD-10-PCS list
93284 $64 $91 1.25 APC 5741 $34 4B02XTZ9328426 2.54
93260 $46 $68 0.859326026 1.89
93285 $27 $43 0.52 4A12X4Z9328526 1.19
93286 $15 $28 0.30 4B02XSZ9328626 0.77
93287 $23 $37 0.45 4B02XTZ9328726 1.02
ICD-10-PCS procedure code does not impact MS-DRG
go to APC list
NA
Not covered for ASC
payment
Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead implantable defibrillator system
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 analysis, review and report by a physician or other qualified health care professional; implantable subcutaneous lead defibrillator system
Peri-procedural device evaluation (in person) and programming of device device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead pacemaker system
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 analysis, review and report by a physician or other qualified health care professional; implantable loop recorder system
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 analysis, review and report by a physician or other qualified health care professional; multiple lead transvenous implantable defibrillator system
ICD-10-PCS procedure code does not impact MS-DRG
CRV-431307-AA OCT2016 Page 11 of 62
+ Signifies Add-on CodeASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU7
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment MS-DRG Payment6
Rhythm Management 2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
HOSPITALOUTPATIENT4
HOSPITALINPATIENT6*PHYSICIAN²
Rhythm Management Device Evaluation Codes continued go to ICD-10-PCS list93288 $21 $37 0.43 APC 5741 $34 4B02XSZ
9328826 1.04
93289 $46 $66 0.92 4B02XTZ9328926 1.84
93261 $39 $61 0.74 4B02XTZ9326126 1.71
93290 $22 $32 0.43 4A02XFZ9329026 0.88
93291 $22 $37 0.43 APC 5732 $319329126 1.02
ICD-10-PCS procedure code does not impact MS-DRG
ICD-10-PCS procedure code does not impact MS-DRG
Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, 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
go to APC list
Not covered for ASC
payment
Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable loop recorder system, including heart rhythm derived data analysis
Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable subcutaneous lead defibrillator system
Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead transvenous implantable defibrillator system, including analysis of heart rhythm derived data elements
Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system
CRV-431307-AA OCT2016 Page 12 of 62
+ Signifies Add-on CodeASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU7
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment MS-DRG Payment6
Rhythm Management 2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
HOSPITALOUTPATIENT4
HOSPITALINPATIENT6*PHYSICIAN²
Rhythm Management Device Evaluation Codes continued go to ICD-10-PCS list93292 $21 $33 0.43 APC 5741 $34 4B02XTZ
9329226 0.91
93293 $16 $54 0.329329326 1.50
93294 $34 $34 0.65 4B02XSZ9329426 0.96
93295 $68 $68 1.29 4B02XTZ9329526 1.90
93296 NA $26 0.00 APC 5741 $34 4B02XSZ9329626 0.73 4B02XTZ
93297 $27 $27 0.52 4A02X9Z9329726 0.75
ICD-10-PCS procedure code does not impact MS-DRG
ICD-10-PCS procedure code does not impact MS-DRGNot covered for ASC
payment
Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; wearable defibrillator systemTranstelephonic rhythm strip pacemaker evaluation(s) single, dual or multiple lead pacemaker system, includes recording with and without magnet application with analysis, review and report(s) by a physician or other qualified health care professional, up to 90 days
Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional
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, analysis, review(s) and report(s) by a physician or other qualified health care professional
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
Interrogation device evaluation(s) (remote), up to 90 days single, dual, or multiple lead implantable defibrillator system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional
NA
go to APC list
CRV-431307-AA OCT2016 Page 13 of 62
+ Signifies Add-on CodeASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU7
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment MS-DRG Payment6
Rhythm Management 2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
HOSPITALOUTPATIENT4
HOSPITALINPATIENT6*PHYSICIAN²
Rhythm Management Device Evaluation Codes continued go to ICD-10-PCS list93298 $27 $27 0.52 4A02X9Z
9329826 0.75
93299 $0 0.00 APC 5741 $349329926 0.00
Intracardiac Electrophysiology Procedures/Studies93318 NA NA 2.40 B244ZZ4
9331826 3.32 B246ZZ493318 B24BZZ4
B24CZZ4B24DZZ4
+93462 $217 NA 3.73 4A023N79346226 6.07 MS-DRG 273 with MCC $21,497
93462 MS-DRG 274 without MCC $15,091
93600 Bundle of His recording $123 2.12 APC 5212 $4,698 4A023FZ9360026 3.42
93602 $120 2.129360226 3.35
93603 $120 2.12 APC 5211 $8459360326 3.35+93609 $287 4.99 02K83ZZ
9360926 8.02 MS-DRG 273 with MCC $21,49793609 MS-DRG 274 without MCC $15,091
93610 $170 3.02 APC 5212 $4,698 4A0234Z9361026 4.75
93612 $169 3.029361226 4.72
Please Note: Boston Scientific currently has no FDA-approved ablation catheters for the treatment of atrial fibrillation
ICD-10-PCS procedure code does not impact MS-DRG
Percutaneous Intracardiac Procedures
ICD-10-PCS procedure code does not impact MS-DRG
Contractor priced
Not covered for ASC
payment
Status N, items and services packaged into primary
procedure APC rate. No separate payment
Status N, items and services packaged into primary
procedure APC rate. No separate payment
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
go to APC listNot covered
for ASC payment
NA
Right ventricular recording
Intraventricular pacing
Interrogation device evaluation(s), (remote) up to 30 days; implantable loop recorder system, including analysis of recorded heart rhythm data, analysis, review(s) and report(s) by a physician or other qualified health care professional
Echocardiography, transesophageal (TEE) for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis
Intra-atrial pacing
Intraventricular and/or intra-atrial mapping of tachycardia site(s) with catheter manipulation to record from multiple sites to identify origin of tachycardia (list separately in addition to code for primary procedure)
Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure)
Not covered for ASC
payment
Status N, items and services packaged into primary
procedure APC rate. No separate payment
Percutaneous Intracardiac Procedures
Intra-atrial recording
ICD-10-PCS procedure code does not impact MS-DRG
ICD-10-PCS procedure code does not impact MS-DRG
CRV-431307-AA OCT2016 Page 14 of 62
+ Signifies Add-on CodeASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU7
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment MS-DRG Payment6
Rhythm Management 2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
HOSPITALOUTPATIENT4
HOSPITALINPATIENT6*PHYSICIAN²
Intracardiac Electrophysiology Procedures/Studies go to ICD-10-PCS list+93613 $414 NA 6.99 02K83ZZ
9361326 11.55 MS-DRG 273 with MCC $21,49793613 MS-DRG 274 without MCC $15,091
93615 $53 0.99 APC 5211 $845 4A02X4Z9361526 1.49
93616 $67 1.499361626 1.86
93618 $245 4.259361826 6.84
93619 $418 7.31 APC 5212 $4,698 4A0234Z9361926 11.68 MS-DRG 273 with MCC $21,497
MS-DRG 274 without MCC $15,091
93620 $664 11.579362026 18.54
+93621 $121 2.109362126 3.38 MS-DRG 273 with MCC $21,497
93621 MS-DRG 274 without MCC $15,091
Please Note: Boston Scientific currently has no FDA-approved ablation catheters for the treatment of atrial fibrillation
Percutaneous Intracardiac Procedures
ICD-10-PCS procedure code does not impact MS-DRG
Comprehensive electrophysiologic 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
Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left atrial pacing and recording from coronary sinus or left atrium (List separately in addition to code for primary procedure)
Not covered for ASC
payment
Percutaneous Intracardiac Procedures
Percutaneous Intracardiac ProceduresStatus N, items and services packaged into primary procedure APC
rate. No separate payment
Status N, items and services packaged into primary procedure APC
rate. No separate payment
Comprehensive electrohysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia
Induction of arrhythmia by electrical pacing
Esophageal recording of atrial electrogram with or without ventricular electrogram(s); with pacing
Esophageal recording of atrial electrogram with or without ventricular electrogram(s)
Intracardiac electrophysiologic 3-dimensional mapping (List separately in addition to code for primary procedure)
Not covered for ASC
payment
go to APC list
CRV-431307-AA OCT2016 Page 15 of 62
+ Signifies Add-on CodeASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU7
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment MS-DRG Payment6
Rhythm Management 2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
HOSPITALOUTPATIENT4
HOSPITALINPATIENT6*PHYSICIAN²
Intracardiac Electrophysiology Procedures/Studies continued go to ICD-10-PCS list+93622 $177 NA 3.10 4A0234Z
9362226 4.94 MS-DRG 273 with MCC $21,49793622 MS-DRG 274 without MCC $15,091
+93623 $164 2.85 4A023FZ9362326 4.59 3E043KZ
93623 3E033KZ93624 $272 4.80 APC 5212 $4,698 4A023FZ
9362426 7.60
93640 $199 3.519364026 5.56
93641 $339 5.929364126 9.45
93642 $281 4.88 APC 5211 $8459364226 7.85
Please Note: Boston Scientific currently has no FDA-approved ablation catheters for the treatment of atrial fibrillation
go to APC list
Not covered for ASC
payment
4A02XFZ
Percutaneous Intracardiac Procedures
ICD-10-PCS procedure code does not impact MS-DRGElectrophysiologic 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
Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or attempted induction of arrhythmia
Programmed stimulation and pacing after intravenous drug infusion (List separately in addition to code for primary procedure)
Status N, items and services packaged into primary procedure APC
rate. No separate payment
4A02XFZ
Status N, items and services packaged into primary procedure APC
rate. No separate payment
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
Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left ventricular pacing and recording (List separately in addition to code for primary procedure)
4A02XFZElectrophysiologic evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters)
CRV-431307-AA OCT2016 Page 16 of 62
+ Signifies Add-on CodeASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU7
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment MS-DRG Payment6
Rhythm Management 2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
HOSPITALOUTPATIENT4
HOSPITALINPATIENT6*PHYSICIAN²
26 Intracardiac Electrophysiology Procedures/Studies continued go to ICD-10-PCS list93644 $176 $282 3.29 4B02XTZ
9364426 4.91
93650 $627 NA 10.49 APC 5212 $4,698 02583ZZ9365026 17.51 0JH636Z MS-DRG 273 with MCC $21,497
0JH634Z MS-DRG 274 without MCC $15,091
93653 $883 15.00 APC 5213 $15,561 02583ZZ 24.64 4A0234Z
93654 $1,176 20.009365426 32.81
Please Note: Boston Scientific currently has no FDA-approved ablation catheters for the treatment of atrial fibrillation
Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording (when necessary) and His bundle recording (when necessary) with intracardiac catheter ablation of arrhythmogenic focus; with treatment of ventricular tachycardia or focus of ventricular ectopy including intracardiac electrophysiologic 3D mapping, when performed, and left ventricular pacing and recording, when performed
Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording (when necessary) and His bundle recording (when necessary) with intracardiac catheter ablation of arrhythmogenic focus; with treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathway, accessory atrioventricular connection, cavo-tricuspid isthmus or other single atrial focus or source of atrial re-entry
Percutaneous Intracardiac Procedures
go to APC list
Electrophysicial evaluation of subcutaneous implantable defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters
NA
Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of completer heart block, with or without temporary pacemaker placement
ICD-10-PCS procedure code does not impact MS-DRGNot covered for ASC
payment
CRV-431307-AA OCT2016 Page 17 of 62
+ Signifies Add-on CodeASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU7
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment MS-DRG Payment6
Rhythm Management 2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
HOSPITALOUTPATIENT4
HOSPITALINPATIENT6*PHYSICIAN²
Intracardiac Electrophysiology Procedures/Studies continued go to ICD-10-PCS list+93655 $441 NA 7.50 02583ZZ
9365526 12.32 4A0234Z MS-DRG 273 with MCC $21,49793655 MS-DRG 274 without MCC $15,091
93656 $1,176 20.02 APC 5213 $15,5619365626 32.83
+93657 $441 NA 7.50 02563ZZ93657 12.31 02573ZZ
93660 $96 $160 1.89 APC 5723 $397 3E033KZ9366026 2.67 3E043KZ
4A12XFZ
+93662 $145 NA 2.80 B244ZZ39366226 4.05 B245ZZ3
93662 B246ZZ3B24BZZ3B24DZZ3
Please Note: Boston Scientific currently has no FDA-approved ablation catheters for the treatment of atrial fibrillation
ICD-10-PCS procedure code does not impact MS-DRG
Intracardiac catheter ablation of a discrete mechanism of arrhythmia which is distinct from the primary ablated mechanism, including repeat diagnostic maneuvers, to treat a spontaneous or induced arrhythmia (List separately in addition to code for primary procedure)
Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (list separately in addition to code for primary procedure)
Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia including left or right atrial pacing/recording when necessary, right ventricular pacing/recording when necessary and His bundle recording when necessary with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation
go to APC list
Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (List separately in addition to code for primary procedure)
NA
NA
Status N, items and services packaged into primary procedure APC
rate. No separate payment
Evaluation of cardiovascular function with tilt table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention
Percutaneous Intracardiac ProceduresNot covered for ASC
payment
CRV-362201-AA JAN2016 Page 18 of 62
1 Current Procedural Terminology (CPT) CPT® Copyright 2015 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association.
3 Source: CMS website. ASC Addenda Updates: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates.html
5 Source: CMS ICD-10-CM/PCS MS-DRG v34 Definitions Manual https://www.cms.gov/ICD10Manual/version34-fullcode-cms/fullcode_cms/P0001.html
7 Total RVU is the relative value unit total for In-Facility calculation. For codes 93279-93284, 93260, 93285-93289, 93261, and 93290-93299 Total RVUs represent In-office total RVUs.
Note: Some of the codes presented above may be used to code for a variety of procedures (diagnostic and therapeutic) employed in the field of electrophysiology, including atrial fibrillation, atrial flutter, AV Node, SVT and VT ablations. Please note that no Boston Scientific products are approved for sale in the US for atrial fibrillation ablations
2 Source: CMS website. Physician Fee Schedule – 2016 National Physician Fee Schedule Relative Value File: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html
4 Source: CMS website. 2016 OPPS Addendum B: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices.html
6 Source: Data tables (FY2017 IPPS Final Rule). CMS Website. National average (wage index greater than one) MS- DRG rates calculated using the national adjusted full update standardized labor, non-labor and capital amounts. Actual reimbursement will vary for each provider and institution for a variety of reasons including geographic differences in labor and non-labor costs, hospital teaching status, and/or proportion of low-income patients). https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2016-IPPS-Final-Rule-Home-Page.html
Rhythm Management 2016 Procedural Payment Guide
CRV-431307-AA OCT2016 Page 19 of 62
Select Coronary Interventions
CPT®Code¹
CPT Descriptions In-Hospital2Work RVUTotal RVU9
APCCategory
APCPayment3
Possible ICD-10-PCS Codes4
PossibleMS-DRG Assignment MS-DRG Payment5,6
26 Diagnostic Cardiac Catheterization (Use physician modifier -26 as appropriate) go to ICD-10-PCS list93451 $149 2.72 APC 5188 $2,549 4A023N6right 4.16 4A020N6
9345126 MS-DRG 216 with MCC $57,51693530 $228 4.22 MS-DRG 217 with CC $37,691right 6.37 MS-DRG 218 without CC/MCC $33,803
935302693452 $262 4.75 4A023N7
left 7.30 4A020N79345226 MS-DRG 222 with MCC6 $50,148
93462 $217 3.73 MS-DRG 223 without MCC6 $38,837left 6.07
934622693453 $345 6.24 4A023N8
combined 9.64 4A020N8 MS-DRG 224 with MCC6 $45,2389345326
MS-DRG 225 without MCC6 $34,119
93531 $446 8.34combined 12.44
9353126 MS-DRG 233 with MCC $44,65693532 $553 9.99 MS-DRG 234 without MCC $29,535
combined 15.449353226
93533 $369 6.69combined 10.31 MS-DRG 286 with MCC $13,1379353326 MS-DRG 287 without MCC $6,974
AtherosclerosisMS-DRG 302 with MCC $6,207MS-DRG 303 without MCC $3,834
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed
Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure)
*PHYSICIAN²HOSPITAL
OUTPATIENTHOSPITALINPATIENT
go to APC list
Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
Right heart catheterization, for congenital cardiac anomalies
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization
Cardiac defibrillator implant with cardiac catheterization with AMI/HF/Shock
Cardiac defibrillator implant with cardiac catheterization without AMI/HF/ShockCombined right heart catheterization and left heart catheterization including
intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed
Status N, items and services packaged into primary procedure APC
Coronary bypass with cardiac catheterization
Circulatory disorders except AMI with cardiac catheterization
Combined right heart catheterization and transseptal left heart catheterization through intact septum, with or without retrograde left heart catheterization, for congenital cardiac anomalies
Combined right heart catheterization and retrograde left heart catheterization, for congenital cardiac anomalies
Combined right heart catheterization and transseptal left heart catheterization through existing septal opening, with or without retrograde left heart catheterization, for congenital cardiac anomalies)
CRV-431307-AA OCT2016 Page 20 of 62
Select Coronary Interventions
CPT®Code¹
CPT Descriptions In-Hospital2Work RVUTotal RVU9
APCCategory
APCPayment3
Possible ICD-10-PCS Codes4
PossibleMS-DRG Assignment MS-DRG Payment5,6
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENTHOSPITALINPATIENT
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
26 Diagnostic Cardiac Catheterization (Use physician modifier -26 as appropriate) go to ICD-10-PCS list
93454 $265 4.79 APC 5188 $2,549 B21 _ _ ZZplacement 7.40
93455 $306 5.54 MS-DRG 216 with MCC $57,516placement 8.55 MS-DRG 217 with CC $37,6919345526 MS-DRG 218 without CC/MCC $33,803
93456 $340 6.15placement 9.49 MS-DRG 222 with MCC6 $50,1489345626 MS-DRG 223 without MCC6 $38,837
93457 $381 6.89placement 10.649345726
MS-DRG 224 with MCC6 $45,23893458 $324 5.85 MS-DRG 225 without MCC6 $34,119
placement 9.049345826
93459 $365 6.60 MS-DRG 233 with MCC $44,656placement 10.19 MS-DRG 234 without MCC $29,5359345926
MS-DRG 286 with MCC $13,137MS-DRG 287 without MCC $6,974
93460 $406 7.35placement 11.34 Atherosclerosis
MS-DRG 302 with MCC $6,207MS-DRG 303 without MCC $3,834
934602693461 $448 8.10
placement 12.50
9346126
go to APC list
Cardiac defibrillator implant with cardiac catheterization without AMI/HF/Shock
Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial venous grafts) including intraprocedural injection(s) for bypass graft angiography
Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization
Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed
Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography
Catheter placement in coronary artery(s) for coronary angiography, including intraproceduralinjection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization
Catheter placement in coronary artery(s) for coronary angiography, including intraproceduralinjection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography
Catheter placement in coronary artery(s) for coronary angiography, including intraproceduralinjection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed
Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging S&I
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization
Cardiac defibrillator implant with cardiac catheterization with AMI/HF/Shock
Coronary bypass with cardiac catheterization
Circulatory disorders except AMI with cardiac catheterization
CRV-431307-AA OCT2016 Page 21 of 62
Select Coronary Interventions
CPT®Code¹
CPT Descriptions In-Hospital2Work RVUTotal RVU9
APCCategory
APCPayment3
Possible ICD-10-PCS Codes4
PossibleMS-DRG Assignment MS-DRG Payment5,6
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENTHOSPITALINPATIENT
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
Injection Diagnostic Cardiac Catheterization(Each site may be injected multiple times, only report each code once) go to ICD-10-PCS list
+93563 $61 1.11 3E053KZ93563 1.69 3E063KZ
+93564 $64 1.13 3E053KZ93564 1.78 3E063KZ
+93565 $48 0.86 3E073KZ93565 1.33 3E083KZ
+93566 $48 0.8693566 1.34
+93567 $54 0.97 3E053KZ93567 1.52 3E063KZ
+93568 $49 0.8893568 1.37
26 Miscellaneous+93463 $101 2.00 3E073KZ
93463 2.81 3E083KZ
+93464 $89 1.80 4A1335C9346426 2.48
93464
Injection procedure during cardiac catheterization including imaging supervision and interpretation, and report; for pulmonary angiography (List separately in addition to code for primary procedure)
Injection procedure during cardiac catheterization including imaging supervision and interpretation, and report; for supravalvular aortography (List separately in addition to code for primary procedure)
Injection procedure during cardiac catheterization including imaging supervision and interpretation, and report; for selective opacification of aortocoronary venous or arterial bypass graft(s) (eg, aortocoronary saphenous vein, free radial artery, or free mammary artery graft) to one or more coronary arteries and in situ arterial conduits (eg, internal mammary), whether native or used for bypass to one or more coronary arteries during congenital heart catheterization, when performed (List separately in addition to code for primary procedure)
Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective coronary angiography during congenital heart catheterization (List separately in addition to code for primary procedure)
Status N, items and services packaged into primary procedure APC
rate. No separate payment
Status N, items and services packaged into primary procedure APC
rate. No separate payment
go to APC list
Pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrinone, or other agent) including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration, when performed (List separately in addition to code for primary procedure)
Injection procedure during cardiac catheterization including imaging supervision and interpretation, and report; for selective left ventricular or left arterial angiography (List separately in addition to code for primary procedure)
Injection procedure during cardiac catheterization including imaging supervision and interpretation, and report; for selective right ventricular or right atrial angiography (List separately in addition to code for primary procedure)
NA8
Physiologic exercise study (eg, bicycle or arm ergometry) including assessing hemodynamic measurements before and after (List separately in addition to code for primary procedure)
NA7
CRV-431307-AA OCT2016 Page 22 of 62
Select Coronary Interventions
CPT®Code¹
CPT Descriptions In-Hospital2Work RVUTotal RVU9
APCCategory
APCPayment3
Possible ICD-10-PCS Codes4
PossibleMS-DRG Assignment MS-DRG Payment5,6
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENTHOSPITALINPATIENT
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
Coronary Angioplasty (PTCA), without stent go to ICD-10-PCS list92920 $569 10.10 APC 5191 $4,592 027_3ZZ
15.87 027_3Z6+92921 $0 0.00 MS-DRG 250 with MCC $15,685
92921 0.00 MS-DRG 251 without MCC $10,060
Coronary Atherectomy, without stent92924 $675 11.99 APC 5192 $9,542 02C_3ZZ
18.84
+92925 $0 0.00 MS-DRG 250 with MCC $15,68592925 0.00 MS-DRG 251 without MCC $10,060
Bare Metal Coronary Stent with Angioplasty92928 $631 11.21 APC 5192 $9,542 027_3DZ
17.62 027_3D6MS-DRG 248 with MCC $18,157
+92929 $0 0.00 MS-DRG 249 without MCC $11,54592929 0.00
Drug-Eluting Coronary Stent with AngioplastyC9600 APC 5192 $9,542 027_34Z
027_346MS-DRG 246 with MCC $19,398
+C9601 MS-DRG 247 without MCC $12,659
Percutaneous cardiovascular procedures with drug- eluting stent
Percutaneous cardiovascular procedures without coronary artery stent
Percutaneous transluminal coronary angioplasty; single major coronary artery or branch
Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; single major coronary artery or branch
Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)
NA
Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of major coronary artery
NAPhysicians use codes
92928/+92929
Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch
Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)
NA
NAPercutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)
Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch
Percutaneous cardiovascular procedures with non-drug-eluting stent
Percutaneous cardiovascular procedures without coronary artery stent
go to APC list
NA
CRV-431307-AA OCT2016 Page 23 of 62
Select Coronary Interventions
CPT®Code¹
CPT Descriptions In-Hospital2Work RVUTotal RVU9
APCCategory
APCPayment3
Possible ICD-10-PCS Codes4
PossibleMS-DRG Assignment MS-DRG Payment5,6
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENTHOSPITALINPATIENT
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
Bare Metal Coronary Stent with Atherectomy go to ICD-10-PCS list92933 $706 12.54 APC 5193 $14,612 027_3DZ
19.71 027_3D602C_3ZZ MS-DRG 248 with MCC $18,157
+92934 $0 0.00 MS-DRG 249 without MCC $11,54592934 0.00
Drug-Eluting Coronary Stent with AtherectomyC9602 APC 5193 $14,612 027_34Z
027_34602C_3ZZ MS-DRG 246 with MCC $19,398
+C9603 MS-DRG 247 without MCC $12,659
Bare Metal Stent - Bypass Graft Revascularization92937 $631 11.20 APC 5192 $9,542 027_3DZ
17.60 027_3D602C_3ZZ MS-DRG 248 with MCC $18,157
MS-DRG 249 without MCC $11,545+92938 $0 0.00
92938 0.00
Drug-Eluting Stent - Bypass Graft RevascularizationC9604 APC 5192 $9,542 027_34Z
027_34602C_3ZZ MS-DRG 246 with MCC $19,398
MS-DRG 247 without MCC $12,659+C9605
go to APC list
Percutaneous cardiovascular procedures with non-drug- eluting stent
NA
NA
Percutaneous cardiovascular procedures with drug- eluting stent
Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft (list separately in addition to code for primary procedure)
Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch
Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure
NA
Percutaneous cardiovascular procedures with non-drug- eluting stent
Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch
Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery
Percutaneous cardiovascular procedures with drug- eluting stent
Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel
Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel
NAPhysicians use codes
92937/+92938
NAPhysicians use codes
92933/+92934
Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft
NA
CRV-431307-AA OCT2016 Page 24 of 62
Select Coronary Interventions
CPT®Code¹
CPT Descriptions In-Hospital2Work RVUTotal RVU9
APCCategory
APCPayment3
Possible ICD-10-PCS Codes4
PossibleMS-DRG Assignment MS-DRG Payment5,6
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENTHOSPITALINPATIENT
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
Bare Metal Stent - Acute Myocardial Infarction Revascularization go to ICD-10-PCS list
92941 $708 12.56 APC 5192 $9,542 027_3DZ19.75 027_3D6
02C_3ZZ MS-DRG 248 with MCC $18,157MC-DRG 249 without MCC $11,545
Drug-Eluting Stent - Acute Myocardial Infarction RevascularizationC9606 APC 5193 $14,612 027_34Z
027_34602C_3ZZ MS-DRG 246 with MCC $19,398
MS-DRG 247 without MCC $12,659
Bare Metal Stent - Chronic Total Occlusion Revascularization92943 $707 12.56 APC 5192 $9,542 027_3DZ
19.74 027_3D602C_3ZZ MS-DRG 248 with MCC $18,157
MS-DRG 249 without MCC $11,545+92944 $0 0.0092944 0.00
Drug-Eluting Stent - Chronic Total Occlusion RevascularizationC9607 APC 5193 $14,612 027_34Z
02C_3ZZ027_346 MS-DRG 246 with MCC $19,398
MS-DRG 247 without MCC $12,659+C9608
BSC currently has no stents FDA-approved for CTOs
NA
Percutaneous cardiovascular procedures with non-drug-eluting stent
Percutaneous cardiovascular procedures with drug-eluting stent
NA
go to APC list
Percutaneous cardiovascular procedures with non-drug- eluting stent
Percutaneous cardiovascular procedures with drug- eluting stent
Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (list separately in addition to code for primary procedure)
Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of drug- eluting intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel
NAPhysicians use codes 92941
Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel
Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft
NAPhysicians use codes
92943/+92944
Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel
Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel
CRV-431307-AA OCT2016 Page 25 of 62
Select Coronary Interventions
CPT®Code¹
CPT Descriptions In-Hospital2Work RVUTotal RVU9
APCCategory
APCPayment3
Possible ICD-10-PCS Codes4
PossibleMS-DRG Assignment MS-DRG Payment5,6
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENTHOSPITALINPATIENT
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
26 Intravascular Ultrasound (Use physician modifier -26 as appropriate) go to ICD-10-PCS list+92978 $99 1.80 B240ZZ392978 2.77 B241ZZ3 MS-DRG 231 with MCC $48,106
9297826 MS-DRG 232 without MCC $35,112
+92979 $80 1.4492979 2.22
9297926$19,398
Fractional Flow Reserve (FFR) (Use physician modifier -26 as appropriate) MS-DRG 247 without MCC $12,659
+93571 $99 1.80 4A033BC93571 2.77
9357126
+93572 $80 1.44 $18,15793572 2.22 MS-DRG 249 without MCC $11,545
9357226
MS-DRG 250 with MCC $15,685MS-DRG 251 without MCC $10,060
MS-DRG 286 with MCC $13,137MS-DRG 287 without MCC $6,974
go to APC list
Status N, items and services packaged into primary procedure APC
rate. No separate payment
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)
Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; initial vessel (List separately in addition to code for primary procedure)
Status N, items and services packaged into primary procedure APC
rate. No separate payment
Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; each additional vessel (List separately in addition to code for primary procedure)
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)
Coronary bypass with PTCA
Percutaneous cardiovascular procedure with drug-eluting stentMS-DRG 246 with MCC or 4+ vessels/stents
Percutaneous cardiovascular procedure with non-drug- eluting stent
MS-DRG 248 with MCC or 4+ vessels/stents
Percutaneous cardiovascular procedure without coronary artery stent
Circulatory disorders except AMI, with cardiac catheterization
CRV-431307-AA OCT2016 Page 26 of 62
Select Coronary Interventions
CPT®Code¹
CPT Descriptions In-Hospital2Work RVUTotal RVU9
APCCategory
APCPayment3
Possible ICD-10-PCS Codes4
PossibleMS-DRG Assignment MS-DRG Payment5,6
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENTHOSPITALINPATIENT
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
Thrombectomy go to ICD-10-PCS list+92973 $185 3.28 02C_3ZZ92973 5.15
$19,398MS-DRG 247 without MCC $12,659
$18,157MS-DRG 249 without MCC $11,545
MS-DRG 250 with MCC $15,685MS-DRG 251 without MCC $10,060
Percutaneous Balloon Valvuloplasty; Aortic Valve92986 $1,387 22.85 5191 $4,539 027F3ZZ
38.72 027F4ZZ MS-DRG 273 with MCC $21,49792987 $1,430 23.63 5192 $9,542 027G3ZZ MS-DRG 274 without MCC $15,091
39.92 027G4ZZ92990 $1,129 18.27 027H3ZZ
31.51 027H4ZZ
Percutaneous transluminal coronary thrombectomy mechanical (List separately in addition to code for primary procedure)
NA
MS-DRG 246 with MCC or 4+ vessels/stents
Percutaneous cardiovascular procedure with drug-eluting stent
Percutaneous balloon valvuloplasty; aortic valve
Percutaneous balloon valvuloplasty; mitral valve
Percutaneous balloon valvuloplasty; pulmonary valve
Percutaneous Intracardiac Procedures
MS-DRG 248 with MCC or 4+ vessels/stents
Percutaneous cardiovascular procedure without coronary artery stent
Percutaneous cardiovascular procedure with non-drug- eluting stent
go to APC list
CRV-431307-AA OCT2016 Page 27 of 62
Select Coronary Interventions
CPT®Code¹
CPT Descriptions In-Hospital2Work RVUTotal RVU9
APCCategory
APCPayment3
Possible ICD-10-PCS Codes4
PossibleMS-DRG Assignment MS-DRG Payment5,6
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENTHOSPITALINPATIENT
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
Endovascular or Transthoracic Valves go to ICD-10-PCS list33361 $1,421 25.13 02RF37ZAortic 39.65 02RF38Z33362 $1,553 27.52 02RF3JZ MS-DRG 266 with MCC $50,057Aortic 43.36 02RF3KZ MS-DRG 267 without MCC $38,59933363 $1,614 28.50Aortic 45.0433364 $1,692 30.00Aortic 47.22
33365 $1,862 33.12Aortic 51.9833366 $2,015 35.88 02RF3JHAortic 56.24
+33367 $655 11.88 02RF3_ZAortic 18.27 5A1221Z33367
+33368 $785 14.39 02RF0_ZAortic 21.91 5A1221Z33368
+33369 $1,037 19.00 02RF3JZAortic 28.95 5A1221Z33369
Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approachTranscatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approachTranscatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac artery approach
Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (e.g., median sternotomy, mediastinotomy)Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transapical exposure (eg, left thoracotomy)
Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with percutaneous peripheral arterial and venous cannulation (e.g., femoral vessels) (list separately in addition to code for primary procedure)
go to APC list
Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with central arterial and venous cannulation (e.g., aorta, right atrium, pulmonary artery) (list separately in addition to code for primary procedure)
Endovascular Cardiac Valve ReplacementNA
Inpatient OnlyProcedure
Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach
Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with open peripheral arterial and venous cannulation (e.g., femoral, iliac, axillary vessels) (list separately in addition to code for primary procedure)
CRV-431307-AA OCT2016 Page 28 of 62
Select Coronary Interventions
CPT®Code¹
CPT Descriptions In-Hospital2Work RVUTotal RVU9
APCCategory
APCPayment3
Possible ICD-10-PCS Codes4
PossibleMS-DRG Assignment MS-DRG Payment5,6
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENTHOSPITALINPATIENT
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
Endovascular or Transthoracic Valves continued go to ICD-10-PCS list0262T 0.00 02RH3_Z
Pulmonary 0.000.00 02RH3_H MS-DRG 266 with MCC $50,0570.00 MS-DRG 267 without MCC $38,599
33418 $1,874 32.25 02UG3JZ52.30
MS-DRG 228 with MCC $42,266
+33419 $441 7.93 MS-DRG 229 without MCC $28,30412.31
33419
WATCHMAN TM Left Atrial Appendage Closure (LAAC) Procedure0281T 0.00 02L73DK
0.00 MS-DRG 273 with MCC $21,497 MS-DRG 274 without MCC $15,091
WATCHMAN is a registered or unregistered trademark of Boston Scientific Corporation. All other trademarks are the property of their respective owners.
Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; additional prosthesis(es) during same session (List separately in addition to code for primary procedure)
Percutaneous Intracardiac ProceduresTranscatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis
33999 Unlisted procedure, cardiac surgery
Implantation of catheter-delivered prosthetic pulmonary valve, endovascular approach Carrier priced
go to APC list
Endovascular Cardiac Valve Replacement
Percutaneous Intracardiac ProceduresPercutaneous transcatheter closure of the left atrial appendage with implant, including fluoroscopy, transseptal puncture, catheter placement(s) left atrial angiography, left atrial appendage angiography, radiological supervision and interpretation
Carrier Priced
NAInpatient Only
Procedure
CRV-431307-AA OCT2016 Page 29 of 62
Select Coronary Interventions 2016 Procedural Payment Guide
6 Not intended as an all inclusive list of MS-DRGs.7 Procedure codes do not exist for this procedure because it does not drive the MS-DRG grouping.8 MS-DRG grouping is driven by other primary procedures that are performed in conjunction with this procedure.9 Total RVU is the relative value unit total for In-Facility calculation
1 Current Procedural Terminology (CPT) © 2015 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association.
2 Source: CMS website. Physician Fee Schedule – 2016 National Physician Fee Schedule Relative Value File: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html
3 Source: CMS website. 2016 OPPS Addendum B: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices.html
4 Source: CMS ICD-10-CM/PCS MS-DRG v34 Definitions Manual https://www.cms.gov/ICD10Manual/version34-fullcode-cms/fullcode_cms/P0001.html5 Source: Data tables (FY2017 IPPS Final Rule). CMS Website. National average (wage index greater than one) MS- DRG rates calculated using the national adjusted full update standardized labor, non-labor and capital amounts. Actual reimbursement will vary for each provider and institution for a variety of reasons including geographic differences in labor and non-labor costs, hospital teaching status, and/or proportion of low-income patients). https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2017-IPPS-Final-Rule-Home-Page.html
CRV-431307-AA OCT2016 Page 30 of 62
Select Peripheral Interventions
ASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU8
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment
MS-DRG Payment67
Peripheral Percutaneous Transluminal Balloon Angioplasty go to ICD-10-PCS list
35471 $549 $2,604 10.05 NA APC 5191 $4,592 04793ZZ15.33 047A3ZZ MS-DRG 252 with MCC $19,756
35472 $374 $1,877 6.90 027W3ZZ MS-DRG 253 with CC $15,76910.45 04703ZZ $10,594
35475 $349 $1,586 6.60 037_3ZZ9.74 03Q_3ZZ
35476 $282 $1,454 5.10 067_3ZZ02HK0JZ 7.87
2675962 $27 02HL0JZ 0.54 NA B31_ _ZZ
7596226 0.76
75964 $18 $89 0.367596426 0.51
75966 $66 $173 1.31 B41_ _ZZ7596626 02HK0JZ 1.83
75968 $18 $88 0.367596826 0.51
75978 $27 $140 0.54 APC 5182 $2,247 B51_ _ZA
7597826 0.76
$1,244
Radiological S&I Codes -Billed in Conjunction with Procedure Code (Use physician modifier -26 as appropriate)Transluminal balloon angioplasty, peripheral artery other than cervical carotid, renal or other visceral artery, iliac and lower extremity, radiological supervision and interpretation
NA 8
Transluminal balloon angioplasty, percutaneous; venous
Transluminal balloon angioplasty, venous (eg, subclavian stenosis), radiological supervision and interpretation
Transluminal balloon angioplasty, renal or other visceral artery, radiological supervision and interpretationTranluminal balloon angioplasty, each additional visceral artery, radiological supervision and interpretation (List separately in addition to code for primary procedure)
Transluminal balloon angioplasty, each additional peripheral artery other than cervical carotid, renal or other visceral artery iliac and lower extremity, radiological supervision and interpretation (List separately in addition to code for primary procedure)
2016 Procedural Payment Guide
Transluminal balloon angioplasty, percutaneous; aortic
Transluminal balloon angioplasty, percutaneous; brachiocephalic trunk or branches, each vessel
$1,315
go to APC list
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENT4HOSPITAL
INPATIENT6
Transluminal balloon angioplasty, percutaneous; renal or visceral artery
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
Other vascular procedures
MS-DRG 254 without CC/MCC
CRV-431307-AA OCT2016 Page 31 of 62
Select Peripheral Interventions
ASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU8
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment
MS-DRG Payment67
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENT4HOSPITAL
INPATIENT6
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
Iliac Artery Revascularization go to ICD-10-PCS list37220 $438 02HK0KZ 8.15 $2,288 APC 5191 $4,592 047_3ZZ
12.22 MS-DRG 252 with MCC $19,75637221 $538 02HL0KZ 10.00 $5,984 APC 5192 $9,542 047_3DZ MS-DRG 253 with CC $15,769
15.01 $10,594
37222 $197 $904 3.73 047_3ZZ5.51
37223 $226 $2,638 4.25 047_3DZ6.32
37224 $482 $3,905 9.00 $2,288 APC 5191 $4,592 047_3ZZ13.44 047_3Z1 MS-DRG 252 with MCC $19,756
MS-DRG 253 with CC $15,76937225 $653 $11,220 12.00 $5,984 APC 5192 $9,542 04C_3ZZ $10,594
18.23
37226 $566 $9,224 10.49 $5,984 APC 5192 $9,542 047_3DZ15.80
37227 $786 $15,151 14.50 $9,819 APC 5193 $14,612 047_3DZ21.94 04C_3ZZ
Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty
Status N, items and services packaged into primary procedure APC
rate. No separate payment
Femoral/Popliteal Artery Revascularization
Other vascular procedures
Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)
MS-DRG 254 without CC/MCC
Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within same vessel, when performed
go to APC list
Other vascular procedures
Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed
Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal angioplasty
Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
MS-DRG 254 without CC/MCC
CRV-431307-AA OCT2016 Page 32 of 62
Select Peripheral Interventions
ASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU8
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment
MS-DRG Payment67
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENT4HOSPITAL
INPATIENT6
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
Tibial/Peroneal Artery Revascularization go to ICD-10-PCS list
37228 $589 $5,548 11.00 $5,984 APC 5192 $9,542 047_3ZZ16.43 047_3Z1 MS-DRG 252 with MCC $19,756
MS-DRG 253 with CC $15,76937229 $762 $11,055 14.05 $9,819 APC 5193 $14,612 04C_3ZZ $10,594
21.26
37230 $751 $8,456 13.80 $9,819 APC 5193 $14,612 047_3ZZ20.95
37231 $816 $13,604 15.00 $9,819 APC 5193 $14,612 047_3DZ22.77 04C_3ZZ
37232 $214 $1,236 4.00 047_3ZZ5.97 MS-DRG 252 with MCC $19,756
MS-DRG 253 with CC $15,769$10,594
37233 $348 $1,494 6.50 04C_3ZZ9.72
37234 $300 $3,950 5.50 047_3ZZ8.38
37235 $426 $4,159 7.80 047_3DZ11.90 04C_3ZZ
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed
Other vascular procedures
go to APC list
MS-DRG 254 without CC/MCC
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal angioplasty
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty. (List separately in addition to code for primary procedure)
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed. (List separately in addition to code for primary procedure)
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
Status N, items and services packaged into primary procedure APC
rate. No separate paymentRevascularization, endovascular, open or percutaneous, tibial/peroneal artery,
unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed. (List separately in addition to code for primary procedure)
Other vascular procedures
MS-DRG 254 without CC/MCC
Revascularization, endovascular, open or percutaneous, tibial\peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed. (List separately in addition to code for primary procedure
CRV-431307-AA OCT2016 Page 33 of 62
Select Peripheral Interventions
ASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU8
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment
MS-DRG Payment67
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENT4HOSPITAL
INPATIENT6
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
(Peripheral stenting is covered at local Medicare contractor discretion. Payment amounts assume procedure is covered) go to ICD-10-PCS list37236 $477 $4,190 9.00 $5,984 APC 5192 $9,542 027_3DZ
13.30 037_3DZ MS-DRG 252 with MCC $19,756047_3DZ MS-DRG 253 with CC $15,769
$10,594
37237 $225 $2,505 4.256.27
37238 $330 $4,271 6.29 $5,984 APC 5192 $9,542 057_3DZ9.21 067_3DZ
37239 $157 $2,067 2.974.39
MS-DRG 254 without CC/MCC
Other vascular procedures
Transcatheter placement of an intravascular stent(s) (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; each additional artery (List separately in addition to code for primary procedure)
Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; initial vein
Status N, items and services packaged into primary procedure APC
rate. No separate payment
Transcatheter placement of an intravascular stent(s) (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery
Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; each additional vein (List separately in addition to code for primary procedure)
Status N, items and services packaged into primary procedure APC
rate. No separate payment
BSC currently has no stent approved for use in the veins of the lower extremities
go to APC listTranscatheter Placement of Intravascular Stents
CRV-431307-AA OCT2016 Page 34 of 62
Select Peripheral Interventions
ASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU8
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment
MS-DRG Payment67
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENT4HOSPITAL
INPATIENT6
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
Medicare will not consider payment for the procedure when performed without embolic protection.) go to ICD-10-PCS list37215 $1,054 NA 18.00 NA 037_3DZ Carotid artery stent procedure
29.41 MS-DRG 034 with MCC $22,963MS-DRG 035 with CC $13,935
37216 $0 NA 0.00 $10,4290.00
37241 $473 $4,871 9.00 NA APC 5192 $9,542 06L_3DZ Other major cardiovascular procedures13.20 MS-DRG 270 with MCC $28,382
MS-DRG 271 with CC $18,650$13,789
37242 $517 $7,806 10.05 03L_3DZ Other vascular procedures14.42 04L_3DZ MS-DRG 252 with MCC $19,756
MS-DRG 253 with CC $15,769MS-DRG 254 without CC/MCC $10,594
MS-DRG 987 $19,84337243 $609 $9,912 11.99 03L_3DZ MS-DRG 988 $10,241
17.01 04L_3DZ MS-DRG 989 $6,300
MS-DRG 749 $16,43137244 $714 $6,907 14.00 03L_3DZ MS-DRG 750 $7,749
19.93 04L_3DZ
NAInpatient only procedure
go to APC list
MS-DRG 272 without CC/MCC
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms)
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles)
Transcatheter Placement of Carotid Stents with embolic protection(Boston Scientifics’ carotid WALLSTENT® Monorail® Endoprosthesis device is indicated for carotid artery stenting with embolic protection only.
MS-DRG 036 without CC/MCC
NANot paid by Medicare
Embolization
Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; without distal embolic protection
Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; with distal embolic protection
CRV-431307-AA OCT2016 Page 35 of 62
Select Peripheral Interventions
ASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU8
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment
MS-DRG Payment67
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENT4HOSPITAL
INPATIENT6
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
Catheter Access go to ICD-10-PCS list36140 $107 $442 2.01 NA NA
3.00
36147 $194 $853 3.72 $482 APC 5181 $8635.42
36148 $51 $267 1.00 NA1.43
36160 $129 $502 2.523.59
36200 $161 $635 3.024.48
go to APC list
NA 8Status N, items and services packaged into primary procedure APC
rate
Introduction of needle or intracatheter, aortic, translumbar
Introduction of catheter, aorta
Introduction of needle or intracatheter; extremity artery
Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/fistula); initial access with complete radiological evaluation of dialysis access, including fluoroscopy, image documentation and report (includes access of shunt, injection[s] of contrast, and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow, including the inferior or superior vena cava)
Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/fistula); additional access for therapeutic intervention (List separately in addition to code for primary procedure)
Status N, items and services packaged into primary procedure APC
rate. No separate payment
CRV-431307-AA OCT2016 Page 36 of 62
Select Peripheral Interventions
ASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU8
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment
MS-DRG Payment67
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENT4HOSPITAL
INPATIENT6
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
Catheter Placement go to ICD-10-PCS list
36215 $245 $1,146 4.67 NA 03H233Z6.85
36216 $290 $1,226 5.27 03H333Z8.10
36217 $346 $2,047 6.29 03H733Z9.65
36218 $56 $196 1.01 03H333Z1.55
36245 $264 $1,397 4.90 04H_33Z7.36
36246 $282 $908 5.277.86
36247 $334 $1,607 6.299.31
36248 $52 $156 1.011.44
36251 $294 $1,453 5.35 APC 5526 $2,719 04H_33Z8.21
go to APC list
Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family
Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family
Selective catheter placement, arterial system; additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate)Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed and flush aortogram when performed; unilateral
NA 8
Selective catheter placement, arterial system; initial third order or more selective thoracic or brachiocephalic branch, within a vascular family
NA 8
Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family
Status N, items and services packaged into primary procedure APC
rate. No separate payment
Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family
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)
Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family
NA 8
CRV-431307-AA OCT2016 Page 37 of 62
Select Peripheral Interventions
ASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU8
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment
MS-DRG Payment67
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENT4HOSPITAL
INPATIENT6
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
Catheter Placement continued go to ICD-10-PCS list
36252 $392 $1,576 6.99 NA APC 5526 $2,719 04H_33Z10.95
36253 $395 $2,305 7.55 APC 5526 $2,71911.02
36254 $456 $2,245 8.1512.72
Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed and flush aortogram when performed; bilateral
NA 8
NA 8Superselective catheter placement (one or more second order or higher renal artery branches), renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed and flush aortogram when performed; unilateral
go to APC list
Superselective catheter placement (one or more second order or higher renal artery branches), renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed and flush aortogram when performed; bilateral
CRV-431307-AA OCT2016 Page 38 of 62
Select Peripheral Interventions
ASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU8
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment
MS-DRG Payment67
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENT4HOSPITAL
INPATIENT6
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
26 Angiography (Use physician modifier -26 as appropriate) go to ICD-10-PCS list
75710 $57 $165 1.14 NA APC 5526 $2,719 B31 _ _ ZZ
7571026 1.60 B41 _ _ ZZ75716 $66 $189 1.31
7571626 1.8375726 $57 $151 1.14
7572626 1.5875731 $58 $174 1.14 B41 _ _ ZZ
7573126 1.6375733 $64 $186 1.31 B418 _ ZZ
7573326 1.8075736 $56 $162 1.14 B41 _ _ ZZ
7573626 1.5775774 $18 $88 0.36
7577426 0.50
37182 $868 NA 16.97 NA 06H43DZ Other vascular procedures24.23 06H83DZ MS-DRG 252 with MCC $19,756
MS-DRG 253 with CC $15,769$10,594
37183 $410 $6,018 7.99 APC 5191 $4,592 06H43DZ11.43 06H83DZ
06PY3DZ06WY3DZ
go to APC list
NA
NA 8
Transhepatic Shunts (TIPS)Insertion of transvenous intrahepatic portosystemic shunt(s) (TIPS) (includes venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract formation/dilatation, stent placement and all associated imaging guidance and documentation)
NA
Revision of transvenous intrahepatic portosystemic shunt(s) (TIPS) (includes venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract recanulization/dilatation, stent placement and all associated imaging guidance and documentation)
MS-DRG 254 without CC/MCC
Angiography, adrenal, unilateral, selective, radiological supervision and interpretationAngiography, adrenal, bilateral, selective, radiological supervision and interpretationAngiography, pelvic, selective or supraselective, radiological supervision and interpretation
Angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision and interpretation
Angiography, extremity, unilateral, radiological supervision and interpretation
Angiography, extremity, bilateral, radiological supervision and interpretation
Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation (List separately in addition to code for primary procedure)
CRV-431307-AA OCT2016 Page 39 of 62
Select Peripheral Interventions
ASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU8
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment
MS-DRG Payment67
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENT4HOSPITAL
INPATIENT6
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
Arteriovenous Fistual Thrombectomy go to ICD-10-PCS list36870 $312 $1,867 5.2 $2,288 APC 5191 $4,592 03CY3ZZ Other vascular procedures
8.71 05CY3ZZ MS-DRG 252 with MCC $19,756MS-DRG 253 with CC $15,769
$10,594
37184 $482 $2,315 8.66 $2,122 APC 5183 $3,795 03C_3ZZ13.46 04C_3ZZ MS-DRG 270 with MCC $28,382
MS-DRG 271 with CC $18,650$13,789
37185 $176 $737 3.284.92
Other vascular proceduresMS-DRG 252 with MCC $19,756MS-DRG 253 with CC $15,769
37186 $262 $1,406 4.92 $10,5947.32
37187 $427 $2,098 8.03 $2,122 APC 5183 $3,795 05C_3ZZ11.91 MS-DRG 270 with MCC $28,382
MS-DRG 271 with CC $18,650$13,789
37188 $307 $1,811 5.71 $1,2578.56
Other vascular proceduresMS-DRG 252 with MCC $19,756MS-DRG 253 with CC $15,769
$10,594
Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy
Venous Thrombectomy
MS-DRG 272 without CC/MCC
Other major cardiovascular procedures
Other major cardiovascular procedures
go to APC list
Thrombectomy, percutaneous, arteriovenous fistula, autogenous or nonautogenous graft (includes mechanical thrombus extraction and intra- graft thrombolysis)
MS-DRG 254 without CC/MCC
Secondary percutaneous transluminal thrombectomy (eg, nonprimary mechanical, snare basket, suction technique), noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with another percutaneous intervention other than primary mechanical thrombectomy (List separately in addition to code for primary procedure
MS-DRG 272 without MCC/CC
Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance
Arterial Thrombectomy
Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); second and all subsequent vessel(s) within the same vascular family (List separately in addition to code for primary mechanical thrombectomy procedure)
Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel
MS-DRG 254 without CC/MCC
MS-DRG 254 without CC/MCC
CRV-431307-AA OCT2016 Page 40 of 62
Select Peripheral Interventions
ASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU8
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment
MS-DRG Payment67
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENT4HOSPITAL
INPATIENT6
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
Thrombolysis go to ICD-10-PCS list37211 $419 NA 8.00 $2,122 APC 5183 $3,795 3E05317
11.69 3E06317 MS-DRG 299 with MCC $8,446MS-DRG 300 with CC $6,010
37212 $368 NA 7.06 $482 APC 5181 $863 3E03317 $4,31610.28 3E04317
37213 $259 NA 5.00 NA APC 5182 $2,247 3E033177.22 3E04317
3E053173E06317
37214 $142 NA 2.74 NA APC 5182 $2,2473.95
37191 $250 $2,681 4.71 NA APC 5183 $3,795 06H03DZ Other vascular procedures6.97 MS-DRG 252 with MCC $19,756
MS-DRG 253 with CC $15,769$10,594
37192 $385 $1,579 7.35 NA 06WY3DZ10.74
37193 $383 $1,631 7.35 NA 06PY3DZ10.69
Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed
MS-DRG 301 without MCC/CC
Peripheral vascular disorders
Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day
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
go to APC list
Repositioning of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed
Retrieval (removal) of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed
MS-DRG 254 without CC/MCC
Transcatheter therapy, arterial infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, initial treatment day
Vena Cava Filters
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
CRV-431307-AA OCT2016 Page 41 of 62
Select Peripheral Interventions
ASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU8
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment
MS-DRG Payment67
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENT4HOSPITAL
INPATIENT6
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
Intravascular Ultrasound go to ICD-10-PCS list
37252 $97 $1,422 1.80 $0 B44_ZZ3 Other vascular procedures2.70 B54_ZZ3 MS-DRG 252 with MCC $19,756
MS-DRG 253 with CC $15,769
37253 $77 $221 1.44 $0 $10,5942.16
Biliary ProceduresDiagnostic
47531 $100 $378 1.80 $0 APC 5524 $352 BF001ZZ2.78 MS-DRG 444 with MCC $9,527
MS-DRG 445 with CC $6,157$4,557
47532 $224 $832 4.25 $0 APC 5351 $2,177 BF030ZZ6.26 BF0C1ZZ
BF100ZZBF111ZZBF130ZZBF140ZZ
Drainage (Internal Stent/External Cathether)47533 $318 $1,359 6.00 $1,217 APC 5351 $2,177 0F24X0Z
8.88
47534 $422 $1,674 8.03 $1,217 0F24XYZ11.77
47535 $242 $1,123 4.50 $1,217 0F2BX0Z6.76
Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation; existing access
Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation; new access (eg, percutaneous transhepatic cholangiogram)
Disorders of the biliary tract
MS-DRG 446 without CC/MCC
Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure)
NA
MS-DRG 254 without CC/MCC
go to APC list
Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel (List separately in addition to code for primary procedure)
Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; externalPlacement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; internal-externalConversion of external biliary drainage catheter to internal-external biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation
CRV-431307-AA OCT2016 Page 42 of 62
Select Peripheral Interventions
ASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU8
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment
MS-DRG Payment67
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENT4HOSPITAL
INPATIENT6
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
Biliary ProceduresDrainage (Internal Stent/External Cathether) continued go to ICD-10-PCS list
47536 $153 $828 2.88 $1,217 APC 5351 $2,177 0F2BXYZ4.28 MS-DRG 444 with MCC $9,527
MS-DRG 445 with CC $6,157$4,557
47537 $104 $410 1.83 $270 APC 5391 $483 0F753DZ2.89
47538 $341 $4,570 6.60 $2,303 APC 5352 $4,118 0F753ZZ9.53
47539 $462 $4,995 9.00 $2,303 0F754DZ12.89
47540 $552 $5,195 10.75 $2,303 0F763DZ15.40
47541 $294 $1,200 5.61 $1,217 APC 5351 $2,177 0F763ZZ8.20
Disorders of the biliary tract
MS-DRG 446 without CC/MCC
Exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation
Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation, each stent; new access, without placement of separate biliary drainage catheter
Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation, each stent; new access, with placement of separate biliary drainage catheter (eg, external or internal-external)
Placement of access through the biliary tree and into small bowel to assist with an endoscopic biliary procedure (eg, rendezvous procedure), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation, new access
Removal of biliary drainage catheter, percutaneous, requiring fluoroscopic guidance (eg, with concurrent indwelling biliary stents), including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation
Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation, each stent; existing access
go to APC list
CRV-431307-AA OCT2016 Page 43 of 62
Select Peripheral Interventions
ASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU8
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment
MS-DRG Payment67
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENT4HOSPITAL
INPATIENT6
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
26 Biliary ProceduresDrainage (Internal Stent/External Cathether) continued go to ICD-10-PCS list
47542 $139 $525 2.50 $0 0F764DZ3.87 MS-DRG 444 with MCC $9,527
MS-DRG 445 with CC $6,157$4,557
47543 $175 $1,350 3.07 $04.89
47544 $219 $825 4.29 $06.12
49421 $240 NA 4.21 $1,461 APC 5341 $2,613 0WHG03Z6.71
49423 $75 $559 1.46 $675 APC 5392 $1,208 0D2_X0Z2.09 0W2_X0Z
75984 $36 $36 0.72 BF10_ZZ7598426 1.00
Status N, items and services packaged into primary procedure APC
rate. No separate payment
N/A 8
Disorders of the biliary tract
MS-DRG 446 without CC/MCC
Balloon dilation of biliary duct(s) or of ampulla (sphincteroplasty), percutaneous, including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, each duct (List separately in addition to code for primary procedure)
Insertion of intraperitoneal cannula or catheter for drainage or dialysis, open
Exchange of previously placed abscess or cyst drainage catheter under radiological guidance (separate procedure) Change of percutaneous tube or drainage catheter with contrast monitoring (eg, genitourinary system, abscess), radiological supervision and interpretation
Endoluminal biopsy(ies) of biliary tree, percutaneous, any method(s) (eg, brush, forceps, and/or needle), including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, single or multiple (List separately in addition to code for primary procedure)
NAgo to APC list
Removal of calculi/debris from biliary duct(s) and/or gallbladder, percutaneous, including destruction of calculi by any method (eg, mechanical, electrohydraulic, lithotripsy) when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)
CRV-431307-AA OCT2016 Page 44 of 62
Select Peripheral Interventions
ASC³
CPT®Code¹
CPT DescriptionsIn-Hospital
(-26)In-Office(Global)
Work RVUTotal RVU8
ASCPayment³
APCCategory
APCPayment4
Possible ICD-10-PCS Codes5
PossibleMS-DRG Assignment
MS-DRG Payment67
2016 Procedural Payment Guide
Payer policies will vary and should be verified prior to treatment for limiations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
*National Average Medicare physician payment rates calculated using the 2016 conversion factor of $35.8279
*PHYSICIAN²HOSPITAL
OUTPATIENT4HOSPITAL
INPATIENT6
Inpatient information effective through September 30, 2017 │ APC and ASC information effective through December 31, 2016 │ Physician fee information effective through December 31, 2016
47556 $435 NA 8.55 $2,303 APC 5352 $4,118 0F783DZ4755626 12.13 0F793DZ MS-DRG 444 with MCC $9,527
0F9430Z MS-DRG 445 with CC $6,1570F9530Z $4,5570F9830Z
26
74363 $44 $44 0.88 NA BF00_ZZ
7436326 1.22 BF10_ZZBF12_ZZ
Radiofrequency Ablation go to ICD-10-PCS list
47370 $1,298 NA 20.80 NA APC 5362 $6,861 0F5_4ZZ4737026 36.24 MS-DRG 405 with MCC $32,482
MS-DRG 406 with CC $16,59547382 $800 $5,095 15.22 $2,303 APC 5352 $4,118 0F5_3ZZ $11,998
4738226 22.3347380 $1,502 NA 24.56 NA 0F5_0ZZ
4738026 41.9326
76940 $105 $105 2.00 NA BF45ZZZ
7694026 2.94
Radiological S&I Codes – Billed in Conjunction with Procedure Code (Use physician modifier -26 as appropriate)Ultrasound guidance for, and monitoring of, parenchymal tissue ablation Status N, items and
services packaged into primary procedure APC
rate. No separate payment
N/A 8
Percutaneous transhepatic dilation of biliary duct stricture with or without placement of stent, radiological supervision and interpretation
Status N, items and services packaged into primary procedure APC
rate. No separate payment
N/A 8
Laparoscopy, surgical, ablation of 1 or more liver tumor(s); radiofrequency
Ablation, 1 or more liver tumor(s), percutaneous, radiofrequency
Ablation, open, of 1 or more liver tumor(s); radiofrequency NA
go to APC list
MS-DRG 407 without CC/MCC
Disorders of the biliary tract
Pancreas, Liver and Shunt Procedures
Biliary StentingBiliary endoscopy, percutaneous via T-tube or other tract; with dilation of biliary duct stricture(s) with stent
MS-DRG 446 without CC/MCC
Radiological S&I Codes – Billed in Conjunction with Procedure Code (Use physician modifier -26 as appropriate)
CRV-431307-AA OCT2016 Page 45 of 62
Select Peripheral Interventions
1 Current Procedural Terminology (CPT) © 2015 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association
6 Not intended as an all inclusive list of MS-DRGs.7 Procedure codes do not exist for this procedure because it does not drive the MS-DRG grouping.8 Total RVU is the relative value unit total for In-Facility calculation
2 Source: CMS website. Physician Fee Schedule – 2016 National Physician Fee Schedule Relative Value File: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html
3 Source: CMS website. ASC Addenda Updates: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates.html
2016 Procedural Payment G
4 Source: CMS website. 2016 OPPS Addendum B: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices.html
5 Source: CMS ICD-10-CM/PCS MS-DRG v34 Definitions Manual https://www.cms.gov/ICD10Manual/version34-fullcode-cms/fullcode_cms/P0001.html
CRV-431307-AA OCT2016 Page 46 of 62
APPENDIX AAPC Reference Table
APC Category APC Payment APC Description5054 $1,411 Level 4 Skin Procedures5181 $863 Level 1 Vascular Procedures5182 $2,247 Level 2 Vascular Procedures5183 $3,795 Level 3 Vascular Procedures5188 $2,549 Diagnostic Cardiac Catheterization5191 $4,592 Level 1 Endovascular Procedures5192 $9,542 Level 2 Endovascular Procedures5193 $14,612 Level 3 Endovascular Procedures5211 $845 Level 1 Electrophysiologic Procedures5212 $4,698 Level 2 Electrophysiologic Procedures5213 $15,561 Level 3 Electrophysiologic Procedures5221 $2,490 Level1 Pacemaker and Similar Procedures5222 $6,697 Level 2 Pacemaker and Similar Procedures5223 $9,273 Level 3 Pacemaker and Similar Procedures5224 $16,914 Level 4 Pacemaker and Similar Procedures5231 $21,930 Level 1 ICD and Similar Procedures5232 $30,490 Level 2 ICD and Similar Procedures5341 $2,613 Peritoneal and Abdominal Procedures 5351 $2,177 Level 1 Percutaneous Abdominal/Biliary Procedures and Related Procedures5352 $4,118 Level 2 Percutaneous Abdominal/Biliary Procedures and Related Procedures5362 $6,861 Level 2 Laparoscopy5391 $483 Level 1 Tube/Catheter Changes/Thoracentesis/Lavage5392 $1,208 Level 2 Tube/Catheter Changes/Thoracentesis/Lavage5524 $352 Level 4 X-Ray and Related Services 5526 $2,719 Level 6 X-Ray and Related Services5723 $397 Level 3 Diagnostic Tests and Related Services5732 $31 Level 2 Minor Procedures5741 $34 Level 1 Electronic Analysis of Devices
CRV-431307-AA OCT2016 Page 47 of 62
APPENDIX BCategory Code (C-Code) Reference Guide 2016
Category Codes Category Code DescriptionC1721 Cardioverter-defibrillator, dual chamber (implantable)C1729 Catheter, drainageC1730 Catheter, electrophysiology, diagnostic, other than 3-D mapping (19 or fewer electrodes)C1731 Catheter, electrophysiology, diagnostic, other than 3-D mapping (20 or more electrodes)C1732 Catheter, electrophysiology, diagnostic/ablation, 3-D or vector mapping C1733 Catheter, electrophysiology, diagnostic/ablation, other than 3-D or vector mapping, other than cool-tipC1766 Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-awayC1769 Guide WireC1772 Cardioverter-defibrillator, single chamber (implantable)C1777 Lead, cardioverter-defibrillator, endocardial single coil (implantable)C1785 Pacemaker, dual chamber, rate-responsive (implantable)C1786 Pacemaker, single chamber, rate-responsive (implantable)C1882 Cardioverter-defibrillator, other than single or dual chamber (implantable)C1883 Adaptor/extension, pacing lead or neurostimulator lead (implantable)C1887 Catheter, guiding (may include infusion/perfusion capability)C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed curve, other than peel-awayC1894 Introducer/sheath, other than guiding, intracardiac electrophysiological, non-laserC1895 Lead, cardioverter-defibrillator, endocardial dual coil (implantable)C1896 Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)C1898 Lead, pacemaker, other than transvenous VDD single passC1900 Lead, coronary venousC2621 Pacemaker, other than single or dual chamber (implantable)C2628 Catheter, occlusionC2630 Catheter, electrophysiology, diagnostic/ablation, other than 3-D or vector mapping cool-tip
BSC C-Code Finder Website
C-Codes are VERY important to future reimbursement. Use of all applicable C-Codes on a claim allows identification of device(s) utilized in a procedure and may affect future payment rates.
Rhythm Management
CRV-431307-AA OCT2016 Page 48 of 62
Category Codes Category Code DescriptionC1724 Catheter, transluminal atherectomy, rotationalC1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)C1753 Catheter, intravascular ultrasoundC1757 Catheter, embolectomy/thrombectomyC1769 Guide wireC1874 Stent, coated/covered, with delivery systemC1876 Stent, noncoated/noncovered, with delivery systemC1884 Embolization protective systemC1887 Catheter, guiding (may include infusion/perfusion capability)C1894 Introducer/sheath, other than guiding, other than intracardiac electrophysiological, nonlaser
Category Codes Category Code DescriptionC1724 Catheter, transluminal atherectomy, rotationalC1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)C1753 Catheter, intravascular ultrasoundC1757 Catheter, thrombectomy, embolectomyC1769 Guide wireC1874 Stent, coated/covered, with delivery systemC1876 Stent, non-coated/non-covered, with delivery systemC1880 Vena cava filterC1884 Embolization protective systemC1887 Catheter, guiding (may include infusion/perfusion capability)C2623 Catheter, transluminal angioplasty, drug-coated, non-laserC2628 Catheter, occlusion
Coronary
Peripheral
CRV-431307-AA OCT2016 Page 49 of 62
APPENDIX CICD-10-PCS Reference Table - Note that some procedures may require multiple procedure codes to be reported
ICD-10-PCS DescriptionRhythm ManagementPacemaker Procedures
0JH604Z Insertion of Pacemaker, Single Chamber into Chest Subcutaneous Tissue and Fascia, Open Approach0JH636Z Insertion of Pacemaker, Dual Chamber into Chest Subcutaneous Tissue and Fascia, Percutaneous Approach0JH604Z Insertion of Pacemaker, Single Chamber into Chest Subcutaneous Tissue and Fascia, Open Approach
0JH605Z Insertion of Pacemaker, Single Chamber - Rate Responsive into Chest Subcutaneous Tissue and Fascia, Open Approach0JH606Z Insertion of Pacemaker, Dual Chamber into Chest Subcutaneous Tissue and Fascia, Open Approach02H63JZ Insertion of Pacemaker Lead into Right Atrium, Percutaneous Approach02H73JZ Insertion of Pacemaker Lead into Left Atrium, Percutaneous Approach02HK3JZ Insertion of Pacemaker Lead into Right Ventricle, Percutaneous Approach02HK0JZ Insertion of Pacemaker Lead into Right Ventricle, Open Approach02HL3JZ Insertion of Pacemaker Lead into Left Ventricle, Percutaneous Approach02HL0JZ Insertion of Pacemaker Lead into Left Ventricle, Open Approach02H43JZ Insertion of Pacemaker Lead into Coronary Vein, Percutaneous Approach 0JPT0PZ Removal of permanent pacemaker pulse generator only 4B02XSZ Measurement of Cardiac Pacemaker, External Approach
0JH607Z Insertion of Cardiac Resynchronization Pacemaker Pulse Generator into Chest Subcutaneous Tissue and Fascia, Open Approach02H63JZ Insertion of Pacemaker Lead into Right Atrium, Percutaneous Approach02HK3JZ Insertion of Pacemaker Lead into Right Ventricle, Percutaneous Approach02HK0JZ Insertion of Pacemaker Lead into Right Ventricle, Open Approach02H43JZ Insertion of Pacemaker Lead into Coronary Vein, Percutaneous Approach
0JH608Z Insertion of Defibrillator Generator into Chest Subcutaneous Tissue and Fascia, Open Approach02H63KZ Insertion of Defibrillator Lead into Right Atrium, Percutaneous Approach 02H73KZ Insertion of Defibrillator Lead into Left Atrium, Percutaneous Approach 02HK3KZ Insertion of Defibrillator Lead into Right Ventricle, Percutaneous Approach02HK0KZ Insertion of Defibrillator Lead into Right Ventricle, Open Approach02HL3KZ Insertion of Defibrillator Lead into Left Ventricle, Percutaneous Approach02HL0KZ Insertion of Defibrillator Lead into Left Ventricle, Open Approach
CRT-P
Defibrillator Procedures
CRV-431307-AA OCT2016 Page 50 of 62
APPENDIX CICD-10-PCS Reference Table - Note that some procedures may require multiple procedure codes to be reported
ICD-10-PCS Description02H43KZ Insertion of Defibrillator Lead into Coronary Vein, Percutaneous Approach 4B02XTZ Measurement of Cardiac Defibrillator, External Approach
CRT-D 0JH609Z Insertion of Cardiac Resynchronization Defibrillator Pulse Generator into Chest Subcutaneous Tissue and Fascia, Open Approach 02H63KZ Insertion of Defibrillator Lead into Right Atrium, Percutaneous Approach 02HK3KZ Insertion of Defibrillator Lead into Right Ventricle, Percutaneous Approach02HK0KZ Insertion of Defibrillator Lead into Right Ventricle, Open Approach02H43KZ Insertion of Defibrillator Lead into Coronary Vein, Percutaneous Approach
0JH60PZ Insertion of Cardiac Rhythm Related Device into Chest Subcutaneous Tissue and Fascia, Open Approach
02PA0MZ Removal of Cardiac Lead from Heart, Open Approach02PA3MZ Removal of Cardiac Lead from Heart, Percutaneous Approach
02WA0MZ Revision of Cardiac Lead in Heart, Open Approach02WA3MZ Revision of Cardiac Lead in Heart, Percutaneous Approach
0JPT0PZ Removal of Cardiac Rhythm Related Device from Trunk Subcutaneous Tissue and Fascia, Open Approach
0JWT0PZ Revision of Cardiac Rhythm Related Device in Trunk Subcutaneous Tissue and Fascia, Open Approach
02L73DK Occlusion of Left Atrial Appendage with Intraluminal Device, Percutaneous Approach
4A02X4Z Measurement of Cardiac Electrical Activity, External Approach
4A12X42 Monitoring of Cardiac Electrical Activity, External Approach4A02X9Z Measurement of Cardiac Electrical Activity, External Approach
Programming ILR and Remote Interrogation of ICM and ILR (Professional and Technical Components)
In Person Interrogation of transvenous ICD, ICM and ILR
Revision of Cardiac Rhythm Related Device in Trunk
WATCHMAN TM Left Atrial Appendace Closure (LAAC) Procedure
Removal of Cardiac Lead
Insertion of Cardiac Rhythm Related Device
Revision of Cardiac Lead
Removal of Cardiac Rhythm Related Device
CRV-431307-AA OCT2016 Page 51 of 62
APPENDIX CICD-10-PCS Reference Table - Note that some procedures may require multiple procedure codes to be reported
ICD-10-PCS Description
4A0234Z Measurement of Cardiac Electrical Activity, Percutaneous Approach 02K83ZZ Map Conduction Mechanism, Percutaneous Approach 4A0234Z Measurement of Cardiac Electrical Activity, Percutaneous Approach 02K83ZZ Map Conduction Mechanism, Percutaneous Approach 4A02X4Z Measurement of Cardiac Electrical Activity, External Approach 4A0234Z Measurement of Cardiac Electrical Activity, Percutaneous Approach3E043GC Introduction of Other Therapeutic Substance into Central Vein, Percutaneous Approach 3E033GC Introduction of Other Therapeutic Substance into Peripheral Vein, Percutaneous Approach 3E043GC Introduction of Other Therapeutic Substance into Central Vein, Percutaneous Approach 4A0234Z Measurement of Cardiac Electrical Activity, Percutaneous Approach02583ZZ Destruction of Conduction Mechanism, Percutaneous Approach 02K83ZZ Map Conduction Mechanism, Percutaneous Approach 02583ZZ Destruction of Conduction Mechanism, Percutaneous Approach 4A0234Z Measurement of Cardiac Electrical Activity, Percutaneous Approach3E033KZ Introduction of Other Diagnostic Substance into Peripheral Vein, Percutaneous Approach 3E043KZ Introduction of Other Diagnostic Substance into Central Vein, Percutaneous Approach 4A12X9Z Monitoring of Cardiac Output, External Approach B244ZZ3 Ultrasonography of Right Heart, Intravascular B245ZZ3 Ultrasonography of Left Heart, Intravascular B246ZZ3 Ultrasonography of Right and Left Heart, Intravascular
B24BZZ3 Ultrasonography of Heart with Aorta, Intravascular B24DZZ3 Ultrasonography of Pediatric Heart, IntravascularB244ZZ4 Ultrasonography of Right Heart, TransesophagealB245ZZ4 Ultrasonography of Left Heart, TransesophagealB246ZZ4 Ultrasonography of Right and Left Heart, TransesophagealB24BZZ4 Ultrasonography of Heart with Aorta, TransesophagealB24CZZ4 Ultrasonography of Pericardium, TransesophagealB24DZZ4 Ultrasonography of Pediatric Heart, Transesophageal
02563ZZ Destruction of Right Atrium, Percutaneous Approach
Electrophysiology Studies
CRV-431307-AA OCT2016 Page 52 of 62
APPENDIX CICD-10-PCS Reference Table - Note that some procedures may require multiple procedure codes to be reported
ICD-10-PCS Description02573ZZ Destruction of Left Atrium, Percutaneous Approach
Interventional CardiologyDiagnostic Cardiac Catheterization
4A020N6 Measurement of Cardiac Sampling and Pressure, Right Heart, Open Approach4A020N7 Measurement of Cardiac Sampling and Pressure, Left Heart, Open Approach4A020N8 Measurement of Cardiac Sampling and Pressure, Bilateral, Open Approach4A023N6 Measurement of Cardiac Sampling and Pressure, Right Heart, Percutaneous Approach4A023N7 Measurement of Cardiac Sampling and Pressure, Left Heart, Percutaneous Approach4A023N8 Measurement of Cardiac Sampling and Pressure, Bilateral, Percutaneous Approach
Injection Diagnostic Cardiac Catheterization4A023N7 Measurement of Cardiac Sampling and Pressure, Left Heart, Percutaneous Approach3E073KZ Introduction of Other Diagnostic Substance into Coronary Artery, Percutaneous Approach3E083KZ Introduction of Other Diagnostic Substance into Heart, Percutaneous Approach3E053KZ Introduction of Other Diagnostic Substance into Peripheral Artery, Percutaneous Approach3E063KZ Introduction of Other Diagnostic Substance into Central Artery, Percutaneous Approach3E073KZ Introduction of Other Diagnostic Substance into Coronary Artery, Percutaneous Approach3E083KZ Introduction of Other Diagnostic Substance into Heart, Percutaneous Approach3E053KZ Introduction of Other Diagnostic Substance into Peripheral Artery, Percutaneous Approach3E063KZ Introduction of Other Diagnostic Substance into Central Artery, Percutaneous Approach
Coronary Angioplasty (PTCA), without stent02703ZZ Dilation of Coronary Artery, One Site, Percutaneous Approach02713ZZ Dilation of Coronary Artery, Two Sites, Percutaneous Approach02723ZZ Dilation of Coronary Artery, Three Sites, Percutaneous Approach02733ZZ Dilation of Coronary Artery, Four or More Sites, Percutaneous Approach02703Z6 Dilation of Coronary Artery, One Site, Bifurcation, Percutaneous Approach02713Z6 Dilation of Coronary Artery, Two Sites, Bifurcation, Percutaneous Approach02723Z6 Dilation of Coronary Artery, Three Sites, Bifurcation, Percutaneous Approach02733Z6 Dilation of Coronary Artery, Four or More Sites, Bifurcation, Percutaneous Approach
Coronary Atherectomy, without stent02C03ZZ Extirpation of Matter from Coronary Artery, One Site, Percutaneous Approach02C13ZZ Extirpation of Matter from Coronary Artery, Two Sites, Percutaneous Approach02C23ZZ Extirpation of Matter from Coronary Artery, Three Sites, Percutaneous Approach
CRV-431307-AA OCT2016 Page 53 of 62
APPENDIX CICD-10-PCS Reference Table - Note that some procedures may require multiple procedure codes to be reported
ICD-10-PCS Description02C33ZZ Extirpation of Matter from Coronary Artery, Four or More Sites, Percutaneous Approach
Bare Metal Coronary Stent with Angioplasty02703DZ Dilation of Coronary Artery, One Site with Intraluminal Device, Percutaneous Approach02713DZ Dilation of Coronary Artery, Two Sites with Intraluminal Device, Percutaneous Approach02723DZ Dilation of Coronary Artery, Three Sites with Intraluminal Device, Percutaneous Approach02733DZ Dilation of Coronary Artery, Four or More Sites with Intraluminal Device, Percutaneous Approach02703D6 Dilation of Coronary Artery, One Site, Bifurcation, with Intraluminal Device, Percutaneous Approach02713D6 Dilation of Coronary Artery, Two Sites, Bifurcation, with Intraluminal Device, Percutaneous Approach02723D6 Dilation of Coronary Artery, Three Sites, Bifurcation, with Intraluminal Device, Percutaneous Approach02733D6 Dilation of Coronary Artery, Four or More Sites, Bifurcation, with Intraluminal Device, Percutaneous Approach
Drug-Eluting Coronary Stent with Angioplasty027034Z Dilation of Coronary Artery, One Site with Drug-eluting Intraluminal Device, Percutaneous Approach027134Z Dilation of Coronary Artery, Two Sites with Drug-eluting Intraluminal Device, Percutaneous Approach027234Z Dilation of Coronary Artery, Three Sites with Drug-eluting Intraluminal Device, Percutaneous Approach027334Z Dilation of Coronary Artery, Four or More Sites with Drug-eluting Intraluminal Device, Percutaneous Approach0270346 Dilation of Coronary Artery, One Site, Bifurcation, with Drug-eluting Intraluminal Device, Percutaneous Approach0271346 Dilation of Coronary Artery, Two Sites, Bifurcation, with Drug-eluting Intraluminal Device, Percutaneous Approach0272346 Dilation of Coronary Artery, Three Sites, Bifurcation, with Drug-eluting Intraluminal Device, Percutaneous Approach0273346 Dilation of Coronary Artery, Four or More Sites, Bifurcation, with Drug-eluting Intraluminal Device, Percutaneous Approach
Bare Metal Coronary Stent with Atherectomy02703DZ Dilation of Coronary Artery, One Site with Intraluminal Device, Percutaneous Approach02713DZ Dilation of Coronary Artery, Two Sites with Intraluminal Device, Percutaneous Approach02723DZ Dilation of Coronary Artery, Three Sites with Intraluminal Device, Percutaneous Approach02733DZ Dilation of Coronary Artery, Four or More Sites with Intraluminal Device, Percutaneous Approach02703D6 Dilation of Coronary Artery, One Site, Bifurcation, with Intraluminal Device, Percutaneous Approach02713D6 Dilation of Coronary Artery, Two Sites, Bifurcation, with Intraluminal Device, Percutaneous Approach02723D6 Dilation of Coronary Artery, Three Sites, Bifurcation, with Intraluminal Device, Percutaneous Approach02733D6 Dilation of Coronary Artery, Four or More Sites, Bifurcation, with Intraluminal Device, Percutaneous Approach02C03ZZ Extirpation of Matter from Coronary Artery, One Site, Percutaneous Approach02C13ZZ Extirpation of Matter from Coronary Artery, Two Sites, Percutaneous Approach02C23ZZ Extirpation of Matter from Coronary Artery, Three Sites, Percutaneous Approach02C33ZZ Extirpation of Matter from Coronary Artery, Four or More Sites, Percutaneous Approach
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APPENDIX CICD-10-PCS Reference Table - Note that some procedures may require multiple procedure codes to be reported
ICD-10-PCS DescriptionDrug-Eluting Coronary Stent with Atherectomy
027034Z Dilation of Coronary Artery, One Site with Drug-eluting Intraluminal Device, Percutaneous Approach027134Z Dilation of Coronary Artery, Two Sites with Drug-eluting Intraluminal Device, Percutaneous Approach027234Z Dilation of Coronary Artery, Three Sites with Drug-eluting Intraluminal Device, Percutaneous Approach027334Z Dilation of Coronary Artery, Four or More Sites with Drug-eluting Intraluminal Device, Percutaneous Approach0270346 Dilation of Coronary Artery, One Site, Bifurcation, with Drug-eluting Intraluminal Device, Percutaneous Approach0271346 Dilation of Coronary Artery, Two Sites, Bifurcation, with Drug-eluting Intraluminal Device, Percutaneous Approach0272346 Dilation of Coronary Artery, Three Sites, Bifurcation, with Drug-eluting Intraluminal Device, Percutaneous Approach0273346 Dilation of Coronary Artery, Four or More Sites, Bifurcation, with Drug-eluting Intraluminal Device, Percutaneous Approach02C03ZZ Extirpation of Matter from Coronary Artery, One Site, Percutaneous Approach02C13ZZ Extirpation of Matter from Coronary Artery, Two Sites, Percutaneous Approach02C23ZZ Extirpation of Matter from Coronary Artery, Three Sites, Percutaneous Approach02C33ZZ Extirpation of Matter from Coronary Artery, Four or More Sites, Percutaneous Approach
Bare Metal Stent - Bypass Graft Revascularization02703DZ Dilation of Coronary Artery, One Site with Intraluminal Device, Percutaneous Approach02713DZ Dilation of Coronary Artery, Two Sites with Intraluminal Device, Percutaneous Approach02723DZ Dilation of Coronary Artery, Three Sites with Intraluminal Device, Percutaneous Approach02733DZ Dilation of Coronary Artery, Four or More Sites with Intraluminal Device, Percutaneous Approach02703D6 Dilation of Coronary Artery, One Site, Bifurcation, with Intraluminal Device, Percutaneous Approach02713D6 Dilation of Coronary Artery, Two Sites, Bifurcation, with Intraluminal Device, Percutaneous Approach02723D6 Dilation of Coronary Artery, Three Sites, Bifurcation, with Intraluminal Device, Percutaneous Approach02733D6 Dilation of Coronary Artery, Four or More Sites, Bifurcation, with Intraluminal Device, Percutaneous Approach02C03ZZ Extirpation of Matter from Coronary Artery, One Site, Percutaneous Approach02C13ZZ Extirpation of Matter from Coronary Artery, Two Sites, Percutaneous Approach02C23ZZ Extirpation of Matter from Coronary Artery, Three Sites, Percutaneous Approach02C33ZZ Extirpation of Matter from Coronary Artery, Four or More Sites, Percutaneous Approach
Drug-Eluting Stent - Bypass Graft Revascularization027034Z Dilation of Coronary Artery, One Site with Drug-eluting Intraluminal Device, Percutaneous Approach027134Z Dilation of Coronary Artery, Two Sites with Drug-eluting Intraluminal Device, Percutaneous Approach027234Z Dilation of Coronary Artery, Three Sites with Drug-eluting Intraluminal Device, Percutaneous Approach027334Z Dilation of Coronary Artery, Four or More Sites with Drug-eluting Intraluminal Device, Percutaneous Approach0270346 Dilation of Coronary Artery, One Site, Bifurcation, with Drug-eluting Intraluminal Device, Percutaneous Approach
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APPENDIX CICD-10-PCS Reference Table - Note that some procedures may require multiple procedure codes to be reported
ICD-10-PCS Description0271346 Dilation of Coronary Artery, Two Sites, Bifurcation, with Drug-eluting Intraluminal Device, Percutaneous Approach0272346 Dilation of Coronary Artery, Three Sites, Bifurcation, with Drug-eluting Intraluminal Device, Percutaneous Approach0273346 Dilation of Coronary Artery, Four or More Sites, Bifurcation, with Drug-eluting Intraluminal Device, Percutaneous Approach02C03ZZ Extirpation of Matter from Coronary Artery, One Site, Percutaneous Approach02C13ZZ Extirpation of Matter from Coronary Artery, Two Sites, Percutaneous Approach02C23ZZ Extirpation of Matter from Coronary Artery, Three Sites, Percutaneous Approach02C33ZZ Extirpation of Matter from Coronary Artery, Four or More Sites, Percutaneous Approach
Bare Metal Stent - Acute Myocardial Infarction Revascularization02703DZ Dilation of Coronary Artery, One Site with Intraluminal Device, Percutaneous Approach02713DZ Dilation of Coronary Artery, Two Sites with Intraluminal Device, Percutaneous Approach02723DZ Dilation of Coronary Artery, Three Sites with Intraluminal Device, Percutaneous Approach02733DZ Dilation of Coronary Artery, Four or More Sites with Intraluminal Device, Percutaneous Approach02703D6 Dilation of Coronary Artery, One Site, Bifurcation, with Intraluminal Device, Percutaneous Approach02713D6 Dilation of Coronary Artery, Two Sites, Bifurcation, with Intraluminal Device, Percutaneous Approach02723D6 Dilation of Coronary Artery, Three Sites, Bifurcation, with Intraluminal Device, Percutaneous Approach02733D6 Dilation of Coronary Artery, Four or More Sites, Bifurcation, with Intraluminal Device, Percutaneous Approach02C03ZZ Extirpation of Matter from Coronary Artery, One Site, Percutaneous Approach02C13ZZ Extirpation of Matter from Coronary Artery, Two Sites, Percutaneous Approach02C23ZZ Extirpation of Matter from Coronary Artery, Three Sites, Percutaneous Approach02C33ZZ Extirpation of Matter from Coronary Artery, Four or More Sites, Percutaneous Approach
Drug-Eluting Stent - Acute Myocardial Infarction Revascularization027034Z Dilation of Coronary Artery, One Site with Drug-eluting Intraluminal Device, Percutaneous Approach027134Z Dilation of Coronary Artery, Two Sites with Drug-eluting Intraluminal Device, Percutaneous Approach027234Z Dilation of Coronary Artery, Three Sites with Drug-eluting Intraluminal Device, Percutaneous Approach027334Z Dilation of Coronary Artery, Four or More Sites with Drug-eluting Intraluminal Device, Percutaneous Approach0270346 Dilation of Coronary Artery, One Site, Bifurcation, with Drug-eluting Intraluminal Device, Percutaneous Approach0271346 Dilation of Coronary Artery, Two Sites, Bifurcation, with Drug-eluting Intraluminal Device, Percutaneous Approach0272346 Dilation of Coronary Artery, Three Sites, Bifurcation, with Drug-eluting Intraluminal Device, Percutaneous Approach0273346 Dilation of Coronary Artery, Four or More Sites, Bifurcation, with Drug-eluting Intraluminal Device, Percutaneous Approach02C03ZZ Extirpation of Matter from Coronary Artery, One Site, Percutaneous Approach02C13ZZ Extirpation of Matter from Coronary Artery, Two Sites, Percutaneous Approach02C23ZZ Extirpation of Matter from Coronary Artery, Three Sites, Percutaneous Approach
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APPENDIX CICD-10-PCS Reference Table - Note that some procedures may require multiple procedure codes to be reported
ICD-10-PCS Description02C33ZZ Extirpation of Matter from Coronary Artery, Four or More Sites, Percutaneous Approach
Bare Metal Stent - Chronic Total Occlusion Revascularization (BSC currently has no stents FDA-approved for CTOs)02703DZ Dilation of Coronary Artery, One Site with Intraluminal Device, Percutaneous Approach02713DZ Dilation of Coronary Artery, Two Sites with Intraluminal Device, Percutaneous Approach02723DZ Dilation of Coronary Artery, Three Sites with Intraluminal Device, Percutaneous Approach02733DZ Dilation of Coronary Artery, Four or More Sites with Intraluminal Device, Percutaneous Approach02703D6 Dilation of Coronary Artery, One Site, Bifurcation, with Intraluminal Device, Percutaneous Approach02713D6 Dilation of Coronary Artery, Two Sites, Bifurcation, with Intraluminal Device, Percutaneous Approach02723D6 Dilation of Coronary Artery, Three Sites, Bifurcation, with Intraluminal Device, Percutaneous Approach02733D6 Dilation of Coronary Artery, Four or More Sites, Bifurcation, with Intraluminal Device, Percutaneous Approach02C03ZZ Extirpation of Matter from Coronary Artery, One Site, Percutaneous Approach02C13ZZ Extirpation of Matter from Coronary Artery, Two Sites, Percutaneous Approach02C23ZZ Extirpation of Matter from Coronary Artery, Three Sites, Percutaneous Approach02C33ZZ Extirpation of Matter from Coronary Artery, Four or More Sites, Percutaneous Approach
Drug-Eluting Stent - Chronic Total Occlusion Revascularization (BSC currently has no stents FDA-approved for CTOs)027034Z Dilation of Coronary Artery, One Site with Drug-eluting Intraluminal Device, Percutaneous Approach027134Z Dilation of Coronary Artery, Two Sites with Drug-eluting Intraluminal Device, Percutaneous Approach027234Z Dilation of Coronary Artery, Three Sites with Drug-eluting Intraluminal Device, Percutaneous Approach027334Z Dilation of Coronary Artery, Four or More Sites with Drug-eluting Intraluminal Device, Percutaneous Approach0270346 Dilation of Coronary Artery, One Site, Bifurcation, with Drug-eluting Intraluminal Device, Percutaneous Approach0271346 Dilation of Coronary Artery, Two Sites, Bifurcation, with Drug-eluting Intraluminal Device, Percutaneous Approach0272346 Dilation of Coronary Artery, Three Sites, Bifurcation, with Drug-eluting Intraluminal Device, Percutaneous Approach0273346 Dilation of Coronary Artery, Four or More Sites, Bifurcation, with Drug-eluting Intraluminal Device, Percutaneous Approach02C03ZZ Extirpation of Matter from Coronary Artery, One Site, Percutaneous Approach02C13ZZ Extirpation of Matter from Coronary Artery, Two Sites, Percutaneous Approach02C23ZZ Extirpation of Matter from Coronary Artery, Three Sites, Percutaneous Approach02C33ZZ Extirpation of Matter from Coronary Artery, Four or More Sites, Percutaneous Approach
Intravascular UltrasoundB240ZZ3 Ultrasonography of Single Coronary Artery, IntravascularB241ZZ3 Ultrasonography of Multiple Coronary Arteries, Intravascular
Fractional Flow Reserve4A033BC Measurement of Arterial Pressure, Coronary, Percutaneous Approach
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APPENDIX CICD-10-PCS Reference Table - Note that some procedures may require multiple procedure codes to be reported
ICD-10-PCS DescriptionThrombectomy
02C03ZZ Extirpation of Matter from Coronary Artery, One Site, Percutaneous Approach02C13ZZ Extirpation of Matter from Coronary Artery, Two Sites, Percutaneous Approach02C23ZZ Extirpation of Matter from Coronary Artery, Three Sites, Percutaneous Approach02C33ZZ Extirpation of Matter from Coronary Artery, Four or More Sites, Percutaneous Approach
Percutaneous Balloon Valvuloplasty; Aortic Valve027F3ZZ Dilation of Aortic Valve, Percutaneous Approach027G3ZZ Dilation of Mitral Valve, Percutaneous Approach027H3ZZ Dilation of Pulmonary Valve, Percutaneous Approach02RF37Z Replacement of Aortic Valve with Autologous Tissue Substitute, Percutaneous Approach02RF38Z Replacement of Aortic Valve with Zooplastic Tissue, Percutaneous Approach02RF3JH Replacement of Aortic Valve with Synthetic Substitute, Transapical, Percutaneous Approach02RF3JZ Replacement of Aortic Valve with Synthetic Substitute, Percutaneous Approach02RF3KZ Replacement of Aortic Valve with Nonautologous Tissue Substitute, Percutaneous Approach02RF0JZ Replacement of Aortic Valve with Synthetic Substitute, Open Approach
02RH37H Replacement of Pulmonary Valve with Autologous Tissue Substitute, Transapical, Percutaneous Approach02UG3JZ Supplement Mitral Valve with Synthetic Substitute, Percutaneous Approach5A1221Z Performance of Cardiac Output, Continuous5A1221Z Performance of Cardiac Output, Continuous
Peripheral InterventionsPercutaneous Transluminal Balloon Angioplasty
04793ZZ Dilation of Right Renal Artery, Percutaneous Approach047A3ZZ Dilation of Left Renal Artery, Percutaneous Approach027W3ZZ Dilation of Thoracic Aorta, Percutaneous Approach04703ZZ Dilation of Abdominal Aorta, Percutaneous Approach03773ZZ Dilation of Right Brachial Artery, Percutaneous Approach03783ZZ Dilation of Left Brachial Artery, Percutaneous Approach03Q73ZZ Repair Right Brachial Artery, Percutaneous Approach03Q83ZZ Repair Left Brachial Artery, Percutaneous ApproachB3110ZZ Fluoroscopy of Right Brachiocephalic-Subclavian Artery using High Osmolar ContrastB3111ZZ Fluoroscopy of Right Brachiocephalic-Subclavian Artery using Low Osmolar ContrastB311YZZ Fluoroscopy of Right Brachiocephalic-Subclavian Artery using Other Contrast
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APPENDIX CICD-10-PCS Reference Table - Note that some procedures may require multiple procedure codes to be reported
ICD-10-PCS DescriptionB4120ZZ Fluoroscopy of Hepatic Artery using High Osmolar ContrastB4121ZZ Fluoroscopy of Hepatic Artery using Low Osmolar ContrastB412YZZ Fluoroscopy of Hepatic Artery using Other ContrastB51B0ZA Fluoroscopy of Right Lower Extremity Veins using High Osmolar Contrast, GuidanceB51B1ZA Fluoroscopy of Right Lower Extremity Veins using Low Osmolar Contrast, GuidanceB51BYZA Fluoroscopy of Right Lower Extremity Veins using Other Contrast, Guidance
Iliac Artery Revascularization047C3ZZ Dilation of Right Common Iliac Artery with Intraluminal Device, Percutaneous Approach047F3ZZ Dilation of Left Internal Iliac Artery, Percutaneous Approach047C3DZ Dilation of Right Common Iliac Artery with Intraluminal Device, Percutaneous Approach047D3DZ Dilation of Left Common Iliac Artery with Intraluminal Device, Percutaneous Approach047F3DZ Dilation of Left Internal Iliac Artery with Intraluminal Device, Percutaneous Approach
Femoral/Popliteal Artery Revascularization04CK3ZZ Extirpation of Matter from Right Femoral Artery, Percutaneous Approach04CL3ZZ Extirpation of Matter from Left Femoral Artery, Percutaneous Approach047K3DZ Dilation of Right Femoral Artery with Intraluminal Device, Percutaneous Approach047M3DZ Dilation of Right Popliteal Artery with Intraluminal Device, Percutaneous Approach047K3Z1 Dilation of Right Femoral Artery using Drug-Coated Balloon, Percutaneous Approach047L341 Dilation of Left Femoral Artery with Drug-eluting Intraluminal Device, using Drug-Coated Balloon, Percutaneous Approach
Tibial/Peroneal Artery Revascularization047P3ZZ Dilation of Right Anterior Tibial Artery, Percutaneous Approach047T3ZZ Dilation of Right Peroneal Artery, Percutaneous Approach04CP3ZZ Extirpation of Matter from Right Anterior Tibial Artery, Percutaneous Approach04CS3ZZ Extirpation of Matter from Left Posterior Tibial Artery, Percutaneous Approach
Transcatheter Placement of Carotid Stents with Embolic Protection037H3DZ Dilation of Right Common Carotid Artery with Intraluminal Device, Percutaneous Approach037L3DZ Dilation of Left Internal Carotid Artery with Intraluminal Device, Percutaneous Approach
Embolization06L43DZ Occlusion of Hepatic Vein with Intraluminal Device, Percutaneous Approach03L43DZ Occlusion of Left Subclavian Artery with Intraluminal Device, Percutaneous Approach04L43DZ Occlusion of Splenic Artery with Intraluminal Device, Percutaneous Approach
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APPENDIX CICD-10-PCS Reference Table - Note that some procedures may require multiple procedure codes to be reported
ICD-10-PCS DescriptionCatheter Placement
03H233Z Insertion of Infusion Device into Innominate Artery, Percutaneous Approach03H333Z Insertion of Infusion Device into Right Subclavian Artery, Percutaneous Approach03H733Z Insertion of Infusion Device into Right Brachial Artery, Percutaneous Approach04HC33Z Insertion of Infusion Device into Right Common Iliac Artery, Percutaneous Approach04HD33Z Insertion of Infusion Device into Left Common Iliac Artery, Percutaneous Approach04H933Z Insertion of Infusion Device into Right Renal Artery, Percutaneous Approach04HA33Z Insertion of Infusion Device into Left Renal Artery, Percutaneous Approach
AngiographyB31H0ZZ Fluoroscopy of Right Upper Extremity Arteries using High Osmolar ContrastB41FYZZ Fluoroscopy of Right Lower Extremity Arteries using Other Contrast
Transhepatic Shunts (TIPS)06H43DZ Insertion of Intraluminal Device into Hepatic Vein, Percutaneous Approach06H83DZ Insertion of Intraluminal Device into Portal Vein, Percutaneous Approach06PY3DZ Removal of Intraluminal Device from Lower Vein, Percutaneous Approach06WY3DZ Revision of Intraluminal Device in Lower Vein, Percutaneous Approach
Thrombectomy03CY3ZZ Extirpation of Matter from Upper Artery, Percutaneous Approach05CY3ZZ Extirpation of Matter from Upper Vein, Percutaneous Approach04CM3ZZ Extirpation of Matter from Right Popliteal Artery, Percutaneous Approach04CT3ZZ Extirpation of Matter from Right Peroneal Artery, Percutaneous Approach
Thrombolysis3E05317 Introduction of Other Thrombolytic into Peripheral Artery, Percutaneous Approach3E06317 Introduction of Other Thrombolytic into Central Artery, Percutaneous Approach3E03317 Introduction of Other Thrombolytic into Peripheral Vein, Percutaneous Approach3E04317 Introduction of Other Thrombolytic into Central Vein, Percutaneous Approach
Vena Cava Filters06H03DZ Insertion of Intraluminal Device into Inferior Vena Cava, Percutaneous Approach06WY3DZ Revision of Intraluminal Device in Lower Vein, Percutaneous Approach06PY3DZ Removal of Intraluminal Device from Lower Vein, Percutaneous Approach
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APPENDIX CICD-10-PCS Reference Table - Note that some procedures may require multiple procedure codes to be reported
ICD-10-PCS DescriptionIntravascular Ultrasound
B44LZZ3 Ultrasonography of Femoral Artery, IntravascularB54CZZ3 Ultrasonography of Left Lower Extremity Veins, Intravascular
Biliary Procedures - DiagnosticBF001ZZ Plain Radiography of Bile Ducts using Low Osmolar ContrastBF00YZZ Plain Radiography of Bile Ducts using Other ContrastBF030ZZ Plain Radiography of Gallbladder and Bile Ducts using High Osmolar ContrastBF031ZZ Plain Radiography of Gallbladder and Bile Ducts using Low Osmolar ContrastBF03YZZ Plain Radiography of Gallbladder and Bile Ducts using Other ContrastBF0C0ZZ Plain Radiography of Hepatobiliary System, All using High Osmolar ContrastBF0C1ZZ Plain Radiography of Hepatobiliary System, All using Low Osmolar ContrastBF0CYZZ Plain Radiography of Hepatobiliary System, All using Other ContrastBF100ZZ Fluoroscopy of Bile Ducts using High Osmolar ContrastBF101ZZ Fluoroscopy of Bile Ducts using Low Osmolar ContrastBF10YZZ Fluoroscopy of Bile Ducts using Other ContrastBF110ZZ Fluoroscopy of Biliary and Pancreatic Ducts using High Osmolar ContrastBF111ZZ Fluoroscopy of Biliary and Pancreatic Ducts using Low Osmolar ContrastBF11YZZ Fluoroscopy of Biliary and Pancreatic Ducts using Other ContrastBF120ZZ Fluoroscopy of Gallbladder using High Osmolar ContrastBF121ZZ Fluoroscopy of Gallbladder using Low Osmolar ContrastBF12YZZ Fluoroscopy of Gallbladder using Other ContrastBF130ZZ Fluoroscopy of Gallbladder and Bile Ducts using High Osmolar ContrastBF131ZZ Fluoroscopy of Gallbladder and Bile Ducts using Low Osmolar ContrastBF13YZZ Fluoroscopy of Gallbladder and Bile Ducts using Other ContrastBF140ZZ Fluoroscopy of Gallbladder, Bile Ducts and Pancreatic Ducts using High Osmolar ContrastBF141ZZ Fluoroscopy of Gallbladder, Bile Ducts and Pancreatic Ducts using Low Osmolar ContrastBF14YZZ Fluoroscopy of Gallbladder, Bile Ducts and Pancreatic Ducts using Other Contrast
0WHG03Z Insertion of Infusion Device into Peritoneal Cavity, Open Approach
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APPENDIX CICD-10-PCS Reference Table - Note that some procedures may require multiple procedure codes to be reported
ICD-10-PCS DescriptionDrainage (Internal stent/External Catheter)
0F24X0Z Change Drainage Device in Gallbladder, External Approach0F24XYZ Change Other Device in Gallbladder, External Approach0F2BX0Z Change Drainage Device in Hepatobiliary Duct, External Approach0F2BXYZ Change Other Device in Hepatobiliary Duct, External Approach0F753DZ Dilation of Right Hepatic Duct with Intraluminal Device, Percutaneous Approach0F753ZZ Dilation of Right Hepatic Duct, Percutaneous Approach0F754DZ Dilation of Right Hepatic Duct with Intraluminal Device, Percutaneous Endoscopic Approach0F763DZ Dilation of Left Hepatic Duct with Intraluminal Device, Percutaneous Approach0F763ZZ Dilation of Left Hepatic Duct, Percutaneous Approach0F764DZ Dilation of Left Hepatic Duct with Intraluminal Device, Percutaneous Endoscopic Approach0F783DZ Dilation of Cystic Duct with Intraluminal Device, Percutaneous Approach0F783ZZ Dilation of Cystic Duct, Percutaneous Approach0F784DZ Dilation of Cystic Duct with Intraluminal Device, Percutaneous Endoscopic Approach0F793DZ Dilation of Common Bile Duct with Intraluminal Device, Percutaneous Approach0F793ZZ Dilation of Common Bile Duct, Percutaneous Approach0F9430Z Drainage of Gallbladder with Drainage Device, Percutaneous Approach0F943ZX Drainage of Gallbladder, Percutaneous Approach, Diagnostic0F943ZZ Drainage of Gallbladder, Percutaneous Approach0F794DZ Dilation of Common Bile Duct with Intraluminal Device, Percutaneous Endoscopic Approach0F9530Z Drainage of Right Hepatic Duct with Drainage Device, Percutaneous Approach0F953ZX Drainage of Right Hepatic Duct, Percutaneous Approach, Diagnostic0F953ZZ Drainage of Right Hepatic Duct, Percutaneous Approach0F9630Z Drainage of Left Hepatic Duct with Drainage Device, Percutaneous Approach0F963ZX Drainage of Left Hepatic Duct, Percutaneous Approach, Diagnostic0F963ZZ Drainage of Left Hepatic Duct, Percutaneous Approach0F9830Z Drainage of Cystic Duct with Drainage Device, Percutaneous Approach0F983ZX Drainage of Cystic Duct, Percutaneous Approach, Diagnostic
Drainage of Drainage of Cystic Duct, Percutaneous Approach0F9930Z Drainage of Common Bile Duct with Drainage Device, Percutaneous Approach0F993ZX Drainage of Common Bile Duct, Percutaneous Approach, Diagnostic0F993ZZ Drainage of Common Bile Duct, Percutaneous Approach
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