jim collins, cpc, ccc president, … · 3/28/17 2 infusion & induction 93623-26 –programmed...

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3/28/17 1 Electrophysiology Jim Collins, CPC, CCC President, CardiologyCoder.Com, Inc. 1 (c) 2017 CardiologyCoder.Com client # 756 Two Types of Diagnostic EP Studies 93619 Basic, Comprehensive Study RA Record His Record RV Record RA Pace RV Pace 93620 Comprehensive Study + Stimulation Includes all of the components of a comprehensive study PLUS Induction or attempted induction of an arrhythmia “A comprehensive diagnostic electrophysiologic evaluation must include those services used to derive diagnostic information as described by codes 93600, 93602, 93603, 93610, and 93612. For 93620, an attempted arrhythmia induction must also be included with all of the above.” HRSOnLine.Org “Reduced Services: Under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. Under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52.” AMA 2017 Current Procedural Terminology 2 (c) 2017 CardiologyCoder.Com client # 756

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Page 1: Jim Collins, CPC, CCC President, … · 3/28/17 2 Infusion & Induction 93623-26 –Programmed stimulation and pacing after intravenous drug infusion (List separately in addition to

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Electrophysiology

JimCollins,CPC,CCCPresident,CardiologyCoder.Com,Inc.

1(c)2017CardiologyCoder.Com client#756

TwoTypesofDiagnosticEPStudies

93619Basic,ComprehensiveStudy

• RARecord

• HisRecord

• RVRecord

• RAPace

• RVPace

93620ComprehensiveStudy+Stimulation

• IncludesallofthecomponentsofacomprehensivestudyPLUS Inductionorattemptedinductionofanarrhythmia

“Acomprehensivediagnosticelectrophysiologicevaluationmustincludethoseservicesusedtoderivediagnosticinformationasdescribedbycodes93600,93602,93603,93610,and93612.For93620,anattemptedarrhythmiainductionmustalsobeincludedwithalloftheabove.”HRSOnLine.Org

“ReducedServices:Undercertaincircumstancesaserviceorprocedureispartiallyreducedoreliminatedatthediscretionofthephysicianorotherqualifiedhealthcareprofessional.Underthesecircumstancestheserviceprovidedcanbeidentifiedbyitsusualprocedurenumberandtheadditionofmodifier52.”AMA2017CurrentProceduralTerminology

2(c)2017CardiologyCoder.Comclient#756

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Infusion&Induction

93623-26– Programmedstimulationandpacingafterintravenousdruginfusion(Listseparatelyinadditiontocodeforprimaryprocedure)

• Thisisan“add-on”codethatmustbereportedwithaprimaryprocedure:• 93610– RApacing• 93612– RVpacing• 93619– BasiccomprehensiveEPS• 93620– EPSwithinductionattempt• 93653– SVTablation• 93654– VTablation• 93656– PVIablation

• Billablewhendrugsareusedtoinduce&diagnosisanarrhythmia• “Toscreenforarrhythmias,Isuprelwasinfused...

• Notbillablewhenusedtoconfirmthesuccessofanablation• “Toconfirmthesuccessoftheablation,Isuprelwasinfused…”

“29.CPTcode93623(programmedstimulationandpacingafterintravenousdruginfusion)isanadd-oncodethatmaybereportedperCPTManualinstructionsonlywithCPTcodes93619or93620(comprehensiveelectrophysiologicevaluation).CPTcode93623shouldnotbereportedforinjectionsofadrugwithstimulationandpacingfollowinganintracardiac catheterablationprocedure(e.g.,CPTcodes93650-93657)toconfirmadequacyoftheablation.PerCPTManualinstructions,CPTcode93623isnotintendedtobereportedwiththeintracardiac catheterablationprocedurecodes,anconfirmationoftheadequacyofablationisincludedintheintracardiac catheterablationprocedure.”

NationalCorrectCodingInitiative

3(c)2017CardiologyCoder.Comclient#756

Mapping

• 93609-26– 2DMapping• Standardcathetermapping

• 93613- 3DMapping• Medicalnecessityguidelineshavenotyetbeenpublished

Onlyoneformofmappingmaybereportedduringanygivenprocedure.

MappingshouldnotbereportedinconjunctionwithAVnodeablations.

*2017MedicarePhysicianFeeschedule– NationalAveragepayment

4(c)2017CardiologyCoder.Comclient#756

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LeftSidedPacing&Recording

93621-26– Comprehensiveelectrophysiologic evaluationincludinginsertionandrepositioningofmultipleelectrodecatheterswithinductionorattemptedinductionofarrhythmia;withleftatrialpacingand recordingfromcoronarysinusorleftatrium(Listseparatelyinadditiontocodeforprimaryprocedure)• NotemustestablishpacingANDrecordingwasperformed

• Withoutboth– addthereducedservicemodifier(52)• Thisisan“add-on”codethatmustbereportedwithaprimaryprocedure:

• 93620– ComprehensiveEPSwithinductionattempt• 93653– SVTablation• 93654– VTablation

• Thisserviceisbundledintopulmonaryveinisolation93622-26– LVpacing&recording• NotemustestablishpacingANDrecordingwasperformed• Thisisan“add-on”codethatmustbereportedwithaprimaryprocedure:

• 93620– ComprehensiveEPSwithinductionattempt• 93653– SVTablation• 93656– pulmonaryveinisolation

• ThisserviceisbundledintoVTablation

5(c)2017CardiologyCoder.Comclient#756

PulmonaryVeinIsolation

• 93656– Comprehensiveelectrophysiologicevaluationincludingtransseptalcatheterizations,insertionandrepositioningofmultipleelectrodecatheterswithinductionorattemptedinductionofanarrhythmiawithatrialrecordingandpacing,whenpossible,rightventricularpacingandrecording,Hisbundlerecordingwithintracardiaccatheterablationofarrhythmogenic focus,withtreatmentofatrialfibrillationbypulmonaryveinisolation.

q All6componentsofacomprehensivestudywithinduction:ü Rightatrialpacingü Rightatrialrecordingü Rightventricularpacingü Rightventricularrecordingü Hisbundlerecordingü Inductionorattemptedinductionofanarrhythmia

q Pulmonaryveinisolationq Multipletrans-septalcatheterizations

• Don’treport93462q Leftatrialpacing&recording

• Don’treport93621

• “Code93656includeseachofleftatrialpacing/recording,rightventricularpacing/recording,andHisbundlerecordingwhenclinicallyindicated.Whenperformanceofoneormorecomponentsisnotpossibleorindicated,documentthereasonfornotperforming.”CPT

6(c)2017CardiologyCoder.Comclient#756

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Add-onAblationProcedures

• 93657– Additionallinearorfocalintracardiaccatheterablationoftheleftorrightatriumfortreatmentofatrialfibrillationremainingaftercompletionofpulmonaryveinisolation• Onlyreportedwith93656(A-Fibablation)

• 93655– Intracardiaccatheterablationofadiscretemechanismofarrhythmiawhichisdistinctfromtheprimaryablatedmechanism,includingrepeatdiagnosticmaneuvers,totreataspontaneousorinducedarrhythmia• Reportedwith93653(SVT),93654(VT),or93656(AF)• MUE:93655istypicallyonlybilled1X

• MUE:MedicallyUnlikelyEdit

Sequence&documentationmatters:1. Pulmonaryveinisolationcomplete(93656)2. Patientremainsinatrialfibrillation3. AdditionallesionsarecreatedtotreatAF(93657)4. Patientconvertstoatrialflutter5. Additionallesionsarecreatedtotreatatrialflutter(93655)

7(c)2017CardiologyCoder.Comclient#756

AtrialFibrillationAblationHotTopic

• “insufficientevidencetodrawconclusionsregardingtheefficacy,effectiveness,andsafetyofcatheterablation”

CMSTechnologyAssessmentofAFAblation,April,2015

• PotentialcoverageandregulatoryfocuslikePMs&ICDs• Quantifiedsymptomseverity&AFburden• Medicalmanagementstandards(drug&dosage)• First-linetreatmentforOSA andobesity

• CentersofExcellence• Safetyandeffectivenessoftreatment• Notcurrentlyquantifiedortracked

8(c)2017CardiologyCoder.Comclient#756

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SVTAblation

• 93653- Comprehensiveelectrophysiologicevaluationincludinginsertionandrepositioningofmultipleelectrodecatheterswithinductionorattemptedinductionofanarrhythmiawithrightatrialpacingandrecording,rightventricularpacingandrecording,Hisrecordingwithintracardiaccatheterablationofarrhythmogenicfocus;withtreatmentofsupraventriculartachycardiabyablationoffastorslowatrioventricularpathway,accessoryatrioventricularconnection,cavo-tricuspidisthmusorothersingleatrialfocusorsourceofatrialre-entry.• IncludedServices:

qAll6componentsofacomprehensivestudy:üRightatrialpacing(whenpossible)(rightand/orleft)üRightatrialrecording(whenpossible)(rightand/orleft)üRightventricularpacingüRightventricularrecordingüHisbundlerecordingü Inductionorattemptedinductionofanarrhythmia

qSVTablation

Documentthereasonfornotperforminganyof

these

*2017MedicarePhysicianFeeschedule– NationalAveragepayment

9(c)2017CardiologyCoder.Comclient#756

VTAblation

• 93654- Comprehensiveelectrophysiologic evaluationincludinginsertionandrepositioningofmultipleelectrodecatheterswithinductionorattemptedinductionofanarrhythmiawithrightatrialpacingandrecording,rightventricularpacingandrecording(whennecessary),andHisbundlerecording(whennecessary)withintracardiac catheterablationofarrhythmogenic focus;withtreatmentofventriculartachycardiaorfocusofventricularectopyincludingintracardiacelectrophysiologic 3Dmapping,whenperformed,andleftventricularpacingandrecording,whenperformedqAll6componentsofacomprehensivestudy:

ü Rightatrialpacing(whenpossible)(rightand/orleft)ü Rightatrialrecording(whenpossible)(rightand/orleft)ü Rightventricularpacingü Rightventricularrecordingü Hisbundlerecordingü Inductionorattemptedinductionofanarrhythmia

qVTablationq3Dmapping(93613)whenperformedq2Dmapping(93609)whenperformedqLVpacing&recording(93622) whenperformed

Documentthereasonfornotperforminganyof

these

10(c)2017CardiologyCoder.Comclient#756

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AVNodeAblation,ArterialLine,ICE,Peri-Procedural

• AVNodeAblation93650– Intracardiacablationofatrioventricularnodefunction,atrioventricularconductionforcreationofcompleteheartblock,withorwithouttemporarypacemakerplacement.

• ICE93662– Intracardiac echocardiographyduringtherapeutic/diagnosticintervention,includingimagingsupervisionandinterpretation(Listseparatelyinadditiontocodeforprimaryprocedure)

• Thisisan“add-on”codethatmustbereportedwithaprimaryprocedure:• Use93662inconjunctionwith92987,93453,93460-93462,93532,93580,

93581,93620,93621,93622,93653,93654,93656asappropriate– CPT• ArterialLinePlacement

36620-59- Arterialcatheterizationorcannulationforsampling,monitoringortransfusion

• Peri-Proceduraldevicereprogramming• 93286(pacemaker)93287(defibrillator)• BillablewithEPproceduresbutnotdeviceprocedures• Billonetimeforpre-procedurereprogramming– Example93287• Billasecondtimeforpost-procedurereprogramming– Example93287-76

76- RepeatProcedureorServicebySamePhysicianorOtherQualifiedHealthCareProfessional 11(c)2017CardiologyCoder.Comclient#756

CorrectCodingInitiativeEdits

93609 93613 93621 93622 93623

SVT - 93653

VT- 93654 0 0 0

Addtl – 93655

AFib– 93656 0

Addtl - 93657

12(c)2017CardiologyCoder.Comclient#756

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ModerateSedation• Includedinproceduralpaymentuntil2017• Sedation,anditsassociatedpayment,isnowcarvedout.

• Expected2017paymentfordualchamberpacemaker(33208)• 2016payment=$553.53+• 2017MACRA&BudgetNeutralityadj.(0.24%)=$1.32• Expected2017payment=$554.85

• Actual2017payment=$543.35

• Totalreductionformoderatesedation=$11.50

Appliesto:implantablelooprecordersurgeries,pacemakersurgeries,defibrillatorsurgeries,EPstudies,ablations,cardioversions(internalandexternal),andtransesophagealecho.

13(c)2017CardiologyCoder.Comclient#756

ModerateSedationCoding

• Moderatesedationisbillablein15-minuteincrements• 1st 15minutecodebillableafter10minutes• Additional15-minutecodebillableafter23minutes

• 2setsofcodes• Sedationbyoperator:

• 99152– 1st 15minutes(0.25wRVU)• 99153– eachaddtl.15minutes(nowRVU)

• Sedationbyotherqualifiedprofessional:• 99156– 1st 15minutes(1.65wRVU)• 99157– eachaddtl.15minutes(1.25wRVU)

• Someproceduresarereportedwithmultiplecodesthateachhadmoderatesedationcarvedoutofthem- unintendedpaymentreduction:• Defibrillatorimplant(33249)&DFT(93641)• Electroderemoval,electroderepair,orskinpocketrelocationatthetimeofadeviceprocedure(implant,genchange)

Forpatients<5yrs.Oldsubstitute99151for99152and99155for99156

1hour=0.25wRVUs

1hour=5.4wRVUs

Documentmedicalnecessity

14(c)2017CardiologyCoder.Comclient#756

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ModerateSedationDocumentation• Theoperativereportneedstosupportthecodesreported

• 99152- Moderatesedationservicesprovidedbythesamephysicianorotherqualifiedhealthcareprofessionalperformingthediagnosticortherapeuticservicethatthesedationsupports,requiringthepresenceofanindependenttrainedobservertoassistinthemonitoringofthepatient'slevelofconsciousnessandphysiologicalstatus;initial15minutesofintraservice time,patientage5yearsorolder• Establish“administrationofmoderatesedation”• Establishdurationofintraservice time

• Startswhensedatingagent(s)areadministered• Endswiththeprocedure– whenface-to-facetimeconcludes

• Documentthepresenceofadedicated,trainedobserver• 99156- Moderatesedationservicesprovidedbyaphysicianorotherqualifiedhealthcareprofessionalotherthanthephysicianorotherqualifiedhealthcareprofessionalperformingthediagnosticortherapeuticservicethatthesedationsupports;initial15minutesofintraservice time,patientage5yearsorolder• Sameasabove,butnoneedforadedicated,trainedobserver

15(c)2017CardiologyCoder.Comclient#756

ServicesIncludedintheGlobalSurgicalPackage

1. PreoperativeVisits:• Theinitialevaluationforaminorsurgicalprocedure.• Critical care related to the performance of the procedure.

2. IntraoperativeServices:servicesthatarenormallyausualandnecessarypartofthesurgicalprocedure.

3. ComplicationsFollowingSurgery:includealladditionalmedicalorsurgicalservicesrequiredofthesurgeonduringthepostoperativeperiodofthesurgeryduetocomplicationsthatdonotrequireadditionaltripstotheoperatingroom.

4. PostoperativeVisits:follow-upvisitsduringthepostoperativeperiodofthesurgerythatarerelatedtorecoveryfromthesurgery.

5. Postsurgicalpainmanagementbythesurgeon.6. MiscellaneousServices:includesitemssuchasdressingchanges;local

incisioncare;removalofoperativepack;removalofcutaneoussutures,staples,lines,wires,tubes,drains,casts,andsplints;insertion,irrigationandremovalofurinarycatheters;routineperipheralintravenouslines,nasogastricandrectaltubes;andchangesandremovaloftracheostomytubes.

16(c)2017CardiologyCoder.Comclient#756

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ServicesNotIncludedintheGlobalSurgicalPackage

1. Visitsunrelatedtothediagnosisforwhichthesurgicalprocedureisperformed,unlessthevisitsoccurduetocomplicationsfromthesurgery.

2. Postoperativecomplicationsthatrequireareturntriptotheoperatingroom.AnoperatingroomforthispurposeisdefinedinMedicareregulationsas:• Aplaceofservicespecificallyequippedandstaffedforthesolepurposeofperforming

surgicalprocedures.Thetermincludesacardiaccatheterizationsuite,alasersuite,andanendoscopysuite.Itdoesnotincludeapatient’sroom,aminortreatmentroom,arecoveryroom,oranintensivecareunitunlessthepatient’sconditionwassocriticaltherewouldbeinsufficienttimefortransportationtoanoperatingroom.

3. Diagnostictestsandprocedures4. Criticalcareservices(procedurecodes99291and99292)unrelated tothe

surgerywhenaseriouslyinjuredorburnedpatientiscriticallyillandrequiresconstantattendancebytheprovider.Usemodifier24or25asappropriate.

5. Evaluationandmanagement(E/M)servicesunrelatedtoasurgicalprocedure.

17(c)2017CardiologyCoder.Comclient#756

CommonICD-10Codes

ProgrammingEvaluations*

RemoteMonitoring&Interrogations*

*Alsoreportdeviceindication

(unspecified)(unspecifiedcause)

18(c)2017CardiologyCoder.Comclient#756

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Newvs.EstablishedPatientStatus

• Cardiologyconsistsofthreespecialties:1. Generalcardiology2. Interventionalcardiology3. Electrophysiology

• WhenageneralcardiologistreferstoanEP,theEPcanbillnewpatient.• Highlevelnewpatientvisit:99205- $209.23*• Highlevelest patientvisits:99215- $146.43*• Newpatientpremium=$62.80(43%)

*2017MedicarePhysicianFeeschedule– NationalAveragepayment

19(c)2017CardiologyCoder.Comclient#756

JimCollins,CPC,CCCCertifiedProfessionalCoder,[email protected] (518)320-4376

• BillingServices

• Chartauditing

• Training

20(c)2017CardiologyCoder.Comclient#756

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IMPORTANTNOTE:

This program and material is exclusively for the use of Robert Wood Johnson Physician Enterprises. Noother use, duplication, or distribution is permitted.

Health economic and reimbursement information provided by CardiologyCoder.Com, Inc. is gatheredfrom third-party sources and is subject to change without notice as a result of complex and frequentlychanging laws, regulations, rules and policies. This information is presented for illustrative purposesonly and does not constitute legal advice. CardiologyCoder.Com, Inc. encourages providers to submitaccurate and appropriate claims for services. It is always the provider’s responsibility to determinemedical necessity, the proper site for delivery of any services and to submit appropriate codes,charges, and modifiers for services that are rendered.

CPT Copyright 2016 American Medical Association. All rights reserved. CPT is a registered trademark ofthe American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Feeschedules, relative value units, conversion factors and/or related components are not assigned by theAMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly orindirectly practice medicine or dispense medical services. The AMA assumes no liability for datacontained or not contained herein.

All other material is Copyright 2017, CardiologyCoder.Com, Inc.

21(c)2017CardiologyCoder.Comclient#756