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

3/28/17

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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


Mapping

• 93609-26– 2DMapping• Standardcathetermapping

• 93613- 3DMapping• Medicalnecessityguidelineshavenotyetbeenpublished

Onlyoneformofmappingmaybereportedduringanygivenprocedure.

MappingshouldnotbereportedinconjunctionwithAVnodeablations.

*2017MedicarePhysicianFeeschedule– NationalAveragepayment


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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


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


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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)


AtrialFibrillationAblationHotTopic

• “insufficientevidencetodrawconclusionsregardingtheefficacy,effectiveness,andsafetyofcatheterablation”

CMSTechnologyAssessmentofAFAblation,April,2015

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

• CentersofExcellence• Safetyandeffectivenessoftreatment• Notcurrentlyquantifiedortracked


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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



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


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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


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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.


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


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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


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.


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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.


CommonICD-10Codes

ProgrammingEvaluations*

RemoteMonitoring&Interrogations*

*Alsoreportdeviceindication

(unspecified)(unspecifiedcause)


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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%)



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

• BillingServices

• Chartauditing

• Training


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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.


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

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