2017 Stenting Coding and Payment Quick Reference - Boston Scientific

2017 Coding & Payment Quick Reference

Select Stenting Procedures

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.

Medicare Physician, Hospital Outpatient, and ASC Payments

RVUs

2017 Medicare National Average Payment

Physician,2

Facility3

CPT? Code1

Code Description

Work

Total Office

Total Facility

In-Office

In-Facility

Hospital Outpatient

ASC

Biliary Stenting

43274 Endoscopic retrograde cholangiopancreatography (ERCP); with

8.48

placement of endoscopic stent into biliary or pancreatic duct,

including pre- and post-dilation and guide wire passage, when

performed, including sphincterotomy, when performed, each stent

43275 Endoscopic retrograde cholangiopancreatography (ERCP); with

6.86

removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s)

43276 Endoscopic retrograde cholangiopancreatography (ERCP); with

8.84

removal and exchange of stent(s), biliary or pancreatic duct,

including pre- and post-dilation and guide wire passage, when

performed, including sphincterotomy, when performed, each stent

exchanged

Esophageal Stenting

43212 Esophagoscopy, flexible, transoral; with placement of endoscopic

3.40

stent (includes pre- and post-dilation and guide wire passage, when

performed)

43266 Esophagogastroduodenoscopy, flexible, transoral; with placement

3.92

of endoscopic stent (includes pre- and post-dilation and guide wire

passage, when performed)

Colonic and Duodenal Stenting

43266 Esophagogastroduodenoscopy, flexible, transoral; with placement

3.92

of endoscopic stent (includes pre- and post-dilation and guide wire

passage, when performed)

44370 Small intestinal endoscopy, enteroscopy beyond second portion

4.69

of duodenum, not including ileum; with transendoscopic stent

placement (includes predilation)

44379 Small intestinal endoscopy, enteroscopy beyond second portion of

7.36

duodenum, including ileum; with transendoscopic stent placement

(includes predilation)

44384 Ileoscopy, through stoma; with placement of endoscopic stent

2.85

(includes pre- and post-dilation and guide wire passage, when

performed)

44402 Colonoscopy through stoma; with endoscopic stent placement

4.70

(including pre- and post-dilation and guide wire passage, when

performed)

NA

13.62

NA

NA

11.08

NA

NA

14.18

NA

NA

5.58

NA

NA

6.42

NA

NA

6.42

NA

NA

7.84

NA

NA

12.06

NA

NA

4.48

NA

NA

7.65

NA

$489

$3,941 $1,753

$398

$2,511 $1,136

$509

$3,941 $1,753

$200

$3,941 $2,574

$230

$3,941 $2,629

$230

$3,941 $2,629

$281

$3,941 $2,533

$433

$3,941 $1,753

$161

$2,511 $1,136

$275

$3,941 $3,138

See important notes on the uses and limitations of this information on page 4.

CPT copyright 2016 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Effective: 1JAN2017 Expires: 31DEC2017 MS-DRG Rates Expire: 30SEP2017 ENDO-47409-AF FEB2017 1

CPT? Code1

Code Description

Colonic and Duodenal Stenting (Continued)

45327 45347

45389

Proctosigmoidoscopy, rigid; with transendoscopic stent placement (includes predilation) Sigmoidoscopy, flexible; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed) Colonoscopy, flexible; with endoscopic stent placement (includes pre- and post-dilation and guide wire passage, when performed)

Tracheobronchial Stenting

31631 31636 31637*

Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of tracheal stent(s) (includes tracheal/bronchial dilation as required) Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of bronchial stent(s) (includes tracheal/bronchial dilation as required), initial bronchus Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; each additional major bronchus stented (List separately in addition to code for primary procedure)

Foreign Body Removal (Stent Removal)

43194 Esophagoscopy, rigid, transoral; with removal of foreign body(s)

43215 Esophagoscopy, flexible, transoral; with removal of foreign body(s)

43247 43275 44363 45307

Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s)

Endoscopic retrograde cholangiopancreatography (ERCP); with removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s)

Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of foreign body(s)

Proctosigmoidoscopy, rigid; with removal of foreign body

45332 Sigmoidoscopy, flexible; with removal of foreign body(s)

45379 Colonoscopy, flexible; with removal of foreign body(s)

Work

RVUs Total Office

2017 Medicare National Average Payment

Physician,2

Facility3

Total Facility

In-Office

In-Facility

Hospital Outpatient

ASC

1.90

NA

3.30

NA

$118

$3,941 $1,753

2.72

NA

4.54

NA

$163

$3,941 $2,711

5.24

NA

8.53

NA

$306

$3,941 $2,643

4.36

NA

6.63

NA

$238

$4,363 $1,711

4.30

NA

6.37

NA

$229

$4,363 $2,386

1.58

NA

2.14

NA

$77

$0

$0

3.51

NA

5.61

NA

$201

$1,335

$609

2.44

10.23

4.16

$367

$149

$1,335

$609

3.11

9.94

5.20

$357

$187

$700

$378

6.86

NA

11.08

NA

$398

$2,511 $1,136

3.39

NA

5.64

NA

$202

$1,335

$609

1.60

4.74

2.83

$170

$102

$2,168 $1,115

1.76

7.13

3.09

$256

$111

$878

$475

4.28

11.60

7.03

$416

$252

$878

$475

Medicare Hospital Inpatient Coding

One of the following ICD-10 PCS Procedure Codes may be used to report the procedure:

ICD-10 PCS Code

ICD-10 PCS Description

0DH50DZ 0DH50UZ 0DH53DZ 0DH53UZ 0DH54DZ 0DH54UZ 0DH57DZ 0DH57UZ 0DH58DZ 0DH58UZ 0D788DZ 0D798DZ 0D7A8DZ 0D7B8DZ 0D7E8DZ

Insertion of Intraluminal Device into Esophagus, Open Approach Insertion of Feeding Device into Esophagus, Open Approach Insertion of Intraluminal Device into Esophagus, Percutaneous Approach Insertion of Feeding Device into Esophagus, Percutaneous Approach Insertion of Intraluminal Device into Esophagus, Percutaneous Endoscopic Approach Insertion of Feeding Device into Esophagus, Percutaneous Endoscopic Approach Insertion of Intraluminal Device into Esophagus, Via Natural or Artificial Opening Insertion of Feeding Device into Esophagus, Via Natural or Artificial Opening Insertion of Intraluminal Device into Esophagus, Via Natural or Artificial Opening Endoscopic Insertion of Feeding Device into Esophagus, Via Natural or Artificial Opening Endoscopic Dilation of Small Intestine with Intraluminal Device, Via Natural or Artificial Opening Endoscopic Dilation of Duodenum with Intraluminal Device, Via Natural or Artificial Opening Endoscopic Dilation of Jejunum with Intraluminal Device, Via Natural or Artificial Opening Endoscopic Dilation of Ileum with Intraluminal Device, Via Natural or Artificial Opening Endoscopic Dilation of Large Intestine with Intraluminal Device, Via Natural or Artificial Opening Endoscopic

See important notes on the uses and limitations of this information on page 4.

CPT copyright 2016 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Effective: 1JAN2017 Expires: 31DEC2017 MS-DRG Rates Expire: 30SEP2017 ENDO-47409-AF FEB2017 2

Medicare Hospital Inpatient Coding

One of the following ICD-10 PCS Procedure Codes may be used to report the procedure:

ICD-10 PCS Code

ICD-10 PCS Description

0DH88DZ 0DH98DZ 0DHA8DZ 0DHB8DZ 0DHE8DZ 0DHP8DZ 0D7K8DZ 0D7L8DZ 0D7M8DZ 0D7N8DZ 0F758DZ 0F768DZ 0F788DZ 0F798DZ 0FHB4DZ 0FHB8DZ 0F7D4DZ 0C7S0DZ 0C7S3DZ 0C7S4DZ 0C7S7DZ 0C7S8DZ 0CPS0DZ 0CPS3DZ 0CPS7DZ 0CPS8DZ 0B714DZ 0B734DZ 0B744DZ 0B754DZ 0B774DZ 0B784DZ 0B718DZ 0B738DZ 0B748DZ 0B758DZ 0B778DZ 0B788DZ 0BC17ZZ 0BC18ZZ 0BC37ZZ 0BC38ZZ 0BC77ZZ 0BC78ZZ

Insertion of Intraluminal Device into Small Intestine, Via Natural or Artificial Opening Endoscopic Insertion of Intraluminal Device into Duodenum, Via Natural or Artificial Opening Endoscopic Insertion of Intraluminal Device into Jejunum, Via Natural or Artificial Opening Endoscopic Insertion of Intraluminal Device into Ileum, Via Natural or Artificial Opening Endoscopic Insertion of Intraluminal Device into Large Intestine, Via Natural or Artificial Opening Endoscopic Insertion of Intraluminal Device into Rectum, Via Natural or Artificial Opening Endoscopic Dilation of Ascending Colon with Intraluminal Device, Via Natural or Artificial Opening Endoscopic Dilation of Transverse Colon with Intraluminal Device, Via Natural or Artificial Opening Endoscopic Dilation of Descending Colon with Intraluminal Device, Via Natural or Artificial Opening Endoscopic Dilation of Sigmoid Colon with Intraluminal Device, Via Natural or Artificial Opening Endoscopic Dilation of Right Hepatic Duct with Intraluminal Device, Via Natural or Artificial Opening Endoscopic Dilation of Left Hepatic Duct with Intraluminal Device, Via Natural or Artificial Opening Endoscopic Dilation of Cystic Duct with Intraluminal Device, Via Natural or Artificial Opening Endoscopic Dilation of Common Bile Duct with Intraluminal Device, Via Natural or Artificial Opening Endoscopic Insertion of Intraluminal Device into Hepatobiliary Duct, Percutaneous Endoscopic Approach Insertion of Intraluminal Device into Hepatobiliary Duct, Via Natural or Artificial Opening Endoscopic Dilation of Pancreatic Duct with Intraluminal Device, Percutaneous Endoscopic Approach Dilation of Larynx with Intraluminal Device, Open Approach Dilation of Larynx with Intraluminal Device, Percutaneous Approach Dilation of Larynx with Intraluminal Device, Percutaneous Endoscopic Approach Dilation of Larynx with Intraluminal Device, Via Natural or Artificial Opening Dilation of Larynx with Intraluminal Device, Via Natural or Artificial Opening Endoscopic Removal of Intraluminal Device from Larynx, Open Approach Removal of Intraluminal Device from Larynx, Percutaneous Approach Removal of Intraluminal Device from Larynx, Via Natural or Artificial Opening Removal of Intraluminal Device from Larynx, Via Natural or Artificial Opening Endoscopic Dilation of Trachea with Intraluminal Device, Percutaneous Endoscopic Approach Dilation of Right Main Bronchus with Intraluminal Device, Percutaneous Endoscopic Approach Dilation of Right Upper Lobe Bronchus with Intraluminal Device, Percutaneous Endoscopic Approach Dilation of Right Middle Lobe Bronchus with Intraluminal Device, Percutaneous Endoscopic Approach Dilation of Left Main Bronchus with Intraluminal Device, Percutaneous Endoscopic Approach Dilation of Left Upper Lobe Bronchus with Intraluminal Device, Percutaneous Endoscopic Approach Dilation of Trachea with Intraluminal Device, Via Natural or Artificial Opening Endoscopic Dilation of Right Main Bronchus with Intraluminal Device, Via Natural or Artificial Opening Endoscopic Dilation of Right Upper Lobe Bronchus with Intraluminal Device, Via Natural or Artificial Opening Endoscopic Dilation of Right Middle Lobe Bronchus with Intraluminal Device, Via Natural or Artificial Opening Endoscopic Dilation of Left Main Bronchus with Intraluminal Device, Via Natural or Artificial Opening Endoscopic Dilation of Left Upper Lobe Bronchus with Intraluminal Device, Via Natural or Artificial Opening Endoscopic Extirpation of Matter from Trachea, Via Natural or Artificial Opening Extirpation of Matter from Trachea, Via Natural or Artificial Opening Endoscopic Extirpation of Matter from Right Main Bronchus, Via Natural or Artificial Opening Extirpation of Matter from Right Main Bronchus, Via Natural or Artificial Opening Endoscopic Extirpation of Matter from Left Main Bronchus, Via Natural or Artificial Opening Extirpation of Matter from Left Main Bronchus, Via Natural or Artificial Opening Endoscopic

See important notes on the uses and limitations of this information on page 4.

CPT copyright 2016 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Effective: 1JAN2017 Expires: 31DEC2017 MS-DRG Rates Expire: 30SEP2017 ENDO-47409-AF FEB2017 3

Medicare Hospital Inpatient Payment Rates Effective October 1, 2016 - September 30, 2017

Medicare Severity Diagnosis Related Groups (MS-DRGs) resulting from inpatient GI stenting procedures may include (but are not limited to):

MS-DRG

374 375 376 388 389 390 393 394 395 435 436 437 441 442 443 444 445 446

Description

Digestive malignancy with Major Complication or Comorbidity (MCC5) Digestive malignancy with Complication or Comorbidity (CC5) Digestive malignancy without CC/MCC GI obstruction with MCC5 GI obstruction with CC5 GI obstruction without CC/MCC Other digestive system diagnoses with MCC5 Other digestive system diagnoses with CC5 Other digestive system diagnoses without CC/MCC Malignancy of hepatobiliary system or pancreas with MCC5 Malignancy of hepatobiliary system or pancreas with CC5 Malignancy of hepatobiliary system or pancreas without CC/MCC Disorders of liver except malignancy, cirrhosis, alcoholic hepatitis with MCC5 Disorders of liver except malignancy, cirrhosis, alcoholic hepatitis with CC5 Disorders of liver except malignancy, cirrhosis, alcoholic hepatitis without CC/MCC Disorders of the biliary tract with MCC5 Disorders of the biliary tract with CC5 Disorders of the biliary tract without CC/MCC

Hospital Inpatient Medicare National Average Payment4

$12,125 $7,303 $5,066 $9,229 $5,120 $3,586 $9,971 $5,576 $3,933 $10,374 $6,819 $5,549 $11,277 $5,440 $3,962 $9,526 $6,156 $4,557

C-Code Information

For all C-Code information, please reference the C-code Finder: reimbursement

Health economic 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 presented 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 modifies for services that are rendered. Boston Scientific recommends that you consults with your payers, reimbursements 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.

C omprehensive APCs (C-APCs): In 2014, CMS implemented their C-APC policy with the goal of identifying certain high-cost device-related outpatient procedures (formerly "device intensive" APCs). CMS has fully implemented this policy and has identified these high-cost, device-related services as the primary service on a claim. All other services reported on the same date will be considered "adjunctive, supportive, related or dependent services" provided to support the delivery of the primary service and will be unconditionally packaged into the OPPS C-APC payment of the primary service with minor exceptions.

T he 2017 National Average Medicare physician payment rates have been calculated using a 2017 conversion factor of $35.8887. Rates subject to change.

NA "NA" indicates that there is no in-office differential for these codes.

* A dd-on codes are always listed in addition to the primary procedure code.

** WallFlexTM, PercuflexTM C-FlexTM and FleximaTM Biliary RX Stent Systems as well as WALLSTENTTM Biliary Endoprostheses are not FDA-cleared for use in the pancreatic ducts.

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

2 C enter for Medicare and Medicaid Services. CMS Physician Fee Schedule - January 2017 release, RVU17A file

Boston Scientific Corporation 300 Boston Scientific Way Marlboro, MA 01752

3 Source: January 3, 2017 Federal Register CMS-1656-CN.

?2017 Boston Scientific Corporation

4 N ational average (wage index greater than one) DRG rates calculated using the national adjusted full update

or its affiliates. All rights reserved.

standardized labor, non-labor and capital amounts ($5,963.44). Source: August 22, 2016 Federal Register. 5 T he patient's medical record must support the existence and treatment of the complication or comorbidity.

Effective: 1JAN2017 Expires: 31DEC2017

SEQUESTRATION DISCLAIMER: Rates referenced in these guides do not reflect Sequestration, automatic reductions in

MS-DRG Rates Expire: 30SEP2017

federal spending that will result in a 2% across-the-board reduction to ALL Medicare rates as of January 1, 2017.

ENDO-47409-AF FEB2017

4

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