Harmony Transcatheter Pulmonary Valve Commonly Billed Codes Resource Guide

HarmonyTM

transcatheter pulmonary valve

2022 commonly billed codes

HarmonyTM

transcatheter pulmonary valve

2022 commonly billed codes

Index

For native or surgically repaired RVOTs . . . . . . . . . . . . . . . . . . . . 1 Hospital inpatient coding and reimbursement . . . . . . . . . . . . . . . . . 2 ICD-10 PCS procedure codes . . . . . . . . . . . . . . . . . . . 2 Physician coding and reimbursement . . . . . . . . . . . . . . . . 3 Hospital outpatient coding and reimbursement . . . . . . . . . . 4 Select ICD-10 CM potential diagnosis codes. . . . . . . . . . . . 5

Commonly billed codes

2022

c | Commonly billed codes

For native or surgically repaired RVOTs

The HarmonyTM transcatheter pulmonary valve (TPV) system is indicated for use in the management of pediatric and adult patients with severe pulmonary regurgitation (i.e., severe pulmonary regurgitation as determined by echocardiography and/or pulmonary regurgitant fraction 30% as determined by cardiac magnetic resonance imaging) who have a native or surgically repaired right ventricular outflow tract and are clinically indicated for surgical pulmonary valve replacement.

Medtronic provides this information for your convenience only. It does not constitute legal advice or a recommendation regarding clinical practice. Information provided is gathered from third-party sources and is subject to change without notice due to frequently changing laws, rules, and regulations.

The provider has the responsibility to determine medical necessity and to submit appropriate codes and charges for care provided. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other payers as to the correct form of billing or the amount that will be paid to providers of service. Please contact your Medicare contractor, other payers, reimbursement specialists, and/ or legal counsel for interpretation of coding, coverage, and payment policies.

This document provides assistance for FDA-approved only indications. Where reimbursement is sought for FDA-approved only use of a product that may be inconsistent with, or not expressly specified in, the FDAapproved only labeling (e.g., instructions for use, operator's manual, or package insert), consult with your billing advisors or payers on handling such billing issues. Some payers may have policies that make it inappropriate to submit claims for such items or related service.

CPT ?2021 American Medical Association (AMA). All rights reserved. CPT is a trademark of the American Medical Association. Applicable FARS/ DFARS Restrictions Apply to Government Use. Fee schedules, relative values 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. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein.

1 | Commonly billed codes

Hospital inpatient coding and reimbursement

FY2022 (Effective October 1, 2021 to September 30, 2022)

ICD-10 PCS procedure codes

Select ICD-10 PCS codes

Note: The ICD-10 PCS codes shown are those that reflect the typical procedure, using known Medtronic devices where appropriate. Theoretical possibilities are not shown, e.g., approaches that are not common and device types that are not currently on the market.

Transcatheter pulmonary valve procedure codes

ICD-10 PCS procedure code1 02RH38M

ICD-10 PCS procedure code description Replacement of pulmonary valve with zooplastic tissue, native site

Transcatheter pulmonary valve DRGs

MS-DRG 266 267

Description

Endovascular cardiac valve replacement and supplement procedures with MCC

Endovascular cardiac valve replacement and supplement procedures without MCC

MCC = major complication or comorbidity

FY22 Medicare national average2 $46,476 $36,915

1 2022 ICD-10 PCS American Medical Association. 2 CMS 1752-F and CMS 1752-CN at FY 2022 IPPS Final Rule Home Page. Available at: m.edicare/acute-inpatient-pps/fy-2022-ipps-final-rule-home-page

2 | Commonly billed codes

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