Peripheral Embolization Coding & Reimbursement Guide

[Pages:25]PERIPHERAL EMBOLIZATION lCl ODING & REIMBURSEMENT GUIDE 2021

TABLE OF CONTENTS

Overview of Coding and Payment for Use of Embolization Devices in Peripheral Vasculature..........................................4 ICD-10-CM Diagnosis Codes ...................................................................................................................................................6 ICD-10-PCS Procedure Codes .................................................................................................................................................8 HCPCS II Device Codes .......................................................................................................................................................... 11 CPT Codes ............................................................................................................................................................................... 12 Physician Coding and Payment.............................................................................................................................................. 15 Hospital Outpatient Coding and Payment............................................................................................................................ 17 Hospital Inpatient Coding and Payment ............................................................................................................................... 19 ASC Coding and Payment ...................................................................................................................................................... 23

2021 Peripheral Embolization Coding & Reimbursement Guide

2

Medtronic does not represent or guarantee that this information is complete, accurate, or applicable to any particular patient or third-party payer. Medtronic disclaims all liability for any consequence resulting from reliance on this document. The final decision of billing for any service must be made by the health care provider considering the medical necessity of the service furnished as well as the requirements of third-party payers and any local, state, or federal laws and regulations that apply. Medtronic is providing this information in an educational capacity with the understanding that Medtronic is not engaged in rendering accounting, or other professional services.

Health care providers should consult with their own advisors regarding coding, coverage, and payment.

Note: Medtronic does not offer products with approved indications for all procedures listed.

For questions or more information, please contact:

Medtronic Vascular Health Economics, Policy & Payment (866) 260-3987 rs.cardiovascularhealtheconomics@ cvreimbursement

CPT Copyright 2020 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.

2021 Peripheral Embolization Coding & Reimbursement Guide

3

Overview of Coding and Payment for Use of Embolization Devices in Peripheral Vasculature

Embolization devices include coils and plugs. Common applications using embolization devices in peripheral vessels are shown below. Please note this document provides assistance for FDA approved or cleared indications.

Procedures for peripheral embolization are generally performed in the hospital outpatient setting, although embolizations performed for ruptured aneurysms and traumatic hemorrhage are usually performed as inpatient.

Note: Embolization of head and neck vessels uses different codes and is outside the scope of this guide.

Type of Embolization

Vessel(s) Typically Embolized

Embolization of non-target vascular beds (prior to Yttrium-90 radioembolization of liver cancer)

? Right gastric artery ? Gastroduodenal artery

Embolization of portal vein to increase the size of the remaining left lobe of liver (prior to resection of the right lobe of the liver for liver cancer)

? Portal vein

Embolization for varicocele

? Internal testicular (spermatic, gonadal) vein

Embolization for uterine fibroids

? Uterine arteries

Embolization for pelvic congestion syndrome (pelvic varices)

? Ovarian (gonadal) vein ? Internal iliac (hypogastric) vein

Embolization of AAA endoleak from branch vessels (type 2)

? Lumbar artery ? Inferior mesenteric artery ? Internal iliac (hypogastric) artery ? Median (middle) sacral artery

Embolization of AAA endoleak at seal zones (type 1)

? Abdominal aorta ? Thoracic aorta ? Common iliac artery

Embolization of collateral vessel(s) in conjunction with placement of AAA endograft

? Internal iliac (hypogastric) artery

Embolization of pulmonary arteriovenous malformation

? Segmental pulmonary artery

Embolization of uterine arteriovenous malformation

? Uterine arteries

Embolization of renal arteriovenous malformation

? Renal artery

Embolization to exclude unruptured peripheral aneurysms from circulation

? Superior mesenteric artery ? Inferior mesenteric artery ? Gastroduodenal artery ? Splenic artery ? Renal artery ? Hepatic artery ? Internal iliac (hypogastric) artery

Continues on next page

2021 Peripheral Embolization Coding & Reimbursement Guide

4

Overview of Coding and Payment for Use of Embolization Devices in Peripheral Vasculature ?

continued

Type of Embolization Embolization to occlude ruptured peripheral aneurysms with hemorrhage

Embolization to occlude vessels with hemorrhage due to trauma or vessel injury

Vessel(s) Typically Embolized

? Superior mesenteric artery ? Inferior mesenteric artery ? Gastroduodenal artery ? Splenic artery ? Renal artery ? Hepatic artery ? Internal iliac (hypogastric) artery

? Renal artery ? Splenic artery ? Gastroduodenal artery ? Celiac artery ? Internal iliac (hypogastric) artery and its

branches (e.g., superior gluteal artery, obturator artery, internal pudendal artery) ? Arteries of extremities (e.g., axillary, brachial, ulnar, radial, femoral, popliteal, tibial, peroneal arteries)

2021 Peripheral Embolization Coding & Reimbursement Guide

5

ICD-10-CM Diagnosis Codes

ICD-10-CM diagnosis codes are used by both hospitals and physicians to document the indication for the procedure. The codes below are those commonly associated with peripheral coil and plug embolization procedures.

Diagnosis

Liver cancer (including for nontarget vessels and to increase lobe size prior to radioembolization or liver resection) Varicocele Uterine fibroids Pelvic congestion syndrome (pelvic varices)

AAA endoleak

Abdominal aortic aneurysm (including collateral vessel(s) in conjunction with placement of AAA endograft) Arteriovenous malformation, pulmonary Arteriovenous malformation, uterine Arteriovenous malformation, renal

ICD-10-CM Code C22.0 C22.1 C78.7 C7B.02

Code Description

Liver cell carcinoma (hepatocellular carcinoma) Intrahepatic bile duct carcinoma (cholangiocarcinoma) Secondary malignant neoplasm of liver and intrahepatic bile duct Secondary carcinoid tumors of liver (metastatic neuroendocrine tumor)

I86.1

Scrotal varices

D25.0 - D25.9 Leiomyoma of uterus

I86.2

Pelvic varices

Note: "Pelvic congestion syndrome" is indexed to code N94.89. However, when the term is used to refer to pelvic varicose veins, code I86.2 is specific to this condition.

I97.89

Other postprocedural complications and disorders of the circulatory system, not elsewhere classified (used for type 2)

T82.310A

Breakdown (mechanical) of aortic (bifurcation) graft (replacement) (used for type 1, early or type 1, unspecified)

T82.898A

Other specified complication of vascular prosthetic devices, implants and grafts (used for type 1, late)

I71.4

Abdominal aortic aneurysm, without rupture

Q25.72

Q27.39 I77.0 Q27.34

Congenital pulmonary arteriovenous malformation

Arteriovenous malformation, other site (congenital) Arteriovenous fistula, acquired Arteriovenous malformation of renal vessel (congenital)

Continues on next page

2021 Peripheral Embolization Coding & Reimbursement Guide

6

ICD-10-CM Diagnosis Codes ? continued

Diagnosis Aneurysm, peripheral

Traumatic injury to blood vessel

ICD-10-CM Code

Code Description

I72.2

Aneurysm of renal artery

I72.3

Aneurysm of iliac artery

I72.8

Aneurysm of other specified arteries (e.g., SMA, splenic, celiac, hepatic)

Note: The same diagnosis codes are used regardless of whether the peripheral aneurysm is ruptured or unruptured.

S35.211A-S35.218A Injury of celiac artery

S35.221A - S35.228A Injury of superior mesenteric artery

S35.231A - S35.238A Injury of inferior mesenteric artery

S35.291A - S35.298A

Injury of branches of celiac and mesenteric artery (including gastric, gastroduodenal, hepatic, and splenic arteries)

S35.411A - S35.412A Laceration of renal artery

S35.491A - S35.492A Other specified injury of renal artery

S35.511A - S35.512A Injury of iliac artery

S35.531A - S35.532A Injury of uterine artery

S35.59XA

Injury of other iliac blood vessels

S45.011A - S45.099A Injury of axillary artery

S45.111A - S45.199A Injury of brachial artery

S55.011A - S55.099A Injury of ulnar artery at forearm level

S55.111A - S55.199A Injury of radial artery at forearm level

S65.011A - S65.099A Injury of ulnar artery at wrist and hand level

S65.111A - S65.199A Injury of radial artery at wrist and hand level

S75.011A - S75.099A Injury of femoral artery

S85.011A - S85.099A Injury of popliteal artery

S85.111A - S85.129A S85.141A - S85.159A S85.171A - S85.189A

Injury of tibial artery (anterior, posterior)

S85.211A - S85.299A Injury of peroneal artery

2021 Peripheral Embolization Coding & Reimbursement Guide

7

ICD-10-PCS Procedure Codes

ICD-10-PCS procedure codes are used by hospitals to report inpatient services.

ICD-10-PCS codes are standardized. The third character in each ICD-10-PCS codes is the "root operation" which captures the objective of the procedure. Three different root operations can be used for embolization:

? L - Occlusion is used when the objective is to completely close the lumen of the vessel and prevent all blood flow through it, e.g., for tumors, varicoceles, fibroids, varices, endoleak type 2, collateral vessels with AAA, AVMs, and traumatic hemorrhage.

? V - Restriction is used when the objective is to partially close the vessel to allow blood flow through the lumen while excluding blood flow to other areas, e.g., for unruptured aneurysm.

? W - Revision is used when the objective is to correct a previously placed device that is now displaced or otherwise malfunctioning, e.g., for endoleak type 1.

Fifth character 3-Percutaneous is used for the endovascular approach and sixth character D-Intraluminal device is used for embolization coils and plugs.

ICD-10-PCS Code

Code Description

Occlusion Procedures, Peripheral Arteries

02LQ3DZ

Occlusion of right pulmonary artery with intraluminal device, percutaneous approach

02LR3DZ

Occlusion of left pulmonary artery with intraluminal device, percutaneous approach

04L03DZ

Occlusion of abdominal aorta with intraluminal device, percutaneous approach

Note: Per the ICD-10-PCS Body Part Key, the abdominal aorta code is also used for the lumbar artery and the median (middle) sacral artery, which branch directly from the abdominal aorta.

04L13DZ

Occlusion of celiac artery with intraluminal device, percutaneous approach

04L23DZ

Occlusion of gastric artery with intraluminal device, percutaneous approach

04L33DZ

Occlusion of hepatic artery with intraluminal device, percutaneous approach

Note: Per the ICD-10-PCS Body Part Key, the hepatic artery code is also used for the gastroduodenal artery, which is a branch of the hepatic artery.

04L43DZ

Occlusion of splenic artery with intraluminal device, percutaneous approach

04L53DZ

Occlusion of superior mesenteric artery with intraluminal device, percutaneous approach

04L93DZ

Occlusion of right renal artery with intraluminal device, percutaneous approach

04LA3DZ

Occlusion of left renal artery with intraluminal device, percutaneous approach

04LB3DZ

Occlusion of inferior mesenteric artery with intraluminal device, percutaneous approach

04LE3DZ

Occlusion of right internal iliac artery with intraluminal device, percutaneous approach

04LF3DZ

Occlusion of left internal iliac artery with intraluminal device, percutaneous approach

Note: Per the ICD-10-PCS Body Part Key, the internal iliac artery codes are also used for the obturator artery, superior gluteal artery, and internal pudendal artery, which are branches of the internal iliac artery.

04LE3DT

Occlusion of right uterine artery with intraluminal device, percutaneous approach

04LF3DU

Occlusion of left uterine artery with intraluminal device, percutaneous approach Continues on next page

2021 Peripheral Embolization Coding & Reimbursement Guide

8

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download