ABBOTT CODING GUIDE
[Pages:37]TABLE OF CONTENTS VASCULAR CARDIAC ELECTROPHYSIOLOGY HEART FAILURE NEURO STRUCTURAL HEART
ABBOTT CODING GUIDE
AMBULATORY SURGICAL CENTER (ASC) AND OFFICE BASED LAB (OBL) REIMBURSEMENT GUIDE
Medicare Physician Fee Schedule
Effective Dates: January 1, 2019 to December 31, 2019
TABLE OF CONTENTS VASCULAR CARDIAC ELECTROPHYSIOLOGY HEART FAILURE NEURO STRUCTURAL HEART
TABLE OF CONTENTS
VASCULAR
Peripheral Vascular Procedures ............................................................................................................................................................................................... 3-8
CARDIAC
Pacemakers...................................................................................................................................................................................................................................9-10 Cardiac Device Monitoring .................................................................................................................................................................................................... 11-14 Implantable/Insertable Cardiac Monitors (ICM) ............................................................................................................................................................ 15-16 Implantable Cardioverter Defibrillator (ICD) ....................................................................................................................................................................17-18
ELECTROPHYSIOLOGY
Electrophysiology .................................................................................................................................................................................................................... 19-20
HEART FAILURE
Left Ventricular Assist Device (LVAD).................................................................................................................................................................................21-22 CardioMEMSTM HF System....................................................................................................................................................................................................23-24
NEUROMODULATION
Spinal Cord Stimulation (SCS).............................................................................................................................................................................................. 25-26 Radiofrequency Ablation (RFA)............................................................................................................................................................................................ 27-28 Deep Brain Stimulation (DBS)..............................................................................................................................................................................................29-32
STRUCTURAL HEART
Congenital Defects & Vascular Plugs................................................................................................................................................................................... 33-34 Surgical Heart Valves............................................................................................................................................................................................................... 35-36 AmplatzerTM PFO Occluder.................................................................................................................................................................................................... 35-36
SUMMARY
Disclaimer........................................................................................................................................................................................................................................ 37
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TABLE OF CONTENTS VASCULAR CARDIAC ELECTROPHYSIOLOGY HEART FAILURE NEURO STRUCTURAL HEART
REIMBURSEMENT FOR PERIPHERAL VASCULAR PROCEDURES
CPT CODE
CPT DESCRIPTION
MEDICARE PHYSICIAN RATE
2019
2019
FACILITY NON-FACILITY
ILIAC ARTERY REVASCULARIZATION
37220 37221 37222 37223
Iliac revascularization
Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within same vessel, when performed
Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)
Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
FEMORAL/POPLITEAL ARTERY REVASCULARIZATION
37224
Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal angioplasty
$421 $520 $195 $223
$466
$3,019 $4,284 $816 $2,256
$3,628
37225
Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed
$635
$12,444
37226
Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
$547
$10,793
37227
Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
$763
$16,033
TIBIAL/PERONEAL ARTERY REVASCULARIZATION
37228
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal angioplasty
$570
$5,260
37229
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed
$741
$12,451
37230 37231 37232 37233
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty.
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed.
$735 $799 $211 $343
$10,600 $15,230 $1,122 $1,367
+ Indicates add-on code NA: There are no Medicare Evaluations for these codes as these procedures are not typically performed in an in-office setting. The 26 modifier may be applicable for a number of these codes.
It is incumbent upon the physician to determine which, if any modifiers should be used first.
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TABLE OF CONTENTS VASCULAR CARDIAC ELECTROPHYSIOLOGY HEART FAILURE NEURO STRUCTURAL HEART
REIMBURSEMENT FOR PERIPHERAL VASCULAR PROCEDURES
CPT CODE
CPT DESCRIPTION
ILIAC ARTERY REVASCULARIZATION
37220 Iliac revascularization
37221
Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within same vessel, when performed
ASC RATE
$2,002 $5,834
37222
Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with No separate
transluminal angioplasty (List separately in addition to code for primary procedure)
payment
37223
Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
No separate payment
FEMORAL/POPLITEAL ARTERY REVASCULARIZATION
37224
Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal angioplasty
$2,887
37225
Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed
$6,410
37226
Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
$6,223
37227
Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
$10,354
TIBIAL/PERONEAL ARTERY REVASCULARIZATION
37228
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal angioplasty
$5,484
37229
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed
$9,787
37230 37231 37232
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty.
37233
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed.
$9,604
$9,851
No separate payment
No separate payment
+ Indicates add-on code NA: There are no Medicare Evaluations for these codes as these procedures are not typically performed in an in-office setting. The 26 modifier may be applicable for a number of these codes.
It is incumbent upon the physician to determine which, if any modifiers should be used first.
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TABLE OF CONTENTS VASCULAR CARDIAC ELECTROPHYSIOLOGY HEART FAILURE NEURO STRUCTURAL HEART
REIMBURSEMENT FOR PERIPHERAL VASCULAR PROCEDURES
CPT CODE
CPT DESCRIPTION
MEDICARE PHYSICIAN RATE
2019
2019
FACILITY NON-FACILITY
TIBIAL/PERONEAL ARTERY REVASCULARIZATION (CONTINUED)
37234 37235
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed.
Revascularization, endovascular, open or percutaneous, tibial\peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed.
TRANSLUMINAL BALLOON ANGIOPLASTY
37246 37247 37248 37249
Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery
Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure)
Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein
Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure)
EMBOLIZATION/CATHETER ACCESS
37241 37242 37243
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles)
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms)
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction
$300 $421
$365 $179 $312 $152
$463 $500 $589
$3,955 $4,291
$2,136 $814 $1,527 $604
$4,950 $7,622 $9,861
37244
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation
$696
$7,052
36140 Introduction of needle or intracatheter; extremity artery
$94
$459
+ Indicates add-on code NA: There are no Medicare Evaluations for these codes as these procedures are not typically performed in an in-office setting. The 26 modifier may be applicable for a number of these codes.
It is incumbent upon the physician to determine which, if any modifiers should be used first.
Abbott confidential and proprietary information. Limit distribution to intended recipients. Effective Dates: January 1, 2019 - December 31, 2019
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TABLE OF CONTENTS VASCULAR CARDIAC ELECTROPHYSIOLOGY HEART FAILURE NEURO STRUCTURAL HEART
REIMBURSEMENT FOR PERIPHERAL VASCULAR PROCEDURES
CPT CODE
CPT DESCRIPTION
TIBIAL/PERONEAL ARTERY REVASCULARIZATION (CONTINUED)
ASC RATE
37234
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed.
No separate payment
37235
Revascularization, endovascular, open or percutaneous, tibial\peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed.
No separate payment
TRANSLUMINAL BALLOON ANGIOPLASTY
37246 37247 37248 37249
Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery
Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure)
Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein
Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure)
$2,002
No separate payment
$2,002
No separate payment
EMBOLIZATION/CATHETER ACCESS
37241 37242 37243
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles)
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms)
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction
$4,056 $5,787 $4,056
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural
37244 roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage
NA
or lymphatic extravasation
36140 Introduction of needle or intracatheter; extremity artery
No separate payment
+ Indicates add-on code NA: There are no Medicare Evaluations for these codes as these procedures are not typically performed in an in-office setting. The 26 modifier may be applicable for a number of these codes.
It is incumbent upon the physician to determine which, if any modifiers should be used first.
Abbott confidential and proprietary information. Limit distribution to intended recipients. Effective Dates: January 1, 2019 - December 31, 2019
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TABLE OF CONTENTS VASCULAR CARDIAC ELECTROPHYSIOLOGY HEART FAILURE NEURO STRUCTURAL HEART
REIMBURSEMENT FOR PERIPHERAL VASCULAR PROCEDURES
CPT CODE
CPT DESCRIPTION
MEDICARE PHYSICIAN RATE
2019
2019
FACILITY NON-FACILITY
EMBOLIZATION/CATHETER ACCESS (CONT'D)
36160 Introduction of needle or intracatheter, aortic, translumbar
36200 Introduction of catheter, aorta
DIALYSIS CIRCUIT
36901
Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contract, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report
$129 $146
$176
$527 $585
$661
36902
... with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty
$251
$1,301
36903
... with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment
36904 36905
Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural thrombolytic injection(s);
... with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty
36906
... with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment
36907 36908 36909
Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the angioplasty
Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysis segment
Dialysis circuit permanent vascular embolization or occlusion, endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention
$333
$388 $465 $537 $154 $217 $210
$5,485
$1,914 $2,407 $6,723 $736 $2,451 $1,981
New Coding Updates: A new CPT procedure code was creatd for vessel access and closure in endograft procedures.
CPT CODE
CPT DESCRIPTION
2019 FACILITY
2019 NON-FACILITY
34713
Percutaneous access and closure of femoral artery for delivery of endograft through a large sheath (12F or larger), including ultrasound guidance, when performed, unilateral
$134
NA
This code is applicable only for aortic and iliac artery repair procedures using an endograft. The code may be listed twice for bilateral procedures. This will result in a total payment of 150% of the base payment rate (National Average Payment = $203).
+ Indicates add-on code NA: There are no Medicare Evaluations for these codes as these procedures are not typically performed in an in-office setting. The 26 modifier may be applicable for a number of these codes.
It is incumbent upon the physician to determine which, if any modifiers should be used first.
Abbott confidential and proprietary information. Limit distribution to intended recipients. Effective Dates: January 1, 2019 - December 31, 2019
print pages
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TABLE OF CONTENTS VASCULAR CARDIAC ELECTROPHYSIOLOGY HEART FAILURE NEURO STRUCTURAL HEART
REIMBURSEMENT FOR PERIPHERAL VASCULAR PROCEDURES
CPT CODE
CPT DESCRIPTION
EMBOLIZATION/CATHETER ACCESS (CONT'D)
ASC RATE
36160 Introduction of needle or intracatheter, aortic, translumbar 36200 Introduction of catheter, aorta
No separate payment
NA
DIALYSIS CIRCUIT
36901
Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contract, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report
$523
36902
... with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty
$2,002
36903
... with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment
$6,002
36904 36905
Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural thrombolytic injection(s);
... with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty
$2,663 $4,056
36906
... with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment
$9,724
36907 36908 36909
Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the angioplasty
Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysis segment
Dialysis circuit permanent vascular embolization or occlusion, endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention
No separate payment
No separate payment
No separate payment
New Coding Updates: A new CPT procedure code was creatd for vessel access and closure in endograft procedures.
CPT CODE
CPT DESCRIPTION
34713
Percutaneous access and closure of femoral artery for delivery of endograft through a large sheath (12F or larger), including ultrasound guidance, when performed, unilateral
ASC RATE
No separate payment
This code is applicable only for aortic and iliac artery repair procedures using an endograft. The code may be listed twice for bilateral procedures. This will result in a total payment of 150% of the base payment rate (National Average Payment = $203).
+ Indicates add-on code NA: There are no Medicare Evaluations for these codes as these procedures are not typically performed in an in-office setting. The 26 modifier may be applicable for a number of these codes.
It is incumbent upon the physician to determine which, if any modifiers should be used first.
Abbott confidential and proprietary information. Limit distribution to intended recipients. Effective Dates: January 1, 2019 - December 31, 2019
print pages
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