ABBOTT CODING GUIDE
[Pages:40]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, 2020 to December 31, 2020
TABLE OF CONTENTS VASCULAR CARDIAC ELECTROPHYSIOLOGY HEART FAILURE NEURO STRUCTURAL HEART
TABLE OF CONTENTS
VASCULAR
Peripheral Vascular Procedures................................................................................................................................................................................................ 3-8 Coronary Procedures..................................................................................................................................................................................................................9-10
CARDIAC RHYTHM MANAGEMENT
Pacemakers.................................................................................................................................................................................................................................. 11-12 Cardiac Device Monitoring ................................................................................................................................................................................................... 12-16 Implantable/Insertable Cardiac Monitors (ICM) .............................................................................................................................................................17-18 Implantable Cardioverter Defibrillators (ICD) ................................................................................................................................................................ 19-20 Cardiac Resynchronization Therapy (CRT).......................................................................................................................................................................21-22
ELECTROPHYSIOLOGY
Electrophysiology .................................................................................................................................................................................................................... 23-26
HEART FAILURE
Left Ventricular Assist Device (LVAD) ............................................................................................................................................................................... 27-28 Acute Mechanical Circulatory System (MCS) .................................................................................................................................................................. 27-28 CardioMEMSTM HF System....................................................................................................................................................................................................29-30
NEUROMODULATION
Spinal Cord Stimulation (SCS)...............................................................................................................................................................................................31-32 Radiofrequency Ablation (RFA)............................................................................................................................................................................................ 33-34 Deep Brain Stimulation (DBS).............................................................................................................................................................................................. 35-37
STRUCTURAL HEART
Congenital Defects & Vascular Plugs................................................................................................................................................................................... 38-39 Surgical Heart Valves............................................................................................................................................................................................................... 38-39 AmplatzerTM PFO Occluder ................................................................................................................................................................................................... 38-39
SUMMARY
Disclaimer........................................................................................................................................................................................................................................40
Effective Dates: January 1, 2020 - December 31, 2020
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TABLE OF CONTENTS VASCULAR CARDIAC ELECTROPHYSIOLOGY HEART FAILURE NEURO STRUCTURAL HEART
REIMBURSEMENT FOR PERIPHERAL VASCULAR PROCEDURES
CPT CODE
CPT CODE DESCRIPTION
Table of Contents
MEDICARE PHYSICIAN RATE
2020
2020
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 $519 $196 $223
$467
$2,963 $4,012 $767 $1,965
$3,524
37225
Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed
$633
$11,582
37226
Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
$546
$10,286
Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral;
37227 with transluminal stent placement(s) and atherectomy, includes angioplasty within the same
$761
vessel, when performed
$14,891
TIBIAL/PERONEAL ARTERY REVASCULARIZATION
37228
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal angioplasty
$570
$5,072
37229
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed
$738
$11,626
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.
$734 $795 $210 $342
$10,457 $14,476 $1,049 $1,288
+ Indicates add-on code NA: There is no established Medicare payment in this setting. It is incumbent upon the physician to determine which, if any modifiers should be used first.
Effective Dates: January 1, 2020 - December 31, 2020
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TABLE OF CONTENTS VASCULAR CARDIAC ELECTROPHYSIOLOGY HEART FAILURE NEURO STRUCTURAL HEART
REIMBURSEMENT FOR PERIPHERAL VASCULAR PROCEDURES
CPT CODE
CPT CODE DESCRIPTION
ILIAC ARTERY REVASCULARIZATION
37220 Iliac revascularization
Table of Contents ASC RATE
$2,142
37221
Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within same vessel, when performed
$6,179
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
$3,120
37225
Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed
$6,675
37226
Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
$6,444
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
TIBIAL/PERONEAL ARTERY REVASCULARIZATION
37228
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal angioplasty
37229
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed
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.
$10,941
$5,670 $10,286
$10,101
$10,649 No separate
payment No separate
payment
"NA" expresses that Medicare has no payment associated with those codes in the ASC setting as they do not designate ASCs as an appropriate site of service for those procedures. Some private payers may
reimburse these procedures in an ASC according to their policies and contracts with your program. Please verify with your professional coding and billing staff for this information. + Indicates add-on code NA: There is no established Medicare payment in this setting. It is incumbent upon the physician to determine which, if any modifiers should be used first.
Effective Dates: January 1, 2020 - December 31, 2020
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TABLE OF CONTENTS VASCULAR CARDIAC ELECTROPHYSIOLOGY HEART FAILURE NEURO STRUCTURAL HEART
REIMBURSEMENT FOR PERIPHERAL VASCULAR PROCEDURES
CPT CODE
CPT CODE DESCRIPTION
Table of Contents
MEDICARE PHYSICIAN RATE
2020
2020
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.
$300 $422
$3,985 $4,199
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)
$365 $179 $312 $153
$2,106 $749 $1,549 $566
EMBOLIZATION/CATHETER ACCESS
37241
37242 37243 37244 36140
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
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
Introduction of needle or intracatheter; extremity artery
$458
$500 $588 $697 $94
$5,059
$7,824 $9,873 $7,246 $493
DIAGNOSTIC ANGIOGRAPHY LOWER EXTREMITY
75710 75716
Angiography, extremity, unilateral, radiological supervision and interpretation Angiography, extremity, bilateral, radiological supervision and interpretation
$88
$88
$98
$98
+ Indicates add-on code NA: There is no established Medicare payment in this setting. It is incumbent upon the physician to determine which, if any modifiers should be used first.
Effective Dates: January 1, 2020 - December 31, 2020
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TABLE OF CONTENTS VASCULAR CARDIAC ELECTROPHYSIOLOGY HEART FAILURE NEURO STRUCTURAL HEART
REIMBURSEMENT FOR PERIPHERAL VASCULAR PROCEDURES
CPT CODE
CPT CODE DESCRIPTION
TIBIAL/PERONEAL ARTERY REVASCULARIZATION (CONTINUED)
Table of Contents
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)
$2,142
No separate payment
$2,142
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
$4,183 $6,096 $4,183
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
DIAGNOSTIC ANGIOGRAPHY
75710 75716
Angiography, extremity, unilateral, radiological supervision and interpretation Angiography, extremity, bilateral, radiological supervision and interpretation
No separate payment
NA NA
"NA" expresses that Medicare has no payment associated with those codes in the ASC setting as they do not designate ASCs as an appropriate site of service for those procedures. Some private payers may
reimburse these procedures in an ASC according to their policies and contracts with your program. Please verify with your professional coding and billing staff for this information. + Indicates add-on code NA: There is no established Medicare payment in this setting. It is incumbent upon the physician to determine which, if any modifiers should be used first.
Effective Dates: January 1, 2020 - December 31, 2020
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TABLE OF CONTENTS VASCULAR CARDIAC ELECTROPHYSIOLOGY HEART FAILURE NEURO STRUCTURAL HEART
REIMBURSEMENT FOR PERIPHERAL VASCULAR PROCEDURES
CPT CODE
CPT CODE DESCRIPTION
Table of Contents
MEDICARE PHYSICIAN
RATE
2020
2020
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
$130 $147
$177
$562 $608
$712
36902
... with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty
$250
$1,335
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
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
$332
$388 $465 $537 $153 $217 $210 $131
$5,281
$1,976 $2,481 $6,556 $710 $2,152 $2,051
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 is no established Medicare payment in this setting. It is incumbent upon the physician to determine which, if any modifiers should be used first.
Effective Dates: January 1, 2020 - December 31, 2020
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TABLE OF CONTENTS VASCULAR CARDIAC ELECTROPHYSIOLOGY HEART FAILURE NEURO STRUCTURAL HEART
REIMBURSEMENT FOR PERIPHERAL VASCULAR PROCEDURES
CPT CODE
CPT CODE DESCRIPTION
EMBOLIZATION/CATHETER ACCESS (CONT'D)
Table of Contents
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
$573
36902
... with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty
$2,142
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
$6,319
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
$2,875 $4,183
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
$10,181
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
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
No separate payment
"NA" expresses that Medicare has no payment associated with those codes in the ASC setting as they do not designate ASCs as an appropriate site of service for those procedures. Some private payers may
reimburse these procedures in an ASC according to their policies and contracts with your program. Please verify with your professional coding and billing staff for this information. + Indicates add-on code NA: There is no established Medicare payment in this setting. It is incumbent upon the physician to determine which, if any modifiers should be used first.
Effective Dates: January 1, 2020 - December 31, 2020
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