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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