Diagnostic and interventional venous procedures (lower extremity)


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Coding and Medicare national payment guide
2018
Diagnostic and interventional venous procedures (lower extremity)

All coding, coverage, billing and payment information provided herein by Philips is gathered from third-party sources and is subject to change. The information is intended to serve as a general reference guide and does not constitute reimbursement or legal advice. For all coding, coverage and reimbursement matters or questions about the information contained in this material, Philips recommends that you consult with your payers, certified coders, reimbursement specialists and/or legal counsel. Philips does not guarantee that the use of any particular codes will result in coverage or payment at any specific level. Coverage for these procedures may vary by Payer. Philips recommends that providers verify coverage prior to date of service. This information may include some codes for procedures for which Philips currently offers no cleared or approved products. In those instances, such codes have been included solely in the interest of providing users with comprehensive coding information and are not intended to promote the use of any products. The selection of a code must reflect the procedure(s) documented in the medical record. Providers are responsible for determining medical necessity, the proper place of service, and for submitting accurate claims. Payment amounts set forth herein are 2018 Medicare national averages; local Medicare payment amounts and private payer rates will vary.

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1 Hospital inpatient Hospitals are reimbursed by Medicare for inpatient procedures and services under the FY2018 Inpatient Prospective
Payment System (IPPS), which utilizes the Medicare Severity Diagnosis Related Group (MS-DRG) system.

1.1 Hospital inpatient diagnosis codes
Not an all-inclusive list. Refer to ICD-10-CM 2018: The Complete Official Codebook for additional codes. Depending on procedure performed, multiple codes may be reported.

ICD-10-CM1 I70.401 I70.402 I70.403 I70.411 I70.412 I70.413 I70.421 I70.422 I70.423 I70.461 I70.462 I70.463 I70.491 I70.492 I70.493 I80.10 I80.11 I80.12 I80.13 I80.211 I80.212 I80.213 I80.219 I80.221 I80.222 I80.223

Descriptor Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, right leg Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, left leg Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, bilateral legs Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, right leg Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, left leg Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, bilateral legs Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, right leg Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, left leg Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, bilateral legs Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, right leg Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, left leg Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, bilateral legs Other atherosclerosis of autologous vein bypass graft(s) of the extremities, right leg Other atherosclerosis of autologous vein bypass graft(s) of the extremities, left leg Other atherosclerosis of autologous vein bypass graft(s) of the extremities, bilateral legs Phlebitis and thrombophlebitis of unspecified femoral vein Phlebitis and thrombophlebitis of right femoral vein Phlebitis and thrombophlebitis of left femoral vein Phlebitis and thrombophlebitis of femoral vein, bilateral Phlebitis and thrombophlebitis of right iliac vein Phlebitis and thrombophlebitis of left iliac vein Phlebitis and thrombophlebitis of iliac vein, bilateral Phlebitis and thrombophlebitis of unspecified iliac vein Phlebitis and thrombophlebitis of right popliteal vein Phlebitis and thrombophlebitis of left popliteal vein Phlebitis and thrombophlebitis of popliteal vein, bilateral

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continued from 1.1 Hospital inpatient diagnosis codes

ICD-10-CM1 I80.229 I80.231 I80.232 I80.233 I80.239 187.2

Descriptor Phlebitis and thrombophlebitis of unspecified popliteal vein Phlebitis and thrombophlebitis of right tibial vein Phlebitis and thrombophlebitis of left tibial vein Phlebitis and thrombophlebitis of tibial vein, bilateral Phlebitis and thrombophlebitis of unspecified tibial vein Venous insufficiency (chronic) (peripheral)

1.2 Hospital inpatient procedure codes
Not an all-inclusive list. Refer to ICD-10-PCS 2018: The Complete Official Codebook for additional codes. Depending on procedure performed, multiple codes may be reported.

ICD-10-PCS2 Descriptor

Non-coronary intravascular ultrasound (IVUS)

B543ZZ3

Ultrasonography of Right Jugular Veins, Intravascular

B544ZZ3

Ultrasonography of Left Jugular Veins, Intravascular

B546ZZ3

Ultrasonography of Right Subclavian Vein, Intravascular

B547ZZ3

Ultrasonography of Left Subclavian Vein, Intravascular

B548ZZ3

Ultrasonography of Superior Vena Cava, Intravascular

B549ZZ3

Ultrasonography of Inferior Vena Cava, Intravascular

B54BZZ3

Ultrasonography of Right Lower Extremity Veins, Intravascular

B54CZZ3

Ultrasonography of Left Lower Extremity Veins, Intravascular

B54DZZ3

Ultrasonography of Bilateral Lower Extremity Veins, Intravascular

B54JZZ3

Ultrasonography of Right Renal Vein, Intravascular

B54KZZ3

Ultrasonography of Left Renal Vein, Intravascular

B54LZZ3

Ultrasonography of Bilateral Renal Veins, Intravascular

B54MZZ3

Ultrasonography of Right Upper Extremity Veins, Intravascular

B54NZZ3

Ultrasonography of Left Upper Extremity Veins, Intravascular

B54PZZ3

Ultrasonography of Bilateral Upper Extremity Veins, Intravascular

B54TZZ3

Ultrasonography of Portal and Splanchnic Veins, Intravascular

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continued from 1.2 Hospital inpatient procedure codes

ICD-10-PCS2 Descriptor

Venous stent

067C3DZ

Dilation of Right Common Iliac Vein with Intraluminal Device, Percutaneous Approach

067C4DZ

Dilation of Right Common Iliac Vein with Intraluminal Device, Percutaneous Endoscopic Approach

067D3DZ

Dilation of Left Common Iliac Vein with Intraluminal Device, Percutaneous Approach

067D4DZ

Dilation of Left Common Iliac Vein with Intraluminal Device, Percutaneous Endoscopic Approach

067F3DZ

Dilation of Right External Iliac Vein with Intraluminal Device, Percutaneous Approach

067F4DZ

Dilation of Right External Iliac Vein with Intraluminal Device, Percutaneous Endoscopic Approach

067G3DZ

Dilation of Left External Iliac Vein with Intraluminal Device, Percutaneous Approach

067G4DZ

Dilation of Left External Iliac Vein with Intraluminal Device, Percutaneous Endoscopic Approach

067M3DZ

Dilation of Right Femoral Vein with Intraluminal Device, Percutaneous Approach

067M4DZ

Dilation of Right Femoral Vein with Intraluminal Device, Percutaneous Endoscopic Approach

067N0DZ

Dilation of Left Femoral Vein with Intraluminal Device, Open Approach

067N3DZ

Dilation of Left Femoral Vein with Intraluminal Device, Percutaneous Approach

067N4DZ

Dilation of Left Femoral Vein with Intraluminal Device, Percutaneous Endoscopic Approach

067P3DZ

Dilation of Right Saphenous Vein with Intraluminal Device, Percutaneous Approach

067P4DZ

Dilation of Right Saphenous Vein with Intraluminal Device, Percutaneous Endoscopic Approach

067Q3DZ

Dilation of Left Saphenous Vein with Intraluminal Device, Percutaneous Approach

067Q4DZ

Dilation of Left Saphenous Vein with Intraluminal Device, Percutaneous Endoscopic Approach

1.3 FY2018 Hospital inpatient diagnosis related groups (DRG)
For peripheral venous primary interventional procedures; assignment varies based on patient condition.

DRG 299 300 301

Descriptor Peripheral vascular disorders with MCC4 Peripheral vascular disorders with CC5 Peripheral vascular disorders without CC/MCC

Payment3 $8,505 $6,137 $4,370

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2 Hospital outpatient and ambulatory surgery center
Hospitals are reimbursed by Medicare for outpatient procedures and services under the Outpatient Prospective Payment System (OPPS), which utilizes the CY2018 Ambulatory Payment Classification (APC) system. Ambulatory Surgery Centers are reimbursed based on a percentage of the OPPS Payment Rates.

2.1 Hospital outpatient procedure and ASC procedure codes

Outpatient hospital6

ASC6

CPT code7

Descriptor

APC/Status Payment Payment indicator8

Selective catheter placement

36011 Selective catheter placement, venous system; first order branch (eg, renal N vein, jugular vein)

$0

$0

36012

; second order, or more selective, branch (eg, left adrenal vein, petrosal sinus) N

$0

$0

Diagnostic venography

36005 Injection procedure for extremity venography (including introduction of N needle or intracatheter)

$0

$0

75820

Venography, extremity, unilateral, radiological supervision and interpretation 5181 / Q2

$613

$0

75822

Venography, extremity, bilateral, radiological supervision and interpretation 5182 / Q2

$983

$0

Non-coronary intravascular ultrasound (IVUS)

+37252

Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and N interpretation; initial non-coronary vessel (list separately in addition to code for primary procedure)

$0

$0

+37253

; each additional non-coronary vessel (list separately in addition to code for N primary procedure)

$0

$0

Venous stent placement

37238

Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; initial vein

5193 / J1

$10,510 $6,518

+37239

; each additional vein (List separately in addition to code for primary procedure)

N

$0

$0

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2.2 HCPCS supply code
In the outpatient setting, when devices are used in combination with device-related procedures, hospitals report C codes. While the supply codes are not paid separately from the procedure, the assignment of charges and reporting these supply codes identify device-related costs. This information is important for future rate-setting by Medicare. Private payers’ policies vary if they accept the use of these C codes.

HCPCS code C1753

Descriptor Catheter, intravascular ultrasound

Device name
Visions PV Intravascular Ultrasound Catheter

APC/Status indicator Payment

N

$0

3 Physician Physician services are paid by Medicare based on the CY2018 Physician Fee Schedule.

3.1 Physician procedure codes - inpatient, outpatient, ASC and office

CPT code7

Descriptor

Work RVU9

Facility10 (hospital or ASC)

Payment11,12

Total RVU9

Selective catheter placement

36011

Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, 3.14 within a vascular family

$164

4.56

36012

Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery 3.51 branch, within a vascular family

$181

5.04

Diagnostic venography

36005 Injection procedure for extremity venography (including .95 $50 introduction of needle or intracatheter)

75820

Venography, extremity, unilateral, radiological supervision and interpretation

.70

$36

75822

Venography, extremity, bilateral, radiological supervision 1.06 $53 and interpretation

Non-coronary intravascular ultrasound (IVUS)

1.40 .99 1.48

+37252

Intravascular ultrasound (non-coronary vessel) during

diagnostic evaluation and/or therapeutic intervention,

including radiological supervision and interpretation;

1.80 $96

initial non-coronary vessel (list separately in addition to

code for primary procedure)

2.66

Non-facility10 (in-office, OBL)

Payment11,12

Total RVU9

$847 $868

23.52 24.12

$332 $118 $138

9.22 3.27 3.84

$1,398

38.83

+37253

Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; each additional non-coronary vessel (list separately in addition to code for primary procedure)

1.44 $77

2.14

$211

5.86

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continued from 3.1 Physician procedure codes - inpatient, outpatient, ASC and office

Facility10 (hospital or ASC)

CPT code7

Descriptor

Work RVU8

Payment11,12

Total RVU9

Venous stent placement

37238

Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; initial vein

6.04

$314

8.73

+37239

; each additional vein (List separately in addition to code for primary procedure)

2.97

$159

4.43

Non-facility10 (in-office, OBL)

Payment11,12

Total RVU9

$4,250

118.06

$2,058

57.16

4 Moderate sedation Also known as conscious sedation.
Effective January 1, 2017 Moderate sedation was removed from all procedural services it was previously inherently included. CPT codes have been revised to reflect the removal of the moderate sedation CPT symbol indicating which procedure included moderate sedation. Moderate sedation is now separately billed using the new moderate sedation codes. Six new CPT codes CPT 99151-99157 were created. Providers should report the appropriate moderate sedation code(s) in addition to the procedure CPT codes when moderate sedation is performed. For further coding instructions, please refer to the coding guidelines and moderate sedation table in 2018 CPT Professional.

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Highlights
For complete guidance, refer to CPT Medicare and private payer edits and rules.
Intravascular ultrasound
• Services described by the IVUS CPT codes include all transducer manipulations and repositioning within the specific vessel being examined during a diagnostic procedure or before, during, and/or after therapeutic intervention (e.g., stent or stent graft placement, angioplasty, atherectomy, embolization, thrombolysis, transcatheter biopsy). –– CPT Copyright© 2017 American Medical Association –– CPT Changes: An Insider’s View, Surgery, 2016
• IVUS is designated as an add-on procedure and is always performed in conjunction with a primary procedure. –– CPT Copyright© 2017 American Medical Association –– CPT Changes: An Insider’s View, Surgery, 2016
• The catheter supply cost is packaged into the facility payment for the primary procedure. IVUS codes 37252, 37253 are designated as status “N” in the facility setting by Medicare, which means the payment for IVUS has been packaged into other services and there is no separate payment. –– Medicare Claims Processing Manual Chapter 4 - Part B Hospital (Including Inpatient Hospital Part B and OPPS): 10.4
• If a lesion extending across the margins of one vessel into another is imaged with IVUS, report using only 37252 (first vessel) despite imaging more than one vessel. –– CPT Copyright© 2017 American Medical Association –– CPT Changes: An Insider's View, Surgery, 2016
Intervention
• 37238, 37239 includes any and all balloon angioplasty(s) performed in the treated vessel, including any predilation (whether performed as a primary or secondary angioplasty), post-dilation following stent placement, treatment of a lesion outside the stented segment but in the same vessel, or use of larger/smaller balloon to achieve therapeutic result. Angioplasty in a separate and distinct vessel may be reported separately. Non-selective and/or selective catheterization(s) is reported separately. Intravascular ultrasound may be reported separately (ie, 37252, 37253). –– CPT Changes: An Insider’s View: Surgery 2016
• If a lesion extends across the margins of one vessel into another, but can be treated with a single therapy, the intervention should be reported only once. When additional, different vessels are treated in the same session, report 37239 as appropriate –– CPT Copyright© 2017 American Medical Association –– CPT Changes: An Insider’s View: Surgery, 2016

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Third-party sources
• 2018 CPT Professional Edition • 2016 CPT Changes, An Insider’s View • 2017 CPT Changes, An Insider's View • CPT Assistant • 2018 ICD-10-CM and ICD-10-PCS: The Complete Official Codebook
1. Refer to ICD-10-CM 2018: The Complete Official Codebook for a complete list of diagnosis codes and specific character codes. 2. Refer to ICD-10-PCS 2018: The Complete Official Codebook for a complete list of procedure codes and specific character codes. 3. Medicare Inpatient Prospective Payment System 2018 Final Rule (CMS-1677-CN) Federal Register Vol 82 No. 191, October 4, 2017. Table 5 CN. Payment rates assume
full update amount for hospitals which have submitted quality data and hospitals have a wage index greater than 1. 4. Major complications and comorbidities 5. Complications and comorbidities 6. Medicare Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs. 2018 Final Rule (CMS-1678-
CN), Published in the Federal Register December 14, 2017, OPPS Addendum B and ASC Addendas AA-EE. 7. CPT Copyright 2017 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. 8. Status J1: Comprehensive APC – accounts for all costs and component services typically involved in the provision of the complete primary procedure; Status N: No separate APC payment. Packaged into payment for other services. 9. RVU: Relative Value Units assigned under the Medicare Physician Fee Schedule, Addendum B. For each CPT code, RVUs are assigned to account for the relative resource costs used to provide the service. 10.Medicare Physician Fee Schedule. Final Policy, Payment, and Quality Provisions in the Medicare Physician Fee Schedule for Calendar Year 2018, (CMS-1676-F), November 2, 2017. Federal Register Vol. 82, No. 219. Addendum B, 2018 conversion factor 35.9996. 11. Standard payment adjustment rules for multiple procedures apply. If procedure is reported on the same day as another procedure (with fee schedule indicator 1, 2, or 3) rank the procedures by fee schedule amount and apply the appropriate reduction to this code (100%, 50%, 50%, 50% and by report). Payment based on the lower of: (a) the actual charge or (b) the fee schedule amount reduced by the appropriate percentage. (Modifier -51) 12. 150% payment adjustment for bilateral procedures applies. If the code is billed with the bilateral modifier or is reported twice on the same day by any other means (e.g., with RT and LT modifiers, or with a 2 in the units field), base the payment for these codes when reported as bilateral procedures on the lower of: (a) the total actual charge for both sides or (b) 150% of the fee schedule amount for a single code. If the code is reported as a bilateral procedure and is reported with other procedure codes on the same day, apply the bilateral adjustment before applying any multiple procedure rules. CPT® Copyright 2018 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. For further information about Philips and Spectranetics products, please visit www.philips.com/IGTdevices or www.spectranetics.com.
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Diagnostic and interventional venous procedures (lower extremity)