ABBOTT CODING GUIDE

[Pages:18]INTRO CONGENITAL DEFECTS SURGICAL HEART VALVES AMPLATZERTM PFO OCCLUDER

ABBOTT CODING GUIDE

STRUCTURAL HEART AND VALVES

CONGENITAL DEFECTS SURGICAL HEART VALVES AMPLATZERTM PFO OCCLUDER

Effective January 1, 2019

References & Brief Summary

INTRO CONGENITAL DEFECTS SURGICAL HEART VALVES AMPLATZERTM PFO OCCLUDER

STRUCTURAL HEART AND VALVES

Effective Janaury 1, 2019

Introduction

The Structural Heart and Valves Coding Guide is intended to provide reference material related to the reimbursement of Abbott products when used consistently with their labeling.

Reimbursement Hotline

In addition, Abbott offers a reimbursement hotline, which provides live coding and reimbursement information from dedicated reimbursement specialists. Coding and reimbursement support is available from 8 a.m. to 5 p.m. Central Time, Monday through Friday at (855) 569-6430 or hce@.

This guide and all supporting documents are available at https:// cardiovascular.abbott/us/en/hcp/reimbursement/structur-

al-heart.html. Coding and reimbursement assistance is provided subject to the disclaimers set forth in this guide.

Disclaimer

This document and the information contained herein is for general information purposes only and is not intended and does not constitute legal, reimbursement, coding, business or other advice. Furthermore, it is not intended to increase or maximize payment by any payer. Nothing in this document should be construed as a guarantee by Abbott regarding levels of reimbursement, payment or charge, or that reimbursement or other payment will be received. Similarly, nothing in this document should be viewed as instructions for selecting any particular code. The ultimate responsibility for coding and obtaining payment/reimbursement remains with the customer. This includes the responsibility for accuracy and veracity of all coding and claims submitted to third-party payers. Also note that the information presented herein represents only one of many potential scenarios, based on the assumptions, variables and data presented. In addition, the customer should note that laws, regulations, coverage and coding policies are complex and updated frequently. Therefore, the customer should check with their local carriers or intermediaries often and should consult with legal counsel or a financial, coding or reimbursement specialist for any coding, reimbursement or billing questions or related issues. This information is for reference purposes only. It is not provided or authorized for marketing use.

References & Brief Summary

INTRO CONGENITAL DEFECTS SURGICAL HEART VALVES AMPLATZERTM PFO OCCLUDER PHYSICIAN CODING HOSPITAL OUTPATIENT HOSPITAL INPATIENT ADDITIONAL CODES

ABBOTT CODING GUIDE

CONGENITAL DEFECTS

Effective January 1, 2019

References & Brief Summary

INTRO CONGENITAL DEFECTS SURGICAL HEART VALVES AMPLATZERTM PFO OCCLUDER PHYSICIAN CODING HOSPITAL OUTPATIENT HOSPITAL INPATIENT ADDITIONAL CODES

CODING AND REIMBURSEMENT FOR CONGENITAL DEFECTS

Physician1

CPT CODE

DESCRIPTION

ATRIAL SEPTAL DEFECT/PATENT FORAMEN OVALE

93580

Percutaneous transcatheter closure of congenital interatrial communication (i.e., fontan fenestration, atrial septal defect) with implant

PATENT DUCTUS ARTERISUS

93582 Percutaneous transcatheter closure of patent ductus arteriosus

VENTRICULAR SEPTAL DEFECT

93581

Percutaneous transcatheter closure of congenital ventricular septal defect with implant

WORK RVU

NATIONAL MEDICARE RATE FACILITY NON FACILITY

17.97

$1,025

NA

12.31

$700

NA

24.39

$1,397

NA

It is incumbent upon the physician to determine which, if any modifiers should be used first.

References & Brief Summary

Effective Dates: January 1, 2019 - December 31, 2019

INTRO CONGENITAL DEFECTS SURGICAL HEART VALVES AMPLATZERTM PFO OCCLUDER PHYSICIAN CODING HOSPITAL OUTPATIENT HOSPITAL INPATIENT ADDITIONAL CODES

CODING AND REIMBURSEMENT FOR CONGENITAL DEFECTS

Hospital Outpatient2

CPT CODE

DESCRIPTION

STATUS INDICATOR

ATRIAL SEPTAL DEFECT

93580

Percutaneous transcatheter closure of congenital interatrial communication (i.e., fontan fenestration, atrial septal defect) with implant

J1

PATENT DUCTUS ARTERIOSUS

93582 Percutaneous transcatheter closure of patent ductus arteriosus

J1

VENTRICULAR SEPTAL DEFECT

93581

Percutaneous transcatheter closure of congenital ventricular septal defect with implant

J1

APC

5194 5194 5194

NATIONAL MEDICARE RATE

$15,355

$15,355

$15,355

J1 = Hospital Part B services paid through a comprehensive APC

References & Brief Summary

Effective Dates: January 1, 2019 - December 31, 2019

INTRO CONGENITAL DEFECTS SURGICAL HEART VALVES AMPLATZERTM PFO OCCLUDER

PHYSICIAN CODING

HOSPITAL OUTPATIENT

HOSPITAL INPATIENT PAGE 1 PAGE 2

ADDITIONAL CODES

CODING AND REIMBURSEMENT FOR CONGENITAL DEFECTS

Hospital Inpatient3

ICD-10 PCS CODE

PATENT DUCTUS ARTERIOSUS

DESCRIPTION

02LR3DT Occlusion of ductus ateriosis with intraluminal device, percutaneous

TYPICAL MS-DRG ASSIGNMENT

NATIONAL MEDICARE RATE

270 with MCC

271 with CC

272 without CC/MCC

$30,924 $21,345 $15,995

*For vascular plug ICD-10 PCS position four code, please click on Additonal Codes, and then Vessel Location

References & Brief Summary

Effective Dates: October 1, 2018 - September 30, 2019

INTRO CONGENITAL DEFECTS SURGICAL HEART VALVES AMPLATZERTM PFO OCCLUDER

PHYSICIAN CODING

HOSPITAL OUTPATIENT

HOSPITAL INPATIENT PAGE 1 PAGE 2

ADDITIONAL CODES

CODING AND REIMBURSEMENT FOR CONGENITAL DEFECTS

Hospital Inpatient3

ICD-10 PCS CODE

ATRIAL SEPTAL DEFECT

DESCRIPTION

02U53JZ Supplement atrial septum with synthetic substitute, percutaneous approach

VENTRICULAR SEPTAL DEFECT

02UM3JZ

Supplement ventriclar septum with synthetic substitute, percutaneous approach

TYPICAL MS-DRG ASSIGNMENT

NATIONAL MEDICARE RATE

273 with MCC

274 without MCC

$22,314 $18,196

228 with MCC

229 without MCC

$40,176 $28,399

References & Brief Summary

Effective Dates: October 1, 2018 - September 30, 2019

INTRO CONGENITAL DEFECTS SURGICAL HEART VALVES AMPLATZERTM PFO OCCLUDER

PHYSICIAN CODING

HOSPITAL OUTPATIENT

HOSPITAL INPATIENT ADDITIONAL CODES C-CODES DIAGNOSIS

CODING AND REIMBURSEMENT FOR CONGENITAL DEFECTS

HCPCS Device Category C-Codes5

C-CODE DESCRIPTION

C1817 C1769 C1766

Septal defect implant system, intracardiac Guide wire Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away

References & Brief Summary

Effective Dates: January 1, 2019 - December 31, 2019

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