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2011-2012 Facility and Physician Billing Guide
Critical Care Technologies
PHYSICIAN BILLING CODES
Clinicians use Current Procedural Terminology (CPT1) codes to bill for procedures and services. Each CPT code is assigned unique relative value units (RVUs), which are used to determine payment by the Centers for Medicare & Medicaid Services (CMS). Some commonly billed CPT codes used to describe procedures related to Edwards Lifesciences’ Critical Care technologies (e.g. Swan-Ganz catheter, FloTrac sensor, PreSep and PediaSat oximetry catheters) are listed below. 2This list may not be comprehensive or complete. These procedures may be subject to the CMS multiple procedure reduction rule. When applicable, a payment reduction of 50% is applied to all payment amounts except the procedure with the greatest RVUs, which is paid at 100% unless exempt by CPT instructions or payer policy.BR>
| Procedures | Medicare
National Average
Physician Payment3 | | CPT Code | Description | Facility Setting
(Various POSs) | | 36555 | Insertion of non-tunneled centrally inserted central venous catheter; younger than 5 years of age | $124 | | 36556 | Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older | $123 | | 36620 | Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous | $51 | | 93503 | Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes) | $134 | | 99291 | Critical Care Evaluation and Management of the critically ill or critically injured, first 30-74 minutes | $217 | | 99292 | Critical Care Evaluation and Management of the critically ill or critically injured, each additional 30 minutes | $109 |
INPATIENT HOSPITAL BILLING CODES
Medicare inpatient hospital reimbursement is based upon the Medicare Severity-Diagnostic Related Group (MS-DRG) classification system, which assigns MS-DRGs based on ICD-9-CM diagnosis and procedure codes. The following codes generally describe procedures associated with the use of Edwards Lifesciences’ Critical Care technologies.
ICD9-CM
Procedure Code4 | Description | | 38.91 | Arterial catheterization | | 38.93 | Venous catheterization, not elsewhere classified | | 89.62 | Central venous pressure monitoring | | 89.64 | Pulmonary artery wedge monitoring | | 89.68 | Monitoring of cardiac output by other technique |
REVENUE CODES 5 AND HCPCS CODES
Revenue codes help hospitals categorize services provided by revenue center. Medicare utilizes revenue codes for cost reporting purposes. It may be appropriate for hospitals to capture the cost for some of Edwards Lifesciences’ Critical Care technologies for payer reporting or cost accounting purposes as expenses within Revenue Code 0278 (Medical/Surgical – Other Implants) on the hospital’s UB-04 billing form. C codes do not apply to inpatient surgical procedures, but should be added to the hospital’s chargemaster to report device costs used in the outpatient setting. Medicare created C codes to track device cost information for future APC rate-setting purposes. No additional facility payment is associated with these codes. CMS may reject hospital claims if the appropriate code is not identified on the claim. C codes may not be recognized by commercial payers.
| C Code | Description | | C1751 | Catheter, infusion, inserted peripherally, centrally or midline, other than hemodialysis | | C1769 | Guide wire | | C1894 | Sheath introducer, other than guiding, other than Intracardiac electrophysiological, non-laser |
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CAUTION: Federal (United States) law restricts these devices to sale by or on the order of a physician. See instructions for use for full prescribing information, including indications, contraindications, warnings, precautions and adverse events.
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