Critical Care Products 2009 Facility and Physician Billing Guide

2009 Facility and Physician Billing Guide

Critical Care Products

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PHYSICIAN AND OUTPATIENT FACILITY BILLING
Clinicians and outpatient facilities use Current Procedural Terminology (CPT®1) codes to bill for their services. For clinicians, each CPT code is assigned a unique relative value unit, which is used to determine Medicare payment based on the RBRVS system. For facilities, each CPT code is assigned a payment level based on historical charge information. Some commonly billed codes used to describe procedures related to Edwards’ Critical Care products (Swan‐Ganz catheter, FloTrac sensor, and PreSep and PediaSat oximetry catheters) are listed below.2 Unless indicated in an endnote below, these procedures may be subject to the CMS multiple procedure discount. When applicable, a payment reduction of 50% is applied to all payment amounts except the highest reimbursed procedure, which is paid at 100%.

		Physician Payment3,4		Facility Payment
CPT Code	Description	Facility Setting (Various POSs)	Non‐Facility Setting (Including POS 11)	Outpatient Hospital (POS 22)		ASC (POS 24)
36555	Insertion of non-tunneled centrally inserted central venous catheter; younger than 5 years of age	$125	$263	0621	$731	$386
36556	Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older	$119	$225	0621	$731	$386
36620	Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous	$50	$50	n/a	n/a (Packaged)	n/a (Packaged)
93503	Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes)	$112	$112	0103	$1,038	Non-covered
99291	Critical Care Evaluation and Management, first 30-74 minutes	$212	$254	0617	$4855	Non-covered
99292	Critical Care Evaluation and Management, each additional 30 minutes	$106	$115	n/a	n/a (Packaged)	Non-covered

INPATIENT HOSPITAL FACILITY BILLING
Medicare inpatient hospital reimbursement is based upon the MS-DRG 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’ Critical Care products.

ICD9-CM Procedure Code⁶	Description
38.91	Arterial catheterization
38.93	Venous catheterization, not elsewhere classified
89.62	Central venous pressure monitoring
89.64	Pulmonary artery wedge monitoring, including Swan-Ganz catheterization
89.68	Monitoring of cardiac output by other technique

HCPCS CODES
Hospitals may capture the cost for some of Edwards’ Critical Care products for payer reporting or cost accounting purposes as expenses within Revenue Code 0272 (Medical/Surgical – Sterile Supply) 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 linked to these codes. However, CMS rejects hospital claims if the appropriate code is not identified on the claim. C codes are often not 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

References
1 Current Procedural Terminology (CPT) copyright 2008 American Medical Association (AMA). All rights reserved. CPT® is a registered trademark of the AMA. 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. Applicable FARS/DFARS restrictions apply to government use.
2 Not all codes provided are applicable for all clinical scenarios in which Edwards’ Critical Care products are used. The most appropriate code(s) for the patient’s clinical presentation must be selected. When radiologic guidance is used for catheter placement, add applicable codes according to the service provided following correct coding guidelines. When performing multiple procedures, review current correct coding guidelines carefully. Services that are considered a component of another procedure cannot always be coded and billed separately.
3 3National Medicare Payment is calculated using 2009 Conversion Factor of $36.0666. Federal Register Volume 73, Number 224, November 19, 2008.
4 For all Medicare Payments for physician, hospital outpatient, and ASC services, the multiple procedure reduction rule may apply. Consult with coding and billing staff, and payer policy for further guidance.
5 When billed in conjunction with an emergency department visit, CMS Status Indicator Q3 applies.
6 2009 ICD‐9‐CM for Hospitals Volumes 1, 2, and 3.

2009 Facility and Physician Billing Guide Critical Care Products

2009 Facility and Physician Billing Guide

Critical Care Products