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2012 Facility and Physician Billing Guide
Transcatheter Heart Valve Replacement Technologies
This guide is intended to support diagnostic and procedural coding for transcatheter aortic valve replacement (TAVR) procedures.PHYSICIAN INPATIENT CODING
Clinicians use Current Procedural Terminology (CPT1)Category III codes to track the use of emerging technology, services, and procedures for clinical efficacy, utilization and outcomes, and to facilitate billing. Category III codes are temporary and do not have relative value units (RVUs) assigned to them unlike the "permanent" CPT Category I codes. Payment has not been established and is therefore based on the payers' policies rather than a yearly fee schedule.
The below procedure was assigned a Category III CPT code in July 2010 with an effective date of January 1, 2011.
| Procedure | CPT Code1,2 | Description | | TAVR - transfemoral approach | 0256T
Modifiers that
may be allowed:
assistants at
surgery
-80
-81
-82 | Implantation of catheter-delivered prosthetic
aortic heart valve; endovascular approach.
Code 0256T does not include cardiac catheterization
[93451-93572] when performed at the
time of the procedure for diagnostic purposes
prior to aortic valve replacement. Code 0256T
includes all other catheterization[s], temporary
pacing, intraprocedural contrast injection[s],
fluoroscopic radiological supervision and interpretation,
and imaging guidance, which are not
reported separately when performed to complete
the aortic valve procedure. |
HOSPITAL INPATIENT DIAGNOSIS AND PROCEDURE CODING
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 diagnosis and procedures associated with the use of the Edwards SAPIEN transcatheter heart valve technologies.
| ICD9-CM3 Procedure Code | Description | | 424.1 | Aortic valve disorders | | 39.49 | Other revisions of vascular procedure |
| ICD9-CM3 Procedure Code | Description | | 35.054 | Endovascular replacement of aortic valve | | Cardiac Catheterization | The cardiac catheterization may be coded when performed for specific evaluation beyond the approach during the procedure. |
| MS_DRG5 | Description | | 216 | Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with MCC | | 217 | Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with CC | | 218 | Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization without MCC or CC | | 219 | Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization with MCC | | 220 | Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization with CC | | 221 | Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization without MCC or CC |
| KEY CONTACTS | | Joan Sunderland Senior Regional Manager, Reimbursement
IA, ID, IN, KS, KY, MI, MN, MO, MT, NE, ND, OH, OR, PA (Pittsburgh only), SD, WA, WI, WV and WY | (949) 250-4029
joan_sunderland@edwards.com | Todd Davis Senior Regional Manager, Reimbursement
AK, AR, AZ, CA, CO, HI, NM, NV, OK, TX and UT | (949) 250-4829
todd_davis@edwards.com | John Rader Senior Regional Manager, Reimbursement
AL, DC, DE, FL, GA, LA, MD, MS, NC, SC, TN and VA | (407) 791-4369
john_rader@edwards.com | Heidi Myers Senior Regional Manager, Reimbursement
CT, IL, MA, ME, NH, NJ, NY, PA (except Pittsburgh), RI and VT | (773) 636-2747
heidi_myers@edwards.com | |
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CAUTION: Federal (United States) law restricts the Edwards SAPIEN transcatheter heart valve to sale by or on the order of a physician. This device has been approved by the FDA for specific indications for use. See instructions for use for full prescribing information, including indications, contraindications, warnings, precautions and adverse events.
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