A one-stop resource for safeguarding your CRM/EP revenues and compliance
Cardiac rhythm management (CRM) and electrophysiology (EP) procedures generate substantial revenue for hospitals and physician practices. But reimbursements can be elusive due to low coding accuracy rates, inconsistent and highly technical physician documentation, along with the sheer complexity of the procedures themselves. Even if revenues are meeting expectations, your claims may be vulnerable to auditors who are fully prepared to find mistakes and take back payments.
Could it get any tougher? The answer is a resounding “yes,” because many coders find themselves struggling with many of the new, deleted and revised codes that have been implemented in recent years, including new codes for remote physiologic monitoring and leadless pacemakers.
Protecting vital CRM/EP revenues hinges upon making certain you have the most dependable and trusted how-to resources at your fingertips. Besides helping you navigate the inherent challenges of CRM coding, billing and documentation, our Cardiac Rhythm Management Coder book will guide you through many recent changes that profoundly impact reimbursements and compliance.
Features and Benefits
Our experts address common questions, concerns, and problem areas:
- Overcoming physician documentation issues, specifically the highly technical language and critical missing details, that can prevent you from assigning the correct codes
- Comprehending subtle differences among procedures and how they relate to code selection
- Coding for ablation procedures, including the use of add-on codes. New guidelines on how to code PV ablation when the pulmonary veins have been previously isolated and are now silent. When can additional lesions be reported separately?
- Diagnostic EP — what may and may not be coded
- Coding rules and guidelines for the implantation, replacement and removal of temporary pacemakers
- The unique challenges and nuances of coding and billing for device remote monitoring — an area of growth for many facilities
Updated and expanded content, including:
- Information on all of 2022’s new, deleted and revised codes – including ablation changes, many new Category III codes with new directives and parenthetical.
- Guidance with remote physiologic monitoring codes and information on telemedicine/virtual visits as it relates to remote monitoring
- New code for intracardiac vegetation debulking
- New codes for programming device evaluations
- Code sets addressing pulse generators with implantable synchronized diaphragmatic stimulation system
- New code for body surface-activation mapping of PM / ICD lead(s)
- New directives for pacemakers and ICDs
- Responses to frequent areas of concern, including coding for remote monitoring, HIS bundle lead with insertion of pacemaker system, electrode repair, diagnostic EP and ablation procedures
- Updated information on NCCI edits and their impact on CRM services
Clear, step-by-step guidance through the tasks you perform every day:
- Coding, billing and documentation for a broad range of CRM devices and procedures, including pacemakers, cardioverter-defibrillators, subcutaneous defibrillators, electrodes, noninvasive program stimulation, EP studies, ablation and cardiovascular electronic device analysis
- Covers code assignments by both hospital (technical) and physician (professional) entities
A proven quick-reference approach for busy professionals:
- Easy to navigate for all patient settings; content is organized into three main sections:
- Basics and background information — includes explanations of common procedures, along with indications and Medicare coverage
- Outpatient coding and billing — includes the various coding systems, hospital OPPS and ASC payments and coding for specific procedures
- Inpatient coding and billing — includes ICD-10 coding system, MS-DRG payments and coding for specific procedures
- Each section on specific procedures includes:
- Description of the procedure and how it’s performed
- Appropriate CPT®/HCPCS or ICD-10 code assignments
- Billing tips
- Clinical examples to reinforce the correct application of current procedural codes and coding rules
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Introduction
- Payment Issues for Medical Devices
- How This Guide Is Organized
- Acronyms Used in This Guide
Chapter 1: The Clinical Side of Cardiac Rhythm Management Procedures
- Electrograms
- Cardiovascular Stress Tests/Exercise Stress Test
- External Cardiovascular Monitoring Services
- Remote Physiologic Monitoring
- Diagnostic EP Testing
- Intracardiac Mapping
- Ablation
- Cardiovascular Implantable Electronic Device (CIED)
- Pacemaker
- Cardiac Resynchronization Therapy Pacemaker (CRT-P)
- Implantable Cardioverter-Defibrillator (ICD)
- Cardiac Resynchronization Therapy Defibrillator (CRT-D)
- Implantable Cardiovascular Monitor (ICM)
- Implantable Loop Recorder (ILR)/Subcutaneous Cardiac Rhythm Monitor
- Left Atrial Appendage (LAA) Closure Device
- Implantable Hemodynamic Monitor—Wireless Pulmonary Artery Pressure Sensor
- Wireless Cardiac Stimulator for Left Ventricular Pacing
- Synchronized Diaphragmatic Stimulation (SDS)
Chapter 2: Indications and Coverage for Cardiac Rhythm Management Devices
- National Coverage Determinations (NCDs)
- ICD National Coverage
- Leadless Pacemaker National Coverage
- Left Atrial Appendage (LAA) Closure National Coverage
- Q0 Modifier Requirement
- MRI Coverage Policy
- Device Follow-Up National Coverage
- Local Coverage Determinations (LCDs)
SECTION 1: Outpatient Procedure Coding
Chapter 3: HCPCS/CPT Procedural Coding
- HCPCS Level I
- HCPCS Level II
- Level II C Codes
- Procedure-to-Procedure (PTP) Edits
- XX Modifiers for Distinct Procedures
- 2022 Medicare Physician Fee Schedule Updates Related to CRM Procedures
- Physician Documentation Tips for EP Procedures
Chapter 4: Hospital OPPS and ASC Payments
- Hospital Outpatient PPS
- 2022 Medicare OPPS Payment Updates
- Important Device-Related OPPS Updates
- Payments for ASCs
- 2022 Medicare ASC Payment Updates
Chapter 5: Diagnostic Cardiac Testing
- Electrocardiograms (93000–93010)
- Rhythm Strips (93040–93042)
- Computerized Database Analysis of Multiple Cycles of Digitized Cardiac Electrical Data From Two or More ECG Leads (93799) (Deleted Code 0206T)
- Cardiovascular Stress Tests/Exercise Stress Tests (93015–93018)
- External Cardiovascular Monitoring Services ≤48 Hours (93224–93227)
- External Mobile Cardiovascular Telemetry up to 30 days (93228, 93229)
- External Extended ECG Monitoring Codes 48 hours to 15 days (93241–93248)
- Patient Event Monitors Up to 30 Days (93268–93272)
- External Patient-Activated Monitors (0497T, 0498T)
- Remote Physiologic Monitoring (99453, 99454, 99457, 99458, 99091, 0607T, 0608T)
Chapter 6: Pacemaker Systems
- Permanent Pacemaker Initial Implantation (33206–33208)
- Pacemaker Generator Insertion Only (33212, 33213, 33221)
- Pacemaker Generator Replacement (33227–33229)
- Pacemaker Generator Upgrade (33214)
- Pacemaker Removal (33233)
- Pacemaker Lead (Electrode) Insertion (33216, 33217)
- Pacemaker Biventricular Lead (Electrode) Placement Into Cardiac Venous System (33224, 33225)
- Pacemaker Lead (Electrode) Repositioning (33215, 33226)
- Pacemaker Lead (Electrode) Removal (33234, 33235)
- Pacemaker Lead (Electrode) Repair (33218, 33220)
- Pacemaker Relocation of Skin Pocket—Pacemaker Generators (33222)
- Temporary Pacing (33210, 33211)
- Transcatheter Leadless Pacemaker Insertion or Replacement (33274)
- Transcatheter Leadless Pacemaker Removal (33275)
Chapter 7: Implantable Defibrillators
- ICD Initial Implant (33249)
- ICD Generator Insertion Only (33240, 33230, 33231)
- ICD Generator Removal Only (33241)
- ICD Pulse Generator Replacement (33262–33264)
- ICD Generator Lead (Electrode) Insertion (33216, 33217)
- ICD Generator Biventricular Lead (Electrode) Placement Into Cardiac Venous System (33224, 33225)
- ICD Generator Lead (Electrode) Repositioning (33215, 33226)
- ICD Generator Lead Removal (Extraction) (33244)
- ICD Generator Lead (Electrode) Repair (33218, 33220)
- ICD Generator Relocation of Skin Pocket (33223)
Chapter 8: Subcutaneous Implantable Defibrillator System
- Subcutaneous Implantable Defibrillator System Implant (33270)
- Subcutaneous Implantable Defibrillator Generator Insertion Only (33240)
- Subcutaneous Implantable Defibrillator Generator Removal Only (33241)
- Subcutaneous Implantable Defibrillator Generator Replacement (33262)
- Subcutaneous Implantable Defibrillator Lead (Electrode) Insertion (33271)
- Subcutaneous Implantable Defibrillator Lead (Electrode) Repositioning (33273)
- Subcutaneous Implantable Defibrillator Lead (Electrode) Removal (33272)
Chapter 9: Implantable Loop Recorder (ILR)/Subcutaneous Cardiac Rhythm Monitor
- ILR Implant (33285)
- ILR Removal (33286)
Chapter 10: Percutaneous Closure of Left Atrial Appendage (LAAC)
- Percutaneous Closure of Left Atrial Appendage (LAAC) (33340)
Chapter 11: Implantable Hemodynamic Monitor—Wireless Pulmonary Artery Pressure Sensor
- Implantable Hemodynamic Monitor—Wireless Pulmonary Artery Pressure Sensor (33289)
Chapter 12: Wireless Cardiac Stimulator for Left Ventricular Pacing
- Wireless Cardiac Stimulator for Left Ventricular Pacing (0515T–0520T)
Chapter 13: Implantable Cardioverter-Defibrillator with Substernal Electrode
- Implantable Cardioverter-Defibrillator with Substernal Electrode (0571T–0574T, 0580T, 0614T)
Chapter 14: Implantable Synchronized Diaphragmatic Stimulation (SDS)
- Implantable Synchronized Diaphragmatic Stimulation (SDS) (0674T, 0675T, 0676T, 0677T, 0678T, 0679T, 0680T, 0681T, 0682T)
Chapter 15: Testing ICD Device and Leads (Electrodes)
- Testing ICD Device and Leads (93640, 93641)
- Testing Subcutaneous Implantable Defibrillator Device and Leads (93644)
Chapter 16: Non-Invasive and Invasive Program Stimulation
- EP Study to Evaluate Therapy (93624)
- EP Study to Evaluate ICD System (93642)
- EP Study to Evaluation Subcutaneous Implantable Defibrillator (93644)
- EP Study to Evaluate Pacemaker (93724)
Chapter 17: Electrophysiology Studies
- Single-Site Studies (93600–93603, 93610, 93612, 93618)
- Esophageal Electrocardiography (93615, 93616)
- Cardioversion (92960, 92961)
- Mapping (Intracardiac) (93609, 93613)
- Cardioversion (92960, 92961)
- Body Surface-Activation Mapping (0695T, 0696T)
- Comprehensive EP Studies (93619, 93620)
- Add-on Codes (93621, 93622, 93623)
Chapter 18: Ablation Procedures
- Stand-Alone Ablation (93650) (Heart Block)
- Combined Comprehensive EP Study and Ablation (93653, 93654, 93655, 93656, 93657)
- Intracardiac Echocardiography (93662)
Chapter 19: Tilt-Table Testing
- Tilt-Table Evaluation (93660)
Chapter 20: Cardiovascular Electronic Device Monitoring
- Pacemaker Device Monitoring (93279–93281, 93286, 93288, 93293, 93294, 93296)
- Pacemaker Programming Device Evaluation (93279–93281)
- Pacemaker Peri-Procedural Device Evaluation and Programming (93286)
- Pacemaker Interrogation Device Evaluation (In Person) (93288)
- Transtelephonic Rhythm Strip Pacemaker Evaluation (93293)
- Pacemaker Device Interrogation (Remote) (93294, 93296)
- Implantable Cardioverter-Defibrillator (ICD) Device Monitoring (93282–93284, 93287, 93289, 93295, 93296)
- ICD Programming Device Evaluation (93282–93284)
- ICD Peri-Procedural Device Evaluation and Programming (93287)
- ICD Interrogation Device Evaluation (In Person) (93289)
- ICD Interrogation Device Evaluation (Remote) (93295, 93296)
- Body Surface–Activation Mapping (0695T, 0696T)
- Subcutaneous Implantable Defibrillator System Monitoring (93260, 93261)
- Subcutaneous Implantable Defibrillator System Programming Device Evaluation (93260)
- Subcutaneous Implantable Defibrillator System Interrogation Device Evaluation (93261)
- Subcutaneous Implantable Defibrillator System Interrogation Device Evaluation (Remote) (93295, 93296)
- Wearable Defibrillator System Device Monitoring (93292, 93745)
- Wearable Defibrillator Interrogation Device Evaluation (In Person) (93292)
- Wearable Defibrillator Initial Set-Up and Programming (93745)
- Implantable Loop Recorder (ILR) Device Monitoring (93285, 93291, 93298, G2066)
- ILR/Subcutaneous Cardiac Rhythm Monitor Programming Device Evaluation (In Person) (93285)
- ILR/Subcutaneous Cardiac Monitor Programming Device Evaluation (Remote) (0650T)
- ILR/Subcutaneous Cardiac Rhythm Monitor Interrogation Device Evaluation (In Person) (93291)
- ILR/Subcutaneous Cardiac Rhythm Monitor Interrogation Device Evaluation (Remote) (93298, G2066)
- Implantable Cardiovascular Monitor (ICM) Device Monitoring (93290, 93297, G2066)
- ICM Interrogation Device Evaluation (In Person) (93290)
- ICM Interrogation Device Evaluation (Remote) (93297, G2066)
- Transcatheter Leadless Pacemaker Device Monitoring (93279, 93286, 93288, 93294, 93296)
- Transcatheter Leadless Pacemaker Programming Device Evaluation (93279)
- Transcatheter Leadless Pacemaker Peri-Procedural Device Evaluation (93286)
- Transcatheter Leadless Pacemaker Interrogation In-Person Device Evaluation (93288)
- Transcatheter Leadless Pacemaker Remote Device Monitoring (93294, 93296)
- Implantable Hemodynamic Monitor—Wireless Pulmonary Artery Pressure Sensor Monitoring (93264)
- Wireless Cardiac Stimulator for Left Ventricular Pacing Device Evaluation Monitoring (0521T, 0522T)
- Implantable Cardioverter-Defibrillator with Substernal Electrode Evaluation Monitoring (0575T–0577T, 0579T, 0580T)
- Implantable Synchronized Diaphragmatic Stimulation (SDS) Device Evaluation (0683T, 0684T, 0685T)
Chapter 21: Unlisted Procedure Codes
- Unlisted Cardiac Surgery (33999)
- Unlisted Cardiovascular Procedure (93799)
SECTION 2: Inpatient Procedure Coding
Chapter 22: Hospital Inpatient Reimbursement
- ICD-10 Coding System
- Common Procedure Coding EP Coding Examples
- MS-DRG Basics
- MS-DRG Payments
Chapter 23: MS-DRG Logic for CRM Procedures
- Pacemakers or Cardiac Resynchronization Pacemakers
- ICD or Cardiac Resynchronization Therapy Defibrillator
- Electrophysiology Study and Ablation
Chapter 24: Pacemaker Implants
Chapter 25: Implantable Defibrillators
Chapter 26: Cardiac Resynchronization Therapy
Chapter 27: Device Testing
- ICD and Pacemaker Testing
Chapter 28: Diagnostic Electrophysiology Studies
Chapter 29: Percutaneous Ablation
Chapter 30: Leadless Pacemaker
Chapter 31: Percutaneous Left Atrial Appendage (LAAC) Closure
Chapter 32: Implantable Hemodynamic Monitor—Wireless Pulmonary Artery Pressure Sensor
Chapter 33: Wireless Cardiac Stimulator for Left Ventricular Pacing
Chapter 34: Medicare Quality Payment Programs
- Overview of Medicare Quality Programs
- Outpatient Department Measures
- Quality Payment Program
- Bundled Payments
Appendices
Appendix A: Clinical Case Examples
Appendix B: NCD for Implantable Automatic Defibrillators
Appendix C: NCD for Cardiac Pacemakers
Appendix D: NCD for Cardiac Pacemaker Evaluation Services
Appendix E: NCD for Leadless Pacemaker
Appendix F: NCD for Percutaneous Left Atrial Appendage Closure (LAAC)
Appendix G: NCD for Magnetic Resonance Imaging
