Abbott Mechanical Thrombectomy and Thrombolysis User Guide
- May 15, 2024
- Abbott
Table of Contents
INTRO | HOSPITAL INPATIENT | HOSPITAL OUTPATIENT | ASC | PHYSICIAN
HEALTH ECONOMICS & REIMBURSEMENT
MECHANICAL THROMBECTOMY AND THROMBOLYSIS
Effective January 1, 2024
INTRODUCTION
This content is intended to provide reference material related to general guidelines for reimbursement when used consistently with the product’s labeling. This content includes information regarding coverage, coding and reimbursement. Additional resources can be found at: www.cardiovascular.abbott/us/en/hcp/reimbursement.html
REIMBURSEMENT HOTLINE
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
PTAhotline@abbott.com. This content and all
supporting documents are available at:
https://www.cardiovascular.abbott/us/en/hcp/reimbursement/vas/peripheral.html
Coding and reimbursement assistance is provided subject to the disclaimers set
forth in this guide.
DISCLAIMER
This material and the information contained herein is for general information
purposes only and is not intended, and does not constitute, legal,
reimbursement, business, clinical, or other advice. Furthermore, it is not
intended to and does not constitute a representation or guarantee of
reimbursement, payment, or charge, or that reimbursement or other payment will
be received. It is not intended to increase or maximize payment by any payer.
Abbott makes no express or implied warranty or guarantee that the list of
codes and narratives in this document is complete or error-free.
Similarly, nothing in this document should be viewed as instructions for
selecting any particular code, and Abbott does not advocate or warrant the
appropriateness of the use of 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. In
addition, the customer should note that laws, regulations, and coverage
policies are complex and are updated frequently and is subject to change
without notice.
The customer should check with its local carriers or intermediaries often and
should consult with legal counsel or a financial, coding, or reimbursement
specialist for any questions related to coding, billing, reimbursement, or any
related issues. This material reproduces information for reference purposes
only. It is not provided or authorized for marketing use.
HOSPITAL INPATIENT
FY 2024 Inpatient Prospective Payment System (IPPS) reimbursement is effective for inpatient services on October 1, 2023. This is not an all-inclusive list of possible MS-DRGs. MS-DRG assignment is based on many factors including documented patient conditions, as well as services rendered during an inpatient admission.
ARTERIAL OR VENOUS PERCUTANEOUS MECHANICAL THROMBECTOMY
Medicare reimbursement for a hospital inpatient admission with percutaneous mechanical thrombectomy of the lower limbs is assigned to MS-DRGs 270, 271, and 272.
POSSIBLE MS-DRG| DESCRIPTION|
MEDICARE REIMBURSEMENT
---|---|---
270| Other Major Cardiovascular Procedures with MCC|
$35,406
271| Other Major Cardiovascular Procedures with CC|
$24,199
272| Other Major Cardiovascular Procedures without CC or MCC|
$17,080
DIALYSIS CIRCUIT PERCUTANEOUS MECHANICAL THROMBECTOMY
Medicare reimbursement for a hospital inpatient admission with percutaneous mechanical thrombectomy of the dialysis circuit is assigned to MS-DRGs 252, 253, and 254.
POSSIBLE MS-DRG| DESCRIPTION|
MEDICARE REIMBURSEMENT
---|---|---
252| Other Vascular Procedures with MCC|
$23,482
253| Other Vascular Procedures with CC|
$17,862
254| Other Vascular Procedures without CC or MCC|
$12,148
ARTERIAL AND VENOUS THROMBOLYSIS
Medicare reimbursement for hospital inpatient admission with thrombolysis treatment is assigned to MS-DRGs 299, 300, and 301.
POSSIBLE MS-DRG| DESCRIPTION|
MEDICARE REIMBURSEMENT
---|---|---
299| Peripheral Vascular Disorders with MCC|
$11,036
300| Peripheral Vascular Disorders with CC|
$7,471
301| Peripheral Vascular Disorders without CC or MCC|
$4,970
HOSPITAL OUTPATIENT
PERCUTANEOUS MECHANICAL THROMBECTOMY
CY 2024 Outpatient Prospective Payment System (OPPS) reimbursement is effective for outpatient services on January 1, 2024. CPT‡ codes 37184-37188 include intraprocedural fluoroscopic radiological supervision and interpretation services for guidance of the procedure and intraprocedural injection(s) of a thrombolytic agent. Subsequent or prior continuous infusion of a thrombolytic is not an included service and is separately reportable (see CPT‡ codes 37211-37214).
CPT‡ CODE
| DESCRIPTION| C-APC|
MEDICARE REIMBURSEMENT
---|---|---|---
ARTERIAL MECHANICAL THROMBECTOMY
37184
| Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non- intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel|
5194
| $16,725
+37185
| Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non- intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); second and all subsequent vessel(s) within the same vascular family (List separately in addition to code for primary mechanical thrombectomy procedure)|
Packaged*
| No separate payment
+37186
| Secondary percutaneous transluminal thrombectomy (eg, nonprimary mechanical, snare basket, suction technique), noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with another percutaneous intervention other than primary mechanical thrombectomy (List separately in addition to code for primary procedure)|
Packaged*
|
No separate payment
VENOUS MECHANICAL THROMBECTOMY
37187
| Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance|
5193
| $10,493
37188
| Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy|
5183
|
$3,040
- Packaged services = no separate payment
+ Indicates an add-on-code. List add-on-code(s) separately in addition to the primary procedure performed.
CY 2024 Outpatient Prospective Payment System (OPPS) reimbursement is effective for outpatient services on January 1, 2024. CPT‡ codes 36904-36906 include intraprocedural fluoroscopic radiological supervision and interpretation services for guidance of the procedure and intraprocedural injection(s) of a thrombolytic agent.
CPT‡ CODE
| DESCRIPTION| C-APC|
MEDICARE REIMBURSEMENT
---|---|---|---
DIALYSIS CIRCUIT THROMBECTOMY
36904
| Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s)|
5192
| $5,452
36905
| Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s); with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty|
5193
| $10,493
36906
| Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s); with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis circuit|
5194
|
$16,725
ARTERIAL AND VENOUS THROMBOLYSIS
CY 2024 Outpatient Prospective Payment System (OPPS) reimbursement is effective for outpatient services on January 1, 2024
CPT‡ CODE
| DESCRIPTION| C-APC| MEDICARE REIMBURSEMENT
---|---|---|---
37211
| Transcatheter therapy, arterial infusion for thrombolysis other than coronary or intracranial, any method, including radiological supervision and interpretation, initial treatment day|
5184
| $5,241
37212
| Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day|
5183
| $3,040
37213
| Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed|
5183
| $3,040
37214
| Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed; cessation of thrombolysis including removal of catheter and vessel closure by any method|
5183
|
$3,040
AMBULATORY SURGERY CENTER
PERCUTANEOUS MECHANICAL THROMBECTOMY
CY 2024 Ambulatory Surgery Center (ASC) reimbursement is effective for ASC services on January 1, 2024 CPT‡ codes 37184-37188 include intraprocedural fluoroscopic radiological supervision and interpretation services for guidance of the procedure and intraprocedural injection(s) of a thrombolytic agent. Subsequent or prior continuous infusion of a thrombolytic is not an included service and is separately reportable (see CPT‡ codes 37211-37214).
CPT‡ CODE
| DESCRIPTION|
MEDICARE REIMBURSEMENT
---|---|---
ARTERIAL MECHANICAL THROMBECTOMY
37184
| Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non- intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel|
$10,116
+37185
| Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non- intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); second and all subsequent vessel(s) within the same vascular family (List separately in addition to code for primary mechanical thrombectomy procedure)|
Packaged*
+37186
| Secondary percutaneous transluminal thrombectomy (e.g., nonprimary mechanical, snare basket, suction technique), noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with another percutaneous intervention other than primary mechanical thrombectomy (List separately in addition to code for primary procedure)|
Packaged*
VENOUS MECHANICAL THROMBECTOMY
37187
| Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance|
$7,269
37188
| Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy|
$2,568
- Packaged services = no separate payment
+ Indicates an add-on-code. List add-on-code(s) separately in addition to the primary procedure performed.
CY 2024 Ambulatory Surgery Center (ASC) reimbursement is effective for ASC services on January 1, 2024 CPT‡ codes 36904-36906 include intraprocedural fluoroscopic radiological supervision and interpretation services for guidance of the procedure and intraprocedural injection(s) of a thrombolytic agent.
CPT‡ CODE
| DESCRIPTION|
MEDICARE REIMBURSEMENT
---|---|---
DIALYSIS CIRCUIT THROMBECTOMY
36904
| Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s)|
$3,223
36905
| Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s); with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty|
$6,106
36906
| Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s); with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis circuit|
$11,288
ARTERIAL AND VENOUS THROMBOLYSIS
CY 2024 Ambulatory Surgery Center (ASC) reimbursement is effective for ASC services on January 1, 2024.
CPT‡ CODE
| DESCRIPTION| MEDICARE REIMBURSEMENT
---|---|---
37211
| Transcatheter therapy, arterial infusion for thrombolysis other than coronary or intracranial, any method, including radiological supervision and interpretation, initial treatment day|
$3,658
37212
| Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day|
$1,964
37213
| Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed|
N/A
37214
| Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed; cessation of thrombolysis including removal of catheter and vessel closure by any method|
N/A
N/A – There is no established Medicare reimbursement in this setting.
PHYSICIAN
PERCUTANEOUS MECHANICAL THROMBECTOMY
CY 2024 Physician Fee Schedule reimbursement is effective for physician services on January 1, 2024. CPT‡ codes 37184-37188 include intraprocedural fluoroscopic radiological supervision and interpretation services for guidance of the procedure and intraprocedural injection(s) of a thrombolytic agent. Subsequent or prior continuous infusion of a thrombolytic is not an included service and is separately reportable (see CPT‡ codes 37211-37214).
CPT‡ CODE
| DESCRIPTION| MEDICARE FACILITY|
REIMBURSEMENT NON-FACILITY
---|---|---|---
ARTERIAL MECHANICAL THROMBECTOMY
37184
| Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non- intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel|
$411
| $1,645
+37185
| Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non- intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); second and all subsequent vessel(s) within the same vascular family (List separately in addition to code for primary mechanical thrombectomy procedure)|
$155
| $457
+37186
| Secondary percutaneous transluminal thrombectomy (e.g., nonprimary mechanical, snare basket, suction technique), noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with another percutaneous intervention other than primary mechanical thrombectomy (List separately in addition to code for primary procedure)|
$232
|
$1,140
VENOUS MECHANICAL THROMBECTOMY
37187
| Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance|
$375
| $1,626
37188
| Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy|
$268
|
$1,393
+ Indicates an add-on-code. List add-on-code(s) separately in addition to the primary procedure performed.
CY 2023 Physician Fee Schedule reimbursement is effective for physician services on January 1, 2023. CPT‡ codes 36904-36906 include intraprocedural fluoroscopic radiological supervision and interpretation services for guidance of the procedure and intraprocedural injection(s) of a thrombolytic agent.
CPT‡ CODE
| DESCRIPTION| MEDICARE FACILITY|
REIMBURSEMENT NON-FACILITY
---|---|---|---
DIALYSIS CIRCUIT THROMBECTOMY
36904
| Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s)|
$351
| $1,740
36905
| Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s); with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty|
$421
| $2,189
36906
| Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s); with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis circuit|
$486
|
$5,188
ARTERIAL AND VENOUS THROMBOLYSIS
CY 2024 Physician Fee Schedule reimbursement is effective for physician services on January 1, 2024.
CPT‡ CODE
| DESCRIPTION| MEDICARE FACILITY| REIMBURSEMENT NON-FACILITY
---|---|---|---
37211
| Transcatheter therapy, arterial infusion for thrombolysis other than coronary or intracranial, any method, including radiological supervision and interpretation, initial treatment day|
$369
| N/A
37212
| Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day|
$322
| N/A
37213
| Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed|
$220
| N/A
37214
| Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed; cessation of thrombolysis including removal of catheter and vessel closure by any method|
$116
|
N/A
N/A – There is no established Medicare reimbursement in this setting.
Effective Dates: January 1, 2024- December 31, 2024
References
- CMS_2024_Hospital Inpatient Prospective Payment-Final Rule Home Page. CMS-1785-F. https://www.cms.gov/medicare/acute-inpatient-pps/fy-2024-ipps-final-rule-home-page
- Hospital Outpatient Prospective Payment- Notice of Final Rulemaking with Comment Period (NFRM) CY2024. CMS 1786-FC. https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/regulations-notices/cms-1786-fc
- Ambulatory Surgical Center Payment- Notice of Final Rulemaking with Comment Period (NFRM) CY2024_CMS-1786-FC. https://www.cms.gov/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc/asc-regulations-and/cms-1786-fc
- Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY 2024. CMS1784-F. https://www.cms.gov/medicare/medicare-fee-service-payment/physicianfeesched/pfs-federal-regulation-notices/cms-1784-f
Information contained herein for DISTRIBUTION in the US ONLY.
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‡ Indicates a third party trademark, which is property of its respective
owner.
www.cardiovascular.abbott
©2023 Abbott. All rights reserved. MAT-2114108 v10.0 | Item approved for U.S.
use only.
HE&R approved for non-promotional use only.
REFERENCES
Documents / Resources
|
Abbott Mechanical Thrombectomy and
Thrombolysis
[pdf] User Guide
Mechanical Thrombectomy and Thrombolysis, Thrombectomy and Thrombolysis,
Thrombolysis
---|---
References
- Cardiac Rhythm Management Resources for Medical Reimbursement | Abbott
- Peripheral Resources for Medical Reimbursement | Abbott
- Home - Centers for Medicare & Medicaid Services | CMS
- FY 2024 IPPS Final Rule Home Page | CMS
- CMS-1786-FC | CMS
- CMS-1786-FC | CMS
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