Abbott CRT-P Cardiac Resynchronization Therapy User Guide

Abbott CRT-P Cardiac Resynchronization Therapy

Product Information

Specifications

• Product: Cardiac Rhythm Management System
• Types: CRT-P (Cardiac Resynchronization Therapy Pacemaker) & CRT-D (Cardiac Resynchronization Therapy Defibrillator)
• Effective Date: January 1, 2024

Product Usage Instructions

• Introduction
  This Cardiac Rhythm Management System is designed to provide cardiac resynchronization therapy for patients with specific cardiac conditions. It includes features for biventricular pacing and is intended to improve the patient’s heart rhythm.

• Setup
  Before using the device, ensure that all components are properly connected and functioning. Follow the manufacturer’s instructions for the initial setup process.

• Implantation
  Implant the device according to the surgical procedure outlined in the user manual. Make sure to follow proper sterilization techniques and guidelines during implantation.

• Programming
  After implantation, program the device settings based on the patient’s specific needs and condition. Adjust pacing parameters as necessary to optimize therapy delivery.

• Monitoring
  Regularly monitor the device’s performance and the patient’s response to therapy. Use the provided tools for remote monitoring and make any adjustments as recommended by healthcare professionals.

• Maintenance
  Follow the recommended maintenance schedule provided by the manufacturer. Ensure that the device remains operational and in good condition for continued therapy delivery.

FAQ

• Q: What should I do if the device malfunctions?
  A: If you suspect a malfunction in the device, contact your healthcare provider immediately for further evaluation and potential device reprogramming or replacement.

• Q: Can the device be used in all patients with cardiac conditions?
  A: The use of this Cardiac Rhythm Management System should be determined by healthcare professionals based on individual patient needs and clinical assessment.

TERMS AND CONDITIONS

• All content herein may be based upon several sources, including but not limited to primary sources, scientific literature, commercially available data sets, customer-supplied information, and external sources.
• The estimates shown are for illustrative purposes only. This content is not intended for any other purpose.
• It should be noted that there are usually differences between economic modelling and actual results. Abbott does not take responsibility for any such discrepancies. There is no guarantee of any potential economic outcome, including payment, cost savings, or procedure volume. Economic outcomes are dependent on many factors and will vary.
• Certain Maryland hospitals paid under Maryland Waiver provisions using All Patient Refined Diagnosis Related Group (APR-DRG) are excluded from payment under the Medicare Inpatient Prospective Payment System (IPPS).
• Reimbursement Calculators should not be provided at no charge to actively licensed Healthcare Professionals (HCPs) who regularly practice in Vermont.
• This information is not to be distributed to third parties.

NATIONAL CARDIAC RHYTHM MANAGEMENT MEDICARE REIMBURSEMENT GUIDE

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 labelling. This content includes information regarding coverage, coding and reimbursement. Additional resources can be found at www.cardiovascular.abbott/us/en/hcp/reimbursement.html.

Biventricular Pacing/Cardiac Resynchronization Therapy (CRT)
In certain circumstances, an additional lead may be required to achieve pacing of the left ventricle (biventricular pacing). In this event, the additional transvenous lead placement should be separately reported using CPT‡ 33224 or 33225. 33226 is reported for repositioning. See the Cardiac Resynchronization Therapy section for more information.

Reimbursement Hotline
Abbott offers a reimbursement hotline, which provides live coding and reimbursement information from dedicated reimbursement specialists. Coding and reimbursement support is available Monday through Friday at 855-569-6430. Coding and reimbursement assistance is provided subject to the disclaimers outlined in this content.

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 the 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 updafrequentlyely,, therefore, 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.

CARDIAC RESYNCHRONIZATION THERAPY (CRT)

Physician
CRT procedures are often reported with add-on code 33225. Add-on code 33225 can be performed when medically appropriate with the primary service/procedure codes listed below. Add-on codes may not be reported as a stand-alone and must be billed when performed in conjunction with the primary service or procedure. Add-on codes qualify for separate payment for physicians and are not subject to the Physician Multiple Payment Reduction Rule.

CPT‡ CODE| ADD-ON CODE CPT‡ CODE DESCRIPTOR (LIST SEPARATELY IN ADDITION TO CODE FOR THE PRIMARY PROCEDURE)| WORK RVU| MEDICARE NATIONAL RATE FACILITY NON-FACILITY| REPORT WITH PRIMARY PROCEDURE CODE
---|---|---|---|---
LEFT VENTRICULAR LEAD PLACEMENT FOR CRT PROCEDURES

+33225

|

Insertion of pacing electrode, the cardiac venous system, for left ventricular pacing, at time of insertion of an implantable defibrillator or pacemaker pulse generator (e.g., for an upgrade to dual chamber system) (List separately in addition to code for primary procedure)

|

8.33

|

$442

|

NA

| 33206, 33207, 33208, 33212,

33213, 33214, 33216, 33217,

33221, 33223, 33228, 33229,

33230, 33231, 33233, 33234,

33235, 33240, 33249, 33263,

or 33264

• NA: Medicare has not established a payment amount for this code. Check with your local Medicare Administrative Contractor (MAC) to verify the payment amount.
• Indicates an add-on code.
• It is incumbent upon the physician to determine which if any, modifiers should be used first.

CPT‡ DESCRIPTION WORK

CODE RVU

| MEDICARE NATIONAL RATE
---|---
FACILITY        NON-FACILITY
OTHER CRT PROCEDURES

33224

| Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator)| ****

9.04

| ****

$491

| ****

NA

33226| Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator)| 8.68| $470| NA
33229| Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; multiple lead system| 5.79| $360| NA
33221| Insertion of pacemaker pulse generator only; with existing multiple leads| 5.55| $346| NA
33264| Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system| 6.35| $390| NA
33231| Insertion of implantable defibrillator pulse generator only; with existing multiple leads| 6.34| $388| NA

• NA: Medicare has not established a payment amount for this code. Check with your local Medicare Administrative Contractor (MAC) to verify the payment amount.
• It is incumbent upon the physician to determine which if any, modifiers should be used first.

Hospital Outpatient
CRT procedures are often reported with add-on code 33225. Add-on code 33225 can be performed when medically appropriate with the primary service/procedure codes listed below. Add-on codes may not be reported as a stand-alone and must be billed when performed in conjunction with the primary service or procedure. Some of these code combinations qualify for a complexity-adjusted APC assignment; APC assignments are shown below.

CPT‡ CODE| ADD-ON CODE CPT‡ CODE DESCRIPTOR (LIST SEPARATELY IN ADDITION TO CODE FOR THE PRIMARY PROCEDURE)| STATUS INDICATOR| REPORT WITH PRIMARY PROCEDURE CODE| APC (WHEN REPORTED

WITH PRIMARY CODE)

| MEDICARE NATIONAL RATE
---|---|---|---|---|---
LEFT VENTRICULAR LEAD PLACEMENT FOR CRT PROCEDURES
 |  |  | 33234, 33235| 5221| $3,746
 |  |  | 33212, 33216, 33217,| 5222| $8,103
 | Insertion of pacing electrode, the cardiac venous system, for left|  | 33233
+33225| ventricular pacing, at the time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for upgrade to dual chamber system) (List separately in addition to code for primary procedure)| N| 33213, 33214| 5223| $10,185
33206, 33207, 33208,

33221, 33228, 33229

| 5224| $18,585
 |  |  | 33230, 33240, 33263| 5231| $22,482
 |  |  | 33231, 33249, 33264| 5232| $31,379

• N: Items and services packaged into APC rates
• Indicates an add-on-code

OTHER CRT PROCEDURES
33221| Insertion of pacemaker pulse generator only; with existing multiple lead| J1| 5224| $18,585

33224

| Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator)| ****

J1

| ****

5223

| ****

$10,185

33226| Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and /or replacement of existing generator)| J1| 5183| $3,040
33229| Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; multiple lead system| J1| 5224| $18,585
33231| Insertion of implantable defibrillator pulse generator only; with existing multiple leads| J1| 5232| $31,379
33264| Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system| J1| 5232| $31,379

• J1: Hospital Part B services paid through a comprehensive APC.

Ambulatory Surgery Center (ASC)

CPT‡ CODE| DESCRIPTION| PAYMENT INDICATOR| MULTI-PROCEDURE DISCOUNT| MEDICARE LOCAL RATE| MEDICARE NATIONAL RATE
---|---|---|---|---|---
CRT-P PROCEDURES
C7537| insertion of atrial pacemaker with left ventricular lead| J8| Y| $10,569| $10,569
C7538| insertion of ventricular pacemaker with left ventricular lead| J8| Y| $10,767| $10,767
C7539| insertion of atrial and ventricular pacemaker with left ventricular lead| J8| Y| $10,985| $10,985
C7540| Removal and replacement of dual pacemaker with left ventricular lead| J8| Y| $10,811| $10,811
OTHER CRT PROCEDURES

33224

| Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator)| ****

J8

| ****

Y

| ****

$7,724

| ****

$7,724

33226| Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator)| J8| Y| $1,950| $1,950
33229| Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; multiple lead system| J8| Y| $12,867| $12,867
33221| Insertion of pacemaker pulse generator only; with existing multiple leads| J8| Y| $13,052| $13,052
33264| Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system| J8| Y| $25,027| $25,027
33231| Insertion of implantable defibrillator pulse generator only; with existing multiple leads| J8| Y| $25,183| $25,183

• G2: Non-office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight
• J8: Device-intensive procedure; paid at an adjusted rate.

Hospital Inpatient

Note:
Report the combination of device insertion and/or lead(s) codes that best describe the procedure performed.

ICD-10 PCS CODE| DESCRIPTION| TYPICAL MS-DRG ASSIGNMENT| MEDICARE NATIONAL RATE
---|---|---|---
PERMANENT CARDIAC PACEMAKER IMPLANT (DRGs 242, 243 AND 244)
0JH607Z| Insertion of cardiac resynchronization pacemaker pulse generator into chest subcutaneous tissue and fascia, open approach|  |
0JH637Z| Insertion of cardiac resynchronization pacemaker pulse generator into chest subcutaneous tissue and fascia, percutaneous approach| 242 with MCC| $24,191
0JH807Z| Insertion of cardiac resynchronization pacemaker pulse generator into abdomen subcutaneous tissue and fascia, open approach|  |
0JH837Z| Insertion of cardiac resynchronization pacemaker pulse generator into abdomen subcutaneous tissue and fascia, percutaneous approach|

243 with CC

|

$15,947

02HL4JZ| Insertion of pacemaker lead into left ventricle, percutaneous endoscopic approach|  |
02HL3JZ| Insertion of pacemaker lead into left ventricle, percutaneous approach|  |
02HL0JZ| Insertion of pacemaker lead into left ventricle, open approach|  |
02H44JZ| Insertion of pacemaker lead into coronary vein, percutaneous endoscopic approach| 244 without CC/MCC| $12,809
02H43JZ| Insertion of pacemaker lead into coronary vein, percutaneous approach|  |
02H40JZ| Insertion of pacemaker lead into coronary vein, open approach|  |

CC: complication or comorbidity. MCC: a major complication or comorbidity when used as a secondary diagnosis.

Note:
Report the combination of device insertion and/or lead(s) codes that best describe the procedure performed.

ICD-10 PCS CODE| DESCRIPTION| TYPICAL MS-DRG ASSIGNMENT| MEDICARE NATIONAL RATE
---|---|---|---
CARDIAC PACEMAKER DEVICE REPLACEMENT (DRGs 258 AND 259)
0JPT0PZ| Removal of cardiac rhythm-related device from trunk subcutaneous tissue and fascia, open approach| 258 with MCC| $18,965
0JPT3PZ| Removal of cardiac rhythm-related device from trunk subcutaneous tissue and fascia, percutaneous approach| 259 without MCC| $13,069
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT (DRGs 260, 261 AND 262)
02WA0MZ| Revision of cardiac lead in heart, open approach|  |
02WA3MZ| Revision of cardiac lead in heart, percutaneous approach| 260 with MCC| $23,212
02WA4MZ| Revision of cardiac lead in heart, percutaneous endoscopic approach| 261 with CC| $13,176
0JWT0PZ| Revision of cardiac rhythm-related device in trunk subcutaneous tissue and fascia, open approach| 262 without CC/MCC| $11,520
0JWT3PZ| Revision of cardiac rhythm-related device in trunk subcutaneous tissue and fascia, percutaneous approach|  |

• CC: complication or comorbidity. MCC: a major complication or comorbidity when used as a secondary diagnosis.

Note:
Report the combination of device insertion and/or lead(s) codes that best describe the procedure performed.

ICD-10 PCS CODE| DESCRIPTION| TYPICAL MS-DRG ASSIGNMENT| MEDICARE NATIONAL RATE
---|---|---|---
CARDIAC DEFIBRILLATOR IMPLANT (DRGs 275, 276, 277)

0JH609Z

| Insertion of cardiac resynchronization defibrillator pulse generator into chest subcutaneous tissue and fascia, open approach| With Cardiac Catheterization, with AMI/HF/SHOCK|
0JH639Z| Insertion of cardiac resynchronization defibrillator pulse generator into chest subcutaneous tissue and fascia, percutaneous approach| 275 with MCC| $49,262
0JH809Z| Insertion of cardiac resynchronization defibrillator pulse generator into abdomen subcutaneous tissue and fascia, open approach| 276 with MCC| $43,481
0JH839Z| Insertion of cardiac resynchronization defibrillator pulse generator into abdomen subcutaneous tissue and fascia, percutaneous approach| 277 without MCC| $33,484
02HL4KZ| Insertion of a defibrillator leads into the left ventricle, percutaneous endoscopic approach|  |
02HL3KZ| Insertion of a defibrillator leads into the left ventricle, percutaneous approach|  |
02HL0KZ| Insertion of a defibrillator leads into the left ventricle, open approach|  |
02H44KZ| Insertion of a defibrillator leads into a coronary vein, percutaneous endoscopic approach|  |
02H43KZ| Insertion of a defibrillator leads into a coronary vein, percutaneous approach|  |
02H40KZ| Insertion of a defibrillator leads into a coronary vein, open approach|  |

CC: complication or comorbidity. MCC: a major complication or comorbidity when used as a secondary diagnosis.

Note:
Report the combination of device insertion and/or lead(s) codes that best describe the procedure performed.

ICD-10 PCS CODE| DESCRIPTION| TYPICAL MS-DRG ASSIGNMENT| MEDICARE NATIONAL RATE
---|---|---|---
AICD GENERATOR PROCEDURES (DRG 245)
0JH609Z| Insertion of Cardiac Resynchronization Defibrillator Pulse Generator into Chest Subcutaneous Tissue and Fascia, Open Approach|

245

|

$31,727

0JH639Z| Insertion of Cardiac Resynchronization Defibrillator Pulse Generator into Chest Subcutaneous Tissue and Fascia, Percutaneous Approach
0JH809Z| Insertion of Cardiac Resynchronization Defibrillator Pulse Generator into Abdomen Subcutaneous Tissue and Fascia, Open Approach
0JH839Z| Insertion of Cardiac Resynchronization Defibrillator Pulse Generator into Abdomen Subcutaneous Tissue and Fascia, Percutaneous Approach
AICD LEAD PROCEDURES (DRG 265)
02H43KZ| Insertion of a defibrillator leads into a coronary vein, percutaneous approach|

265

|

$24,744

02H43MZ| Insertion of cardiac lead into coronary vein, percutaneous approach
02H63KZ| Insertion of a defibrillator leads into the right atrium, percutaneous approach
02H73KZ| Insertion of a defibrillator leads into the left atrium, percutaneous approach
02HK3KZ| Insertion of a defibrillator leads into the right ventricle, percutaneous approach
02HL3KZ| Insertion of a defibrillator leads into the left ventricle, percutaneous approach
02HN0KZ| Insertion of a defibrillator leads into the pericardium, open approach
02HN4KZ| Insertion of a defibrillator leads into the pericardium, percutaneous endoscopic approach

CC:
Complication or comorbidity. MCC: a major complication or comorbidity when used as a secondary diagnosis.

Note:
Report the combination of device insertion and/or lead(s) codes that best describe the procedure performed.

ICD-10 PCS CODE| DESCRIPTION| TYPICAL MS-DRG ASSIGNMENT| MEDICARE NATIONAL RATE
---|---|---|---
AICD LEAD PROCEDURES (DRG 265) (continued)
02HL4KZ| Insertion of a defibrillator leads into the left ventricle, percutaneous endoscopic approach|

265

|

$24,744

02HL0KZ| Insertion of a defibrillator leads into the left ventricle, open approach
02HK4KZ| Insertion of a defibrillator leads into the right ventricle, percutaneous endoscopic approach
02HK0KZ| Insertion of a defibrillator leads into the right ventricle, open approach
02H44KZ| Insertion of a defibrillator leads into a coronary vein, percutaneous endoscopic approach
02H60KZ| Insertion of a defibrillator leads into the right atrium, open approach
02H64KZ| Insertion of a defibrillator leads into the right atrium, percutaneous endoscopic approach
02H70KZ| Insertion of a defibrillator leads into the left atrium, open approach
02H74KZ| Insertion of a defibrillator leads into the left atrium, percutaneous endoscopic approach

CC: complication or comorbidity. MCC: a major complication or comorbidity when used as a secondary diagnosis.

REFERENCES

REFERENCES

1. FY2024 IPPS Final Rule Home Page. U.S. Centers for Medicare and Medicaid Services. [cited: September 2023]. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2024-ipps-final-rule-home-page
2. CY2024 ASC Final Notice Home Page. U.S. Centers for Medicare and Medicaid Services. [cited: November 2023]. https://www.cms.gov/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc/asc-regulations-and-notices
3. CY2024 MPFS Final Rule Home Page. U.S. Centers for Medicare and Medicaid Services. [cited: November 2023]. https://www.cms.gov/medicare/payment/fee-schedules/physician/federal-regulation-notices
4. CY2024 OPPS Final Rule Home Page. U.S. Centers for Medicare and Medicaid Services. [cited: November 2023]. https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/regulations-notices
5. FY2023 IPPS Final Rule Home Page. U.S. Centers for Medicare and Medicaid Services. [cited: August 2022]. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2023-ipps-final-rule-home-page
6. CY2023 OPPS Final Rule with Correction Notice. U.S. Centers for Medicare and Medicaid Services. [cited: November 2023]. https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/regulations-notices
7. Provider Outpatient Hospital Charge Data by APC, CY2021. [cited: November 2023]. https://data.cms.gov/provider-summary-by-type-of-service/medicare-outpatient-hospitals/medicare-outpatient-hospitals-by-provider-and-service
8. Medicare Inpatient Hospitals – by Provider and Service – FY2021 [cited: Sept 2023]. https://data.cms.gov/provider-summary-by-type-of-service/medicare-inpatient-hospitals/medicare-inpatient-hospitals-by-provider-and-service
9. HOSPITAL ACUTE INPATIENT SERVICES PAYMENT SYSTEM – PAYMENT BASICS [cited: September 2023] https://www.medpac.gov/wp-content/uploads/2021/11/MedPAC_Payment_Basics_22_hospital_FINAL_SEC.pdf
10. CGS Medicare Part B Fees [cited: January 2021]. https://www.cgsmedicare.com/partb/fees/index.html
11. First Coast Service Options (FCSO) Medicare Part B Fees [cited: January 2021]. https://medicare.fcso.com/SharedTools/faces/FeeSchedule_en.jspx?lob=&state=
12. National Government Services (NGS) Medicare Fee Schedule Lookup [cited: September 2023]. https://www.ngsmedicare.com/web/ngs/fee-schedules-and-pricers?lob=93617&state=97256&region=93623
13. Noridian Healthcare Solutions Medicare Contractor Status Codes (C-Status) [cited: January 2021]. https://med.noridianmedicare.com/web/jeb/fees-news/fee-schedules/contractor-status-codes-c-status
14. Novitas Solutions Medicare Physician’s Fee Schedule [cited: September 2023]. https://www.novitas-solutions.com/webcenter/portal/MedicareJH/FeeLookup
15. Palmetto GBA Medicare Physician Fee Schedule Part B [cited: January 2021]. https://www.palmettogba.com/palmetto/fees_front.nsf/fee_main?OpenForm
16. WPS Medicare Physician Fee Schedules [cited: January 2021].
    https://www.wpsgha.com/wps/portal/mac/site/fees-and-reimbursements/guides- and- resources/2021-mpfs/!ut/p/z0/fczRCoMgFIDhJ5JjDqTbNhouku1q2LmJwzKTNhWtPf96gl3 -8PEDggEM9PWONh8DvY8eUI4PpaSqat7fhea80dfnqa37862R0AH-B8dBZH
    3RDjDRtjAf5gjG7X6yhVGYWLYl7vllCxjBRcU-aS6QVhx-vBlflA!!/

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References

• medicare.fcso.com/SharedTools/faces/FeeSchedule_en.jspx?lob=&state=12.National
• CGS Administrators, LLC
• Fee Schedules and Pricers - NGSMEDICARE
• novitas-solutions.com/webcenter/portal/MedicareJH/FeeLookup15.Palmetto

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