Abbott Cardiac Rhythm Management Coding and Coverage Resources Instructions
- June 1, 2024
- Abbott
Table of Contents
Abbott Cardiac Rhythm Management Coding and Coverage Resources
Specifications:
- Product: Cardiac Rhythm Management System
- Effective Date : January 1, 2024
- Manufacturer : Abbott
Product Usage Instructions
Introduction :
The Cardiac Rhythm Management System is designed to provide cardiac resynchronization therapy for patients with specific cardiac conditions. It helps in pacing the heart and managing cardiac rhythm disorders.
Disclaimer:
It is important to note that the information provided in this manual is for reference purposes only. Always consult healthcare professionals for specific guidance on using the product.
Biventricular Pacing / Cardiac Resynchronization Therapy (CRT):
In certain circumstances, an additional lead may be required to achieve biventricular pacing. If additional transvenous lead placement is needed, it should be separately reported using CPT codes 33224 or 33225. Code 33226 is used for repositioning. Refer to the Cardiac Resynchronization Therapy section for detailed information.
FAQ :
- Q: How often should the Cardiac Rhythm Management System be checked?
- A: Regular check-ups and monitoring by healthcare professionals are recommended to ensure the proper functioning of the system and to make any necessary adjustments.
- Q: Can patients with pacemakers use this system?
- A: Patients with pacemakers should consult their healthcare providers to determine if the Cardiac Rhythm Management System is suitable for their specific condition
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 modeling 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
Introduction
This content is intended to provide reference material related to general
guidelines for reimbursement when used consistently with the product labeling.
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 set forth 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 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 updated frequently, and, therefore, the customer should check with its local carriers’ 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.
**PACEMAKERS
**
Physician
- 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
- 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.
- J1 : Hospital Part B services paid through a comprehensive APC
- Q2 : T Packaged codes
- J1: Hospital Part B services paid through a comprehensive APC
- Q2: T Packaged codes
- T = Significant procedure, multiple reduction applies
Ambulatory Surgery Center (ASC)
- A2: Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
- 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 describes the procedure performed
- CC: complication or comorbidity. MCC: a major complication or comorbidity when used as a secondary diagnosis
Hospital Inpatient
Note: report the combination of device insertion and/or lead(s) codes that best describes the procedure performed
Hospital Inpatient
Note : report the combination of device insertion and/or lead(s) codes that best describes the procedure performed
- CC: complication or comorbidity. MCC: a major complication or comorbidity when used as a secondary diagnosis
HCPCS Device Category C-Codes
ICD-10-CM Diagnosis Codes
Diagnosis codes are used by both hospitals and physicians to document the indication for the procedure. For Cardiac pacemakers, Implantable cardioverter defibrillators (ICD) and Implantable/Insertable Cardiac Monitors (ICM) patients, there are many possible diagnosis code scenarios and a wide variety of possible combinations. The possible scenarios and combinations are too numerous to capture in this document. The customer should check with their local carriers or intermediaries and should consult with legal counsel or a financial, coding or reimbursement specialist for coding, reimbursement or billing questions related to ICD-10-CM diagnosis codes.
REFERENCES
-
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 -
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 -
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 -
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 -
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 -
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 -
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 -
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 -
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
-
CGS Medicare Part B Fees [cited: January 2021].
https://www.cgsmedicare.com/partb/fees/index.html -
First Coast Service Options (FCSO) Medicare Part B Fees [cited: January 2021].
https://medicare.fcso.com/SharedTools/faces/FeeSchedule_en.jspx?lob=&state= -
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®ion=93623 -
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 -
Novitas Solutions Medicare Physician’s Fee Schedule [cited: September 2023].
https://www.novitas-solutions.com/webcenter/portal/MedicareJH/FeeLookup -
Palmetto GBA Medicare Physician Fee Schedule Part B [cited: January 2021].
https://www.palmettogba.com/palmetto/fees_front.nsf/fee_main?OpenForm -
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- B8dBZH3RDjDRtjAf5gjG7X6yhVGYWLYl7vllCxjBRcU-aS6QVhx-vBlflA!!/
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Abbott
- One St. Jude Medical Dr., St. Paul, MN 55117, USA,
- Tel: 1 651 756 2000
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- www.cardiovascular.abbott
2024 CRM Medicare Reimbursement Guide
Information contained herein for DISPLAY in the US ONLY. Not to be reproduced, distributed or excerpted.
©2023 Abbott. All rights reserved. MAT-1901316 v17.0
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Information contained herein for DISTRIBUTION in the US ONLY.
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