Medtronic Structural Heart ICD-10 Coding for Hospitals
Linda Holtzman RHIA, CCS, CCS-P, CPC,COC Clarity Coding January 2016 Disclaimer
Reimbursement information provided by Medtronic is for illustrative purposes only and does not constitute legal advice. Information provided is gathered from third party sources and is subject to change without notice due to frequently changing laws, rules and regulations. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third party payers as to the correct form of billing or the amount that will be paid to providers of service. The provider of service has the responsibility to determine medical necessity and to submit appropriate codes and charges for care provided. Please contact your local payers, reimbursement specialists and/or legal counsel for interpretation of coding, coverage, and payment policies. Medtronic does not promote the use of its products outside FDA-approved labeling.
2 Topics
Background and Framework ICD-10-CM Diagnosis Codes ICD-10-PCS Procedure Codes DRG Impact Appendix : Key Resources Questions
Attachment : Diagnosis Code Crosswalks
3 Background and Framework
4 Effective Date
ICD-10 went into effect October 1, 2015.
Use of ICD-10 in the United States was formally proposed in August 2008 and finalized in January 2009. Implementation of ICD-10 was initially scheduled for October 2013 and has been postponed twice since then.
ICD-10 is effective by date of discharge, not by date of admission. ICD-10-CM for diagnosis codes and ICD-10-PCS for procedure codes go into effect together on the same date.
5 Who Uses What
Hospitals, physicians and all other providers must use ICD-10 diagnosis codes. Hospitals must also use ICD-10-PCS procedure codes for inpatient cases. Implementation of ICD-10 does not affect use of CPT.
Provider Setting Diagnoses Procedures
Hospitals Inpatient ICD-10-CM ICD-10-PCS
Hospitals Outpatient ICD-10-CM CPT
Physicians Facility/Office ICD-10-CM CPT
ASCs Outpatient ICD-10-CM CPT
6 ICD-10 Coding Guidelines
Guidelines for use of ICD-10 are available from multiple credible sources. Instructions within the ICD-10 codebook itself The ICD-10 Official Guidelines for Coding and Reporting Coding Clinic and AHA Coding Clinic Advisor AHA ICD-10-CM and ICD-10-PCS Coding Handbook Minutes from meetings of the ICD-10 Coordination and Maintenance Committee ICD-10-PCS Reference Manual AHIMA ICD-10-PCS: An Applied Approach
7 General Equivalence Mappings
General Equivalence Mappings (GEMs) are useful tools for going back-and-forth between ICD-9 and ICD-10 codes, for both diagnoses and procedures. Forward GEMs go from ICD-9 to ICD-10; Backward GEMs go from ICD-10 to ICD-9. The GEMs can be found at: http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2105 http://www.cms.gov/Medicare/Coding/ICD10/ 2015-ICD-10-CM-and-GEMs.html GEMs can be a good starting place. But NCHS and CMS strongly recommend coding directly from the ICD-10 codebooks, as studies have consistently indicated that this is most accurate.
8 ICD-10-CM Diagnosis Codes
9 Diagnosis Code Structure
Codes are organized by chapter, mostly by body system. The chapters are virtually identical to those in ICD-9-CM.
Codes are alpha-numeric and can be 3 to 7 digits long.
CategoryDecimal Details Extension T82.223A T 8 2 2 2 3 A Leakage of biological heart valve graft, initial encounter alpha number alpha or number Q21.3 Q 2 1 3 Tetralogy of Fallot I25.10 Atherosclerotic heart disease I 2 5 1 0 of native coronary artery without angina pectoris
10 Volume of Diagnosis Codes
ICD-10-CM has far more diagnosis ICD-9-CM codes than ICD-9-CM and provides a 14,567 codes greater level of specificity. ICD-10-CM Example: Non-rheumatic aortic valve disorders 69,823 codes
ICD-9-CM ICD-10-CM I35.0 Non-rheumatic aortic (valve) stenosis I35.1 Non-rheumatic aortic (valve) insufficiency (regurgitation) Aortic valve 424.1 I35.2 Non-rheumatic aortic (valve) stenosis with insufficiency disorders I35.8 Other non-rheumatic aortic valve disorders I35.9 Non-rheumatic aortic valve disorder, unspecified Example: Mechanical complication of coronary artery bypass graft
ICD-9-CM ICD-10-CM
T82.211A Breakdown (mechanical) of coronary artery bypass graft, initial encounter Mechanical complication T82.212A Displacement of coronary artery bypass graft, initial encounter 996.03 due to coronary artery bypass T82.213A Leakage of coronary artery bypass graft, initial encounter graft T82.218A Other mechanical complication of coronary artery bypass graft, initial encounter
11 Valve Disorders
Aortic valve stenosis and pulmonary valve disorders default to non-rheumatic.
Mitral valve stenosis and tricuspid valve disorders default to rheumatic.
Valve disease with involvement of multiple valves (aortic, mitral, tricuspid) is coded as rheumatic whether documented as rheumatic or not.
12 Angina and Coronary Artery Disease
Angina codes (I20) are not assigned separately if the patient also has CAD. A combination code is used instead. A cause-and-effect relationship between angina and CAD can be assumed.1 To code CAD in ICD-10-CM, the coder must know three things: Does the patient also have angina? What kind of vessel has coronary atherosclerosis? What kind of angina?
Code Description Notes Atherosclerotic heart disease of native coronary artery I25.10 Use for CAD or ASHD NOS without angina without angina pectoris Atherosclerotic heart disease of native coronary artery I25.119 Use for CAD or ASHD NOS with angina with unspecified angina pectoris Atherosclerosis of coronary artery bypass graft(s), I25.709 Use for CAD or ASHD with CABG with angina unspecified, with unspecified angina pectoris
1. ICD-10-CM Official Guidelines for Coding and Reporting (Diagnoses), FY 2015, p.42
13 Device Complications
Mechanical complication is defined the same way in ICD-10-CM as it is in ICD-9-CM. ICD-10-CM differentiates between mechanical complications of artificial valves and tissue valves.
Code Description Notes Breakdown (mechanical) of heart valve prosthesis, initial T82.01xA Artificial valve devices (metallic) encounter Breakdown (mechanical) of biological heart valve graft, Tissue valve devices, including bio- T82.221A initial encounter prosthetics Occlusion of a coronary artery bypass graft due to atherosclerosis is not coded as a complication. Use I25.7 instead.2 ICD-10-CM has a specific code for infection of heart valve device.
Code Description Notes Infection and inflammatory reaction due to cardiac valve T82.6xxA Heart valve devices (any type) prosthesis, initial encounter Infection and inflammatory reaction due to other cardiac T82.7xxA All other cardiac devices and vascular devices, implants, and grafts, initial encounter
2. AHA ICD-10-CM and ICD-10-PCS Coding Handbook, FY 2015, p.535 14 Device Complications
For other (non-mechanical) complications, ICD-10-CM differentiates the type of complication but not the type of device.
ICD-9-CM ICD-10-CM
Other complication T82.817A Embolism of cardiac prosthetic devices, implants and grafts, initial encounter 996.71 due to heart valve T82.827A Fibrosis of cardiac prosthetic devices, implants and grafts, initial encounter prosthesis T82.837A Hemorrhage of cardiac prosthetic devices, implants, grafts, initial encounter Other complication T82.847A Pain from cardiac prosthetic devices, implants and grafts, initial encounter 996.72 due to other T82.857A Stenosis of cardiac prosthetic devices, implants and grafts, initial encounter cardiac device, T82.867A Thrombosis of cardiac prosthetic devices, implants, grafts, initial encounter implant and graft (including coronary Other specified complication of cardiac prosthetic devices, implants and T82.897A artery bypass graft) grafts, initial encounter
Proposals have already been made to ICD-10 C&M Committee to create new codes that provide more detail on the specific device.
15 Status and Encounter
ICD-9-CM ICD-10-CM
Z95.3 Presence of xenogenic heart valve V42.2 Heart valve replaced by transplant (tissue) Z95.4 Presence of other heart valve replacement
V43.3 Heart valve replaced by other means (artificial) Z95.2 Presence of prosthetic heart valve
V45.81 Aortocoronary bypass status Z95.1 Presence of aortocoronary bypass graft Encounter for adjustment and management of V53.39 Fitting and adjustment of other cardiac device Z45.09 other cardiac device Code Z95.2 is used for the presence of a mechanical heart valve. It is also the default code for the presence of any non- native valve. Code Z95.3 is used for the presence of animal tissue valves, including bioprosthetics, eg. CoreValve. Code Z95.4 is used for the presence of a homograft valve. Expected end-of-life for a heart valve graft is not coded as a complication. Use Z45.09 instead.3
3. Coding Clinic, 2nd Q 2008 16 TAVR: Valve-in-Valve
In mid-2015, transcatheter aortic valve replacement received a new indication for treatment of “failure” of a previously placed bioprosthetic valve. For coding purposes, the key factor is whether the “failure” is a complication or an expected occurrence.
Scenario ICD-10-CM
Malposition or displacement of T82.222A Displacement of biological heart valve graft, initial encounter previously placed valve Premature stenosis of the Stenosis of cardiac prosthetic devices, implants and grafts, T82.857A previously placed valve initial encounter Premature regurgitation of the T82.223A Leakage of biological heart valve graft, initial encounter previously placed valve Expected degeneration of Encounter for adjustment and management of other cardiac Z45.09 previously placed valve (end-of-life) device Seventh digit “A” is correct for the complication codes because active treatment is provided for the valve failure.4
4. Coding Clinic, 1st Q 2015 17 ICD-10-PCS Procedure Codes
18 ICD-10-PCS Format
Codes are alpha-numeric and are always 7 digits long. There is no decimal point. There are virtually no unspecified or default codes. Each position in an ICD-10-PCS procedure code represents a distinct element.
1234567
section root operation approach qualifier body system body part device
19 Structure of ICD-10-PCS Codes
In ICD-10-PCS, codes are not assigned per se. They are constructed, character by character.
ICD-10-PCS contains no instructional notes. Standardized terms and definitions are used throughout.
20 Volume of Procedure Codes
ICD-10-PCS has far more procedure ICD-9-CM codes than ICD-9-CM and provides much greater specificity. 3,882 codes ICD-10-PCS CABG: ICD-9-CM 9 codes 71,962 codes ICD-10-PCS 232 codes
Use of ICD-10-PCS requires in-depth clinical and technical coding knowledge: Relevant clinical anatomy Procedural components Exact nature of devices used Standard terms, particularly Root Operation Procedure coding guidelines and precedents
21 Structural Heart Procedures
Surgical Valve Replacement Valve Annuloplasty Transcatheter Aortic Valve Replacement Aortic Root Replacement Valved Conduit Implantation Transcatheter Pulmonary Valve Replacement CABG Cardiopulmonary Bypass
22 Surgical Valve Replacement
Surgical valve replacement refers to open removal of the native valve and implantation of a new valve, either tissue or mechanical. Root Operation R - Replacement Putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a mitral body part valve pulmonary aortic Coding Guidelines valve valve tricuspid Removal of the native valve is not valve coded separately.5
5. ICD-10-PCS Official Guidelines for Coding and Reporting (Procedures), FY 2015, B3.1b
23 Surgical Valve Replacement
Devices 8 – Zooplastic Tissue : 3f, Hancock, Mosaic J – Synthetic Substitute : Open Pivot
Example Open chest excision of aortic valve, implantation of Mosaic valve 02RF08Z Replacement of aortic valve with zooplastic tissue, open approach
24 Valve Annuloplasty
Annuloplasty involves repairing a leaky valve by placing a ring around the valve opening to support the leaflets and bring them together properly. Root Operation U - Supplement6 Putting in or on biological or synthetic material that physically reinforces and/or augments the function of a portion of a body part
Devices J – Synthetic Substitute : Contour 3D, Profile 3D
6. ICD-10-PCS Reference Manual, FY 2015, p.71
25 Valve Annuloplasty
Example Annuloplasty using Contour 3D tricuspid annuloplasty ring 02UJ0JZ Supplement, tricuspid valve with synthetic substitute, open approach
26 Transcatheter Aortic Valve Replacement
This procedure is usually abbreviated TAVR or TAVI. Procedural Components Access is usually through the femoral artery, though it may also be through other access such as the subclavian artery or transaortic approach for the Medtronic CoreValve device The catheter is advanced through the aorta and over the native valve. Valvuloplasty may be performed to crush the native valve. The delivery catheter is placed over the remains of the native valve and expanded to deploy the new valve.
27 Transcatheter Aortic Valve Replacement
Root Operation R - Replacement Putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part Explanation: The body part may have been taken out or replaced, or may be taken out, physically eradicated, or rendered nonfunctional during the Replacement procedure.7 Coding Guidelines Based on the Explanation, balloon valvuloplasty to eradicate the native valve is not coded separately when performed. Devices 8 – Zooplastic Tissue : CoreValve
7. ICD-10-PCS Reference Manual, FY 2015, p.69
28 Transcatheter Aortic Valve Replacement
Example TAVR with implantation of CoreValve 02RF38Z Replacement of aortic valve with zooplastic tissue, percutaneous approach
29 TAVR: Valve-in-Valve Procedure
In a valve-in-valve procedure, a new transcatheter valve is placed directly within the failed previous valve device. Root Operation R - Replacement Valve-in-valve is a redo of the prior valve replacement procedure. The previous valve is rendered non-functional and is replaced with an entirely new valve. A complete re-do of a procedure is coded to the root operation performed. By definition, root operation R-Replacement continues to be used when a device that replaces a body part is itself replaced. 8
8. ICD-10-PCS Reference Manual, FY 2015, p.69
30 Aortic Root Replacement
Anatomy The aortic root is the distal end of aortic arch the ascending thoracic aorta. ascending thoracic aorta The place where the aortic root joins the left ventricle of the heart is the aortic root aortic valve. In other words, the
aortic valve sits inside the aortic root. ostium of coronary valve artery The coronary arteries arise from the annulus aortic root, just before the aorta joins the left ventricle of the heart.
coronary valve artery leaflets
31 Aortic Root Replacement
Devices 8 – Zooplastic Tissue : Freestyle Aortic Root
Procedural Components
The aortic root may be replaced due to, for example, a congenital anomaly or an aortic root aneurysm. There are three different procedural scenarios.
Procedure Scenario 1
Freestyle is used to replace the aortic valve with no other distinct procedural components. Code as a surgical valve replacement.
32 Aortic Root Replacement
Procedure Scenario 2
Freestyle is used to replace the aortic valve as well as a portion of the aortic root. The coronary artery “buttons” must be popped off and later re-implanted. Code as a surgical valve replacement. At this time, precedent indicates that re-implanting the coronary buttons should not be coded separately.9 A coding proposal addressing re-implantation of coronary buttons was presented at the March 2015 C&M meeting, so further guidance and possible code table changes may be forthcoming.
9. See Coding Clinic 4th Q 2013
33 Aortic Root Replacement
Procedure Scenario 3
Freestyle is used to replace the aortic valve as well as a significant portion of the aortic root. The coronary artery buttons are popped off and later re-implanted. The adjacent segment of the ascending thoracic aorta is excised and replaced by a separate graft, which is anastomosed to the Freestyle.
Code a surgical valve replacement. At this time, do not code re-implanting the coronary artery buttons. Assign a separate code for the ascending aorta graft.10
10. See Coding Clinic 4th Q 2013
34 Aortic Root Replacement
Example Aortic valve and aortic root replacement with Freestyle bioprosthesis, excision of ascending aorta and replacement with synthetic graft
02RF08Z Replacement of aortic valve with zooplastic tissue, open approach 02RW0JZ Replacement of thoracic aorta with synthetic substitute, open approach11
11. AHA ICD-10-CM and ICD-10-PCS Coding Handbook, FY 2015, p.435
35 Valved Conduit Implantation
A valved conduit is exactly that: a tube with a valve inside. Device The Contegra Pulmonary Valved Conduit is an RV-PA conduit. 8 – Zooplastic Tissue: Contegra Procedural Components There are two different procedural scenarios: reconstruct the right ventricular outflow tract in congenital heart malformations completely replace a previously placed RV-PA conduit
Humanitarian Use Device: Authorized by Federal law for use in patients under 18 years of age for correction or reconstruction of the Right Ventricular Outflow Tract (RVOT) in the following congenital heart malformations: Pulmonary Stenosis, Tetralogy of Fallot, Truncus Arteriosus, Transposition with Ventricular Septal Defect (VSD), Pulmonary Atresia. In addition, the Contegra Pulmonary Valved Conduit is indicated for the replacement of previously implanted but dysfunctional pulmonary homografts or valved conduits. The effectiveness of this device for these uses has not been demonstrated.
36 Valved Conduit Implantation
Root Operation 1 – Bypass, and this is used in both procedural scenarios12 Coding Guidelines For Bypass, the fourth character shows the body part being bypassed from and the qualifier shows the body part being bypassed to.13 Example Removal of prior RV-PA conduit and replacement with a new Contegra pulmonary valved conduit 021K0KP Bypass right ventricle to pulmonary trunk with nonautologous tissue substitute, open approach14
12. Coding Clinic, 3rd Q 2014 13. ICD-10-PCS Official Guidelines for Coding and Reporting (Procedures), FY 2015, B3.6a 14. Coding Clinic, 4th Q 2014 37 Transcatheter Pulmonary Valve Rplcmnt
This procedure is usually abbreviated TPVI.
Patients who undergo valve transcatheter pulmonary valve location within replacement with the Medtronic conduit device have previously had a valved RV-PA conduit placed. The previously placed RV-PA conduit has either developed complications or reached its expected end-of-life and now needs to be replaced. RV-PA The conduit itself is not replaced conduit but a new valve is placed inside it.
38 Transcatheter Pulmonary Valve Rplcmnt
Procedural Components Access is usually through the femoral vein. The catheter is advanced through the vena cava into the right atrium, through the tricuspid valve, and into the right ventricle. From the right ventricle, the catheter is advanced into the previously placed valved conduit. Valvuloplasty is performed to crush the previously placed valve and prepare the site. The delivery catheter is placed over the remains of the previously placed valve and expanded to deploy the new valve inside the conduit.
Root Operation Devices R - Replacement 8 – Zooplastic Tissue : Melody
39 Transcatheter Pulmonary Valve Rplcmnt
Coding Guidelines Balloon valvuloplasty is not coded separately. There are no published coding guidelines specifically addressing replacement of a pulmonary valve within an RV-PA conduit.15 Example Transcatheter pulmonary valve replacement with Melody 02RH38Z Replacement of pulmonary valve with zooplastic tissue, percutaneous
15. See also AHA ICD-10-CM and ICD-10-PCS Coding Handbook, FY 2015, p.420 40 CABG
Coding Guidelines For Bypass for CABG, the fourth character shows the number of coronary artery sites being bypassed and the qualifier shows the vessel bypassed from, ie. the vessel now supplying the blood.16 The Device character refers to use of a free graft between the vessels:17 9 – autologous venous graft, eg. saphenous vein graft A – autologous arterial graft, eg. radial artery graft J – synthetic substitute, eg. Gore-Tex graft K – nonautologous tissue substitute, eg. cadaveric vessel If the vessels are connected directly without use of a free graft:17 Z – no device Use of hypothermia, cardioplegia, intraoperative pacing, and chest tube insertion are all integral and not coded separately.17 Use of cardiopulmonary bypass is coded separately.17 Harvest of an autologous free graft is also coded separately.17
16. ICD-10-PCS Official Guidelines for Coding and Reporting (Procedures), FY 2015, B3.6b 17. AHA ICD-10-CM and ICD-10-PCS Coding Handbook, FY 2015, p.423-427 41 CABG
Example CABG, aortocoronary bypass to OM branch of LCx and RCA via (right) saphenous vein graft (endoscopic harvest), and LIMA to LAD 021109W Bypass coronary artery, two sites from aorta with autologous venous tissue, open approach 02100Z9 Bypass coronary artery, one site from left internal mammary, open 06BP4ZZ Excision of right greater saphenous vein, perc endoscopic approach
42 Cardiopulmonary Bypass
Coding Guidelines Use of CPB is coded separately with the primary procedure, eg. valve replacement, CABG. Insertion of the cannulae is not coded separately.
Example Cardiopulmonary bypass 5A1221Z Performance of cardiac output, continuous
43 DRG Impact
44 ICD-10 DRG Conversion
The conversion of the DRG Grouper is about coding, not about grouping. CMS has repeatedly stated its goal in the DRG conversion: The same DRG will be assigned regardless of whether the case is coded in ICD-9 or ICD-10. The conversion process has involved only replacing the ICD-9-CM codes with the equivalent ICD-10 codes. DRG titles and underlying DRG logic has not changed, but some minor DRG variations are unavoidable. In a study of 10 million FY 2013 MedPAR records, CMS found a DRG shift of 1.07%, with reimbursement change of -0.04%18 If the same DRG is not assigned, recheck the codes
18. Estimating the Impact of the Transition to ICD-10 on Medicare Inpatient Hospital Payments http://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/Downloads/2015-03-18-Impact-ICD10-Transition.pdf 45 Sample CCs
Code Description Code Description E44.0-E46 other malnutrition venous thrombosis and I82.409-I82.891 E87.0 hypernatremia embolism E87.1 hyponatremia J44.1 acute exacerbation of COPD I31.4 cardiac tamponade acute respiratory distress J80 cardiomyopathy (non-ischemic) syndrome (adult, child) I42.0, I42.5, (dilated, congestive, constrictive, pleural effusion, hemothorax, I42.8-I42.9 J90, J94.2, J94.8 restrictive) hydrothorax (non-traumatic) I44.2 AV block, complete J95.811-J95.812 iatrogenic pneumothorax, air leak I45.2 bifascicular block J96.10-J96.12 respiratory failure, chronic I45.3 trifascicular block J98.11-J98.19 atelectasis, pulmonary collapse I45.89 other conduction disorder K56.0, bowel obstruction, ileus I47.2 ventricular tachycardia K56.60-K56.7 I50.1 left ventricular failure acute renal failure, other and N17.8-N17.9 I50.20 systolic heart failure, unspecified unspecified I50.22 systolic heart failure, chronic N18.4 CKD, stage IV I50.30 diastolic heart failure, unspecified N18.5 CKD, stage V I50.32 diastolic heart failure, chronic N39.0 urinary tract infection combined diastolic/systolic heart I50.40 R65.10 SIRS failure, unspecified R78.81 bacteremia combined diastolic/systolic heart I50.42 Z68.1 BMI less than 19, adult failure, chronic Z68.41-Z68.45 BMI 40 and over, adult
46 Sample MCCs
Code Description A40.0-A40.9, septicemia, sepsis A41.01-A41.9 E41-E43 severe malnutrition I21.01-I21.4, acute myocardial infarction I22.0-I22.9 I26.01-I26.99 pulmonary embolism I50.21 systolic heart failure, acute I50.23 systolic heart failure, acute on chronic I50.31 diastolic heart failure, acute I50.33 diastolic heart failure, acute on chronic I50.41 combined diastolic/systolic heart failure, acute I50.43 combined diastolic/systolic heart failure, acute on chronic J12.0-J18.9 pneumonia J69.0 aspiration pneumonia J81.0 acute pulmonary edema J96.00-J96.02 respiratory failure, acute J96.20-J96.22 respiratory failure, acute on chronic N17.0-N17.2 acute renal failure, specified lesion N18.6 ESRD R65.20-R65.21 severe sepsis
47 Appendix: Key Resources
48 Key Websites
NCHS and CMS have a wealth of ICD-10 resources and educational materials available on-line. NCHS http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2105 • ICD-10-CM Tabular and Index • Diagnosis code GEMS • Official ICD-10-CM guidelines (diagnoses) CMS http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-CM- and-GEMs.html • ICD-10-PCS Code Tables and Index • Procedure code GEMs • Official ICD-10-CM guidelines (procedures) ICD-10 Coordination and Maintenance Committee Diagnoses: http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm Procedures: http://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/ ICD-9-CM-C-and-M-Meeting-Materials.html • Code proposals, presentation slides, videos, summaries 49 Medtronic Contacts
Medtronic is available to assist with your ICD-10 questions and issues. Medtronic Cardiovascular Hotline: 1-866-616-8400 Email us: [email protected] Reach out to the Reimbursement Team directly: Angelica Oyugi, RHIA, Principal Analyst 763-505-8451 [email protected] We’re here to help make this Ann Scott, Program Director 763-514-9735 transition [email protected] smoother for you Bonnie Handke, Sr. Director 763.526.0963 [email protected] © 2016Medtronic. All rights reserved. UC201506613a EN
50 Health Economics & Reimbursement Regional Team
Midwest: Teresa Stamper-Strelitz N Northeast: Jean Plis
Pacific Northwest: Teresa Stamper-Strelitz
N North Central : Kim Munro Greater NY: Jean Plis
P PA Great Lakes: Kim Munro Hollywood: Kim Munro
Capital: Teresa Stamper-Strelitz
SouthEast: Teresa Stamper-Strelitz
South Central: Jean Plis
Kimberly Munro: Cell: 440-340-8266 Email: [email protected] Jeannine Plis: Cell: 518-573-5277 Email: [email protected] Teresa Stamper-Strelitz: Cell: 404-242-6188 Email: [email protected]
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