2020 EP Reimbursement and Coding Guide Physicians and Facilities RESOURCES TO ASSIST YOU WITH THE REIMBURSEMENT PROCESS Resources to assist you with the reimbursement process 2020 Electrophysiology Services Patient Name: Date: Physician: Facility: COMPREHENSIVE EP STUDIES ECHOCARDIOGRAPHY 93619 Comprehensive EPS without induction of arrhythmia 93306 Transthoracic echo, complete with doppler, color flow 93620 Comprehensive EPS with (attempted) induction of arrhythmia 93307 Transthoracic echo, complete without doppler +93621 Left atrial or coronary sinus pacing & recording (w/ 93620, 93653, 93654) 93308 Transthoracic echo, limited or follow-up +93622 Left ventricular pacing & recording (w/ 93620, 93653, 93656) 93312 Transesophageal echo, complete +93320 Spectral Doppler echo (add-on with 93312) MAPPING & ADD-ON PROCEDURES +93321 Spectral Doppler echo, limited or follow-up (add-on with 93308, 93312) +93609 Catheter mapping of tachycardia (w/ 93620, 93653, 93656) +93325 Color flow Doppler (add-on with 93308, 93312) +93613 3-D mapping (w/ 93620, 93653, 93656) +0439T Myocardial contrast perfusion echocardiography +93623 Drug stimulation (w/ 93610, 93612, 93619, 93620, 93653, 93654, 93656) +93356 Myocardial strain imaging using speckle tracking-derived assessment INDIVIDUAL STUDIES & OTHER PROCEDURES EP EVALUATION OF ICD 93600 Bundle of His recording 93642 EP analysis of transvenous ICD with induction of VT/VF 93602 Intra-atrial recording 93644 EP analysis of subcutaneous ICD with induction of VT/VF 93603 Right ventricular recording 0577T EP analysis of substernal ICD with induction of VT/VF 93610 Intra-atrial pacing 93612 Intraventricular pacing PERI-PROCEDURAL DEVICE EVALUATIONS 93618 Induction of arrhythmia by electrical pacing 93286 Peri-procedure evaluation & program, pacemaker (may report x 2) 93615 Esophageal recording of atrial electrogram 93287 Peri-procedural eval & program, transven ICD (x2) (with 93619, 93620, 93616 Esophageal atrial electrogram with pacing 93653) 93624 Follow-up EP study with pacing & recording, (attempted) induction 93261 Peri-procedural eval & program, sub-Q ICD (x2) (with 93619, 93620, 93660 Tilt table study 93653) ABLATIONS MISCELLANEOUS PROCEDURES 93650 AV node ablation 93451 Right heart cath (diagnostic) 93653 Comprehensive EPS with atrial ablation 93452 Left heart cath, retrograde 93654 Comprehensive EPS + 3D mapping with ventricular ablation 93453 Right & left heart cath +93655 Ablate additional discrete arrhythmia focus (w/ 93653, 93654, 93656) 36005 Contrast injection for venography 93656 Comprehensive EPS + transseptal + ablate pulmonary veins for Afib 75820 Venography, extremity, unilateral, S&I +93657 Ablate additional RT or LT atrial site for Afib (with 93656) 93503 Swan-Ganz monitoring catheter placement INTRACARDIAC ECHO / TRANSSEPTAL ACCESS COMMON MODIFIERS +93662 Intracardiac echocardiography -22 Increased procedural service (submission of report / documentation required) +93462 Transseptal or transapical puncture (w/ 93653, 93654) -26 Professional component -52 Reduced services (portion intentionally omitted at physician’s election) CARDIOVERSION / PACING -53 Discontinued procedure (terminate without completion – physician claims) 92960 Cardioversion, elective, external -59 Distinct procedural service (separately identifiable) Cardioversion, elective, internal 92961 -XE Separate Encounter Temporary transcutaneous pacing 92953 -XS Separate Structure -XP Separate Practitioner ELECTROCARDIOGRAMS -XU Unusual Non-Overlapping Service 93000 Electrocardiogram, complete -73 Discontinued procedure prior to administration of anesthesia (OP facility) 93010 Electrocardiogram, interpretation & report only -74 Discontinued procedure after administration of anesthesia (OP facility) 93025 Microvolt T-wave alternans GD Units of service exceeds medically unlikely edit value and represents reasonable and necessary services Notes: Procedures identified with a + symbol preceding the code are designated “add-on” codes; may not be reported stand-alone. Bill in addition to the primary service or procedure. Many of these codes require modifier -26 on physician claims when performed in a facility setting (eg, hospital inpatient or outpatient). THERMOCOOL® Navigation Catheters are approved for drug refractory recurrent symptomatic paroxysmal atrial fibrillation, when used with CARTO® 3 Systems (excluding NAVISTAR® RMT THERMOCOOL® Catheter). Reimbursement and Coding and Reimbursement Electrophysiology EP Procedure Documentation Coding Guide Frequently Asked Questions Coding Checklist Best Practices Online HCPCS C-Code Finder Coding & Reimbursement Webinars Access to Biosense Webster, Inc. Reimbursement Support Services FOR ADDITIONAL QUESTIONS OR INFORMATION CONTACT: [email protected] 800.362.2048 2 Electrophysiology Diagnostic, Ablation, and Intracardiac Echocardiography Guided Transcatheter Procedures This guide has been developed to assist you in obtaining physician payment and hospital reimbursement for: • Electrophysiology (EP) diagnostic and ablation procedures • The acquisition of radiological images • EP and Cardiology procedures that may utilize intracardiac echocardiography (ICE) These procedures may be a covered service if they meet all of the requirements established by Medicare and private payers. It is essential that each claim be coded properly and supported with appropriate documentation in the medical record. TABLE OF CONTENTS PHYSICIAN SERVICES 4-7 CPT® Codes OUTPATIENT FACILITY SERVICES 8 Ambulatory Payment Classifications (APCs) INPATIENT FACILITY SERVICES 9 Medicare Severity Diagnosis Related Groups (MS-DRGs) PROCEDURE CODES 10-11 ICD-10-CM Procedure Codes DIAGNOSIS CODES 12-14 ICD-10-CM Diagnosis Codes HCPCS CODES FOR BIOSENSE WEBSTER, INC. PRODUCTS 15-16 NOTES 17 The information is provided to assist you in understanding the reimbursement process. It is intended to assist providers in accurately obtaining reimbursement for health care services. It is not intended to increase or maximize reimbursement by any payer. We strongly suggest that you consult your payer organization with re gard to local reimbursement policies. The information contained in this document is provided for information purposes only and represents no statement, promise or guarantee by Biosense Webster, Inc. concerning levels of reimbursement, payment or charge. Similarly, all CPT® & HCPCS codes are supplied for information purposes only and represent no statement; promise or guarantee by Biosense Webster, Inc. that these codes will be appropriate or that reimbursement will be made. Third party trademarks used herein are trademarks of their respective owners. Important information: Prior to use, refer to the instructions for use supplied with this device for indications, contraindications, side effects, warnings and precautions. This product can only be used by healthcare professionals www.biosensewebster.com/reimbursement 3 PHYSICIAN SERVICES CPT® codes and Medicare Physician Fee Schedule values for Electrophysiology Diagnostic, Ablation, and Intracardiac Echocardiography Guided Transcatheter Procedures are indicated below. Please note that when reporting ablation therapy codes (93653-93657), the single site electrophysiology studies (93600-93603, 93610, 93612, 93618) and the comprehensive electrophysiology study codes (93619, 93620) are included and may not be reported separately. Other procedures are also bundled into some ablation codes, but should be reported separately with others: review the descriptors and parenthetical notes carefully. Moderate sedation is no longer bundled into CPT® codes as of 2017, and so may be reported separately, although Medicare and some other payers only reimburse the first 15 minutes in a facility setting. There were no revisions to instructional notes or code descriptors for 2020. Intracardiac Electrophysiological Procedures 2020 National 2020 Work 2020 Total Average Medicare CPT® Code2 Description RVUs RVUs Reimbursement3 Left heart catheterization by transseptal puncture through intact + 93462 3.73 6.10 $220 septum or by transapical puncture 93600-26 Bundle of His recording 2.12 3.45 $125 93602-26 Intra-atrial recording 2.12 3.38 $122 93603-26 Right ventricular recording 2.12 3.38 $122 Intraventricular and/or intra-atrial mapping of tachycardia site(s) + 93609-26 with catheter manipulation to record from multiple sites to identify 4.99 8.05 $291 origin of tachycardia 93610-26 Intra-atrial pacing 3.02 4.74 $171 93612-26 Intraventricular pacing 3.02 4.69 $169 + 93613 Intracardiac electrophysiologic three-dimensional mapping 5.23 8.63 $311 Esophageal recording of atrial electrogram with or without 93615-26 0.74 1.09 $39 ventricular electrogram(s); 93616-26 …with pacing 1.24 1.72 $62 93618-26 Induction of arrhythmia by electrical pacing 4.00 6.39 $231 Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His 93619-26 bundle recording, including insertion and repositioning of multiple 7.06 11.33 $409 electrode catheters, without induction or attempted induction of arrhythmia Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction 93620-26 or attempted induction of arrhythmia; with right atrial pacing 11.32 18.16 $655 and recording, right ventricular pacing and recording, His bundle recording …with left atrial pacing and recording from coronary sinus or left + 93621-26 2.10 3.40 $123 atrium + 93622-26 …with