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Solidify your understanding of aortic valve disease and how to report this life-changing treatment. Transcatheter aortic valve replacement (TAVR) is a minimally invasive cardiac procedure to replace a diseased aortic valve in a person’s heart. The most common reason to undergo TAVR is aortic stenosis, which is an abnormal narrowing of the aortic valve opening […]
The post Get to the Heart of Coding TAVR appeared first on AAPC Knowledge Center.
Facilities may also perform TAVRs not expressly listed as an FDA-approved indication when performed within a clinical study if it fulfills standard and added research protocol.
Coding the TAVR:
Coding TAVR is complex, since it’s an intravenous procedure relying on radiology. Medical necessity is key to Medicare reimbursement, and the patient will no doubt be run through a gamut of tests, such as an echocardiogram, CT scan, angiogram, or electrocardiogram. The patient must be in a heart program, and the decision to perform a TAVR isn’t quick. Once confirmed, aortic stenosis is easy to find in ICD-10-CM.
Be sure to correctly note the families of arteries through which the catheters are routed. TAVR cardiovascular access and delivery procedures are reported with CPT 33361-33366 with the appropriate add-on codes for bypass (33367-33369).
Source: TAVR Rules Changes
Updated NCD list:Click Here
Additional Information:
1. The claim must have a Place of Service (POS) 21
2. Also, the claim lines for these procedure codes on professional clinical trial claims must have the modifier Q0 (Investigational clinical service provided in a clinical research study that is in an approved clinical research study
3.Similarly, professional claims for TAVR procedure codes must have modifier 62
4.Finally, the clinical trial claim line must contain the secondary diagnosis code of ICD-10 of Z00.6
5. Claim must have Clinical Trail Number (8 digit number
Transcatheter aortic valve replacement (TAVR) national coverage policy rules have been streamlined by the Centers for Medicare & Medicaid Services (CMS) as the minimally invasive intravenous procedure becomes more commonplace. However, it is still consider a clinical trial because of its relatively recent development. CMS said it will continue to cover TAVR under coverage with evidence […]
The post TAVR Rules Changed by CMS appeared first on AAPC Knowledge Center.
The Centers for Medicare & Medicaid Services (CMS) announced, June 21, a final decision to update the national coverage policy for transcatheter aortic valve replacement (TAVR) for aortic stenosis. It has been seven years since the original national coverage determination (NCD) went into effect. The update was necessary to account for the continued development of […]
The post CMS Updates TAVR National Coverage Policy appeared first on AAPC Knowledge Center.
I understand the ECG gating is bundled into the 75574, right? Would you bill all three CTA codes? If not, can you guide me to any literature saying so?
Thank you!
Here is an example:
EXAM: CT TAVR W/CONTRAST-TG #/##/2018
*
HISTORY: ##-year-old male with aortic stenosis undergoing preprocedural
evaluation and planning for TAVR.
*
TECHNIQUE: After scout images, a noncontrast gated scan of the heart and
nongated acquisition of the chest abdomen pelvis was acquired. Using
retrospective dose modulated ECG gating, CT angiography of the heart, was
obtained following the uneventful administration of 100 cc of Isovue-370.
intravenous contrast. An acquisition of the chest abdomen and pelvis was
then acquired utilizing a flash acquisition. Sagittal and coronal thin
MIP reconstructions were generated and reviewed.
In accordance with CT policies/protocols and the ALARA principle,
radiation dose reduction techniques (such as automated exposure control,
adjustment of mA/kV according to patient size and/or iterative
reconstruction technique) were utilized for this examination.
*
Aortic annular and vascular measurements will be generated within a
separate report.
The body of the report:
FINDINGS:
VASCULAR:
There is a left-sided 3 vessel aortic arch. No aortic aneurysm,
dissection, or intramural hematoma. There are mild ascending aortic
calcifications.
There are moderate calcified and noncalcified atherosclerotic plaques in
the aorta and its major branches. There is severe stenosis of the
bilateral subclavian arteries secondary to bilateral cervical ribs.
Significant calcification and thickening seen about the aortic valve
leaflets, consistent with known aortic stenosis. Aortic valve is
tricuspid.
*
Heart: An atrial diverticulum is noted about the intra-atrial septum.
Slitlike structure about the septum is suggestive of a PFO. Patient is
status post CABG, with patent LIMA to LAD graft as well as 2 left-sided
patent aortocoronary bypass grafts. No right-sided bypass graft
identified. There is no significant pericardial effusion.
*
Pulmonary Arteries:The pulmonary arteries are normal in caliber. No
definite pulmonary artery filling defect identified.
*
There is advanced atherosclerosis throughout the abdominal aorta with
multifocal ulcerating plaque and a penetrating atherosclerotic ulcer in
the infrarenal aorta (location -480.5).
The celiac artery, SMA and IMA are patent.
One right renal artery and one left renal artery are identified. There is
moderate stenosis at the right renal ostium with poststenotic dilatation.
*
Advanced atherosclerotic changes are seen in the bilateral iliofemoral
arteries, with moderate to severe stenoses in the bilateral common iliac
arteries
*
*
CT CHEST:
Thoracic Inlet: Evaluation of the thyroid gland is limited due to beam
hardening. No supraclavicular lymphadenopathy.
Mediastinum / Hila: No pathologically enlarged lymph nodes. The esophagus
is patulous.
Chest wall: Normal.
*
Lungs / Airways: There are emphysematous changes most pronounced in the
upper lobes. Clustered groundglass opacities in the periphery of the left
upper lobe are likely infectious/inflammatory. There is dependent
atelectasis and peripheral reticulation throughout the bilateral lungs.
Central airways are patent without suspicious filling defects.
Pleural Space: There is no significant pleural effusion. No pneumothorax
is seen.
*
CT ABDOMEN / PELVIS:
Liver: Unremarkable.
Gallbladder: Normal.
Bile Ducts: Normal.
Pancreas: No suspicious pancreatic mass.
Spleen: Unremarkable.
GI Tract: Unremarkable.
*
Kidneys: Symmetric perfusion. No hydronephrosis or suspicious renal
masses.
Adrenals: No discrete adrenal nodules.
*
Lymph nodes: No pathologically enlarged lymph nodes.
*
Pelvic Organs: There is prostatomegaly.
Bladder: Diffuse wall thickening is likely related to chronic outlet
obstruction.
Miscellaneous: No significant free fluid.
Abdominal Wall: Unremarkable.
*
Bones: Sternotomy wiring is intact. There are multilevel degenerative
changes throughout the visualized spine. No acute fractures.
*
IMPRESSION:
*Severe stenoses of the bilateral subclavian artery secondary to cervical
ribs. Advanced atherosclerosis of the abdominal aorta and iliofemoral
arteries, with moderate to severe stenoses in the bilateral common iliac
arteries and penetrating atherosclerotic ulcer in the infrarenal aorta.
*Status post CABG with patent LIMA to LAD and 2 patent left sided
aortocoronary bypass grafts.
*Aortic valve thickening and calcification, compatible with known aortic
valve stenosis. Please see separate report for preprocedural TAVR
measurements.
I have seen information stating to use axillary for subclavian approach, but this is for open not percutaneous access?
We have been billing for TAVR for years. Recently, an assisting provider was added up to the TAVR surgeons team and asked me if he can bill for it.
Is it any way we can bill out for two surgeons and an assisting surgeon, with same code with modifier 80? If yes, what documentation requires?
Thank you and I appreciate any answer.
Vicky, CPC-P