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Transcatheter Mitral Valve Implantation/Replacement (TMVI) – 0483T & 0484T

The procedures include vascular access, catheterization, balloon valvuloplasty, valve deployment and (as needed) repositioning, temporary pacemaker insertion for rapid pacing, and access site closure.

0483T Transcatheter mitral valve implantation/replacement (TMVI) with prosthetic valve; percutaneous approach, including trans-septal puncture, when performed

0484T Transthoracic exposure (eg, thoracotomy, transapical)

How to Avoid Denials?

1. CPT must have primary modifier 62 & secondary modifier Q0
2. The diagnosis must have “Mitral Valve Regurgitation and/or Mitral Valve Insufficiency”
3. Place of Service (POS) should be 21
4. Claim must be submitted with Clinical Trial number based on the sponsor.

Approved Clinical Study:

Transcatheter mitral valve repair (TMVR) is a procedure used to treat mitral regurgitation which is the most common type of heart valve insufficiency in the country. 

CMS issued a Medicare National Coverage Determination on August 7, 2014 which allows for coverage of TMVR under Coverage with Evidence Development (CED) with certain conditions.  The complete determination is available on our website.  As part of CED, we are identifying below the Medicare approved registry and Medicare approved clinical trial which have been reviewed and determined to meet the requirements of coverage.

Registry Approvals:

STS/ACC TVT Registry Mitral Module (TMVR)
Sponsor: American College of Cardiology
ClinicalTrials.gov Number:  NCT02245763
CMS Approval Date: 08/07/2014

Clinical Study Approvals:

Study Title: Edwards SAPIEN XT or SAPIEN 3 transcatheter heart valve in the mitral position.
Sponsor:  Edwards SAPIEN XT™and SAPIEN 3™
ClinicalTrials.gov Number:  NCT02370511
CMS Approval Date: February 25, 2015

Study Title: Edwards PASCAL TrAnScatheter Mitral Valve RePair System Pivotal Clinical Trial (CLASP IID) Pivotal Trial 
Sponsor: Edwards Lifesciences
ClinicalTrials.gov Number: NCT03706833 
Investigational Device Exemption (IDE) Number: G170166 
CMS Approval Date: 11/19/2018

Study Title:  Cardiovascular Outcomes Assessment of the MitraClip® Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (the COAPT trial)
Sponsor:  Abbott Vascular
ClinicalTrials.gov Number:  NCT01626079
Investigational Device Exemption (IDE) Number:  G120024/S021
CMS Approval Date: 02/05/2015

Reference:

https://clinicaltrials.gov/ct2/show/results/NCT02370511

https://www.cms.gov/Medicare/Coverage/Coverage-with-Evidence-Development/TMVR.html



Coding Ahead

0484T- Transapical transcatheter valve in mitral ring via left thoracotomy

Hi,

Is this the appropriate CPT code for this procedure.

0484T – Transapical transcatheter valve in mitral ring via left thoracotomy.

Also require clincial trail number for "29 mm Edwards Sapien 3 transcatheter valve"

Medical Billing and Coding Forum

Transapical transcatheter valve in mitral ring via left thoracotomy

Hi,

Require CPT codes and Clinical Trail for mentioned below procedure.

I though the appropriate CPT code 0484T

PROCEDURE PERFORMED:
1. Transapical transcatheter valve in mitral ring via left thoracotomy.
2. Temporary transvenous pacemaker insertion.
3. Transesophageal echocardiography.

OPERATIVE REASON FOR PROCEDURE: Intermediate risk for surgical mitral valve replacement,
4% to 8% risk of 30-day mortality.

IMPLANTATION: 29 mm Edwards Sapien 3 transcatheter valve in mitral ring via left
thoracotomy transapical approach.

CLINICAL INDICATIONS:

The patient is an 85-year-old male, who recently presented with
progressive symptoms of shortness of breath and fatigue, and was found to have severe
mitral stenosis. He does have a prior history of mitral valve repair with placement of a
mitral annuloplasty ring in 1998. He also has multiple other comorbidities including
nonischemic cardiomyopathy, ejection fraction of 30% to 40%, status post prior AICD
implantation, chronic atrial fibrillation, on long-term oral anticoagulation with
Coumadin, history of atrial fibrillation ablation twice. Due to his severe symptoms of
shortness of breath and fatigue, and underlying mitral valve stenosis, he was evaluated
initially by Cardiovascular Surgery, Dr. Accola, for an open heart surgery. However,
considering his advanced age, multiple comorbidities, diminished left ventricular ejection
fraction, he was felt to be at high risk for postoperative complications. Thus, the
decision was made to proceed with placement of a transcatheter mitral valve in his mitral
ring through a transapical approach. The rationale of the procedure, other options, all
the risks and benefits were extensively discussed with the patient and his family, and
consent was signed to proceed as planned. His case was also discussed extensively in our
structural heart meeting

DETAILS OF PROCEDURE:

Intraoperative transesophageal echocardiography was performed and
showed significant pannus within the prior mitral ring with presence of severe mitral
valve stenosis. There was no significant mitral regurgitation present. The patient was
brought to the hybrid operating room and placed in the supine position. He was prepped
and draped in the usual fashion. The patient was placed under general anesthesia.
Transesophageal echocardiography probe was placed and used throughout the procedure to
evaluate the mitral valve and position of our catheters. A 5-French bipolar pacing
catheter was placed in the apex of the right ventricle through right femoral venous
access. We also obtained access in the right femoral artery and placed a 5-French sheath,
just in case we needed to place an intra-aortic balloon pump for hemodynamic support
during the case. Subsequently, the left chest was opened via anterior thoracotomy, and we
found the anterior apical portion which would be appropriate for placement of the valve.
Two pledgetted sutures were placed around the LV apex. The left apex was cannulated with
a needle, and a soft wire was placed into the left atrium. Using a JR4 catheter, we
placed the wire into the right superior pulmonary vein. Then, we exchanged out the wire
for a stiff Amplatz wire. At that point, the patient had already been anticoagulated with
heparin to keep an ACT greater than 250 seconds. At that point, we placed an Ascendra
transcatheter valve introducer into the left ventricular apex, and subsequently we
prepared a 29 mm Edwards Sapien 3 transcatheter valve. Since this was a 31 mm ring, we
decided to go with a 29 mm regular prep of Sapien valve. We also had measured the ring
area on echocardiography. The transcatheter valve was deployed with rapid ventricular
pacing, and the valve was very carefully deployed under fluoroscopy guidance. The valve
deployed in excellent position. The delivery device was subsequently removed. We did
postdilate the valve by adding 1 mL of contrast due to presence of mild paravalvular leak.
After the postdilatation, there was only trivial paravalvular leak noted. There was no
central mitral regurgitation. The mitral valve seemed to be well seated inside the prior
mitral ring. This concluded the operation. The patient tolerated the surgery well, and
there were no complications. The postprocedure mitral valve area was 2.66 sq cm, the mean
gradient across the valve was 3 mmHg. There was presence of trivial paravalvular mitral
insufficiency after valve deployment. The patient was transferred to the cardiovascular
recovery area in a stable condition.

Medical Billing and Coding Forum

Aortic valve debridement and replacement and bovine pericardial patch repair

I am trying to verify the codes for the following:

Aortic valve debridement and replacement using 23 mm St Jude mechanical valve. (33405)
Aortic valve annulus abscess incision and drainage, debridement with bovine pericardial patch repair. (?)

I would appreciate any feedback on how to bill for the annulus I&D with bovine patch repair. The bovine patch was placed in the soft tissue defect of the commissure in between the right and left coronary sinus.

Thank you
Ruth Ann Grimes, CPC

Medical Billing and Coding Forum

Need payment information for combination Valve replacement with CABG

I work mainly as a coder and auditor, so it’s been quite a while since I’ve dealt with the reimbursement side, but I’ve been asked a question that I can’t find an answer for. When performing multiple procedures, the primary procedure is paid at 100% of the fee schedule and each subsequent procedure is paid at 50% of the fee schedule per the MPFS. Is there an additional reduction with Valve replacements and CABG done at the same time? I seem to remember an additional reduction to the CABG codes was also done, but I can’t find any documentation from Medicare (or any other payer) that explains reimbursement for these combined procedure situations.

Any help will be greatly appreciated!

Medical Billing and Coding Forum

Medicare patient seen for gingivitis with history of Mitral Valve Prolapse-Dx code

Hello! I am hoping for some direction on correct coding of a claim. Patient has Medicare, she came to our physician office because of gum and teeth pain. She was diagnosed with gingivitis. She has a history of mitral valve prolapse, due to this she was put on an antibiotic right away. Medicare does not cover services related to teeth or gums so they denied the claim with primary dx of gingivitis. We added the dx for history of mitral valve prolapse but I feel this should be the secondary diagnosis. Our biller called Medicare and was told as long as the gingivitis diagnosis is on the claim they will not pay. I certainly feel that we need to have the gingivitis diagnosis on the claim. Do you agree gingivitis primary diagnosis, hx of MVP secondary? Looking for reassurance…..:o

Thank you for your response.

Medical Billing and Coding Forum