Hospital Inpatient and Outpatient Resources

Coding Resources

Medtronic provides medical coding resources related to Cardiac Rhythm Disease Management products and procedures to help facilitate appropriate medical billing and coding practices for service provided. 

CMS C-code Requirements

Effective January 1, 2005, CMS began requiring hospitals to bill appropriate C-codes for all device-dependent Ambulatory Payment Classifications (APCs). If a hospital outpatient bill includes a device-related CPT/HCPCS II procedure code but the C code for the associated device is not present, the claim is edited and returned to the hospital. Furthermore, if a C code is billed without the appropriate procedure code, the claim will be returned.

For most C-codes, the hospital does not receive additional reimbursement for devices. The C-codes are required because CMS is collecting charge data for these devices for use in setting future reimbursement rates.

Medicare C-code List

Cardiac Rhythm Disease Management Products – Medicare C-Code List for Hospital Outpatient Device Reporting (PDF, 365 KB, Color)

Cardiac Rhythm Disease Management Products – Medicare C-Code List for Hospital Outpatient Device Reporting (PDF, 377 KB, B/W)
This list provides the appropriate C-codes for Medtronic CRDM devices.

Coding Reference Guides

2013 CPT^® Codes for Cardiac Device Monitoring

2013 CPT^® Codes for Cardiac Device Monitoring (PDF, 188 KB)
Coding reference guide with 2013 CPT codes for cardiac device monitoring.

Atrial Fibrillation Catheter Ablation Reimbursement Guide

Catheter Ablation Reimbursement Guide (PDF, 1 MB)
This booklet presents reimbursement information for Atrial Fibrillation Catheter Ablation. 8 pages.

2012 Reveal XT^™ and Reveal^® DX Reimbursement Guide

2012 Reveal XT™ and Reveal^® DX Insertable Cardiac Monitors Reimbursement Guide (PDF, 430 KB)
This booklet presents reimbursement information for Reveal XT and Reveal DX Insertable Cardiac Monitors. 2 pages.

Hospital Lab Sheet for Outpatient Procedures

2013 – Hospital Outpatient Services Lab Sheet (PDF, 176 KB)
This form contains a listing of CPT or HCPCS codes for Outpatient services performed in the hospital. Services listed include the implant, replacement/removal and follow-up of pacemakers, ICDs, ILRs and CRT devices. 2 pages.

QR Modifier Is Replaced With Q0 (Zero) Modifier - Implemented July 6, 2010

CMS Manual System: Pub 100-20 One-Time Notification (PDF, 195 KB)
The QR modifier which was used to identify primary prevention patients indicated for an ICD has been replaced with a new modifier, Q0 (zero). The Q0 modifier should be used on both physician and hospital outpatient claims.This document provides full details on the modification.

Reimbursement Guide for ICD Implants

Reimbursement Guide for ICD Implants (PDF, 366 KB)
This guide has been developed to assist you in seeking coverage and payment for ICD and CRT-D therapies. This guide also incorporates information regarding the use of ICDs for patients with the expanded coverage indications reflected in the SCD-HeFT and MADIT-II studies. Updated coding information and answers to frequently asked questions (FAQs) about coverage, coding and payment are also in this guide. 24 pages.

2013 Hospital Reference Guide for CRDM Procedures

2013 Hospital Coding Reference Guide for CRDM Procedures (PDF, 589 KB)
This booklet includes hospital inpatient and outpatient procedure codes, Medicare MS-DRG and Medicare APC assignments for select CRDM procedures.

Payment Resources

Medicare pays for outpatient services using the Medicare Outpatient Prospective Payment System. This system uses Ambulatory Payment Classifications (APCs) to establish payment rates for each procedure or service performed in the outpatient setting.

Medicare outpatient payment rates are updated annually and effective January 1 – December 31 of each year.

Medicare Releases 2011 Hospital Outpatient Final Rule

All related information can be found here.

Medicare Payment Reference Guides

Payment System Fact Sheet

Medicare Learning Network Catalog of Products (PDF, 5.6MB)
Fact sheet presented by CMS and the Medicare Learning Network. 44 pages.

Reimbursement Guides

Reveal^® DX and XT Indications, Guidelines, Clinical Evidence, and Coding Overview for Diagnosing Suspected Arrhythmias (PDF, 429 KB)

Reimbursement Guide for ICD Implants (PDF, 366 KB)
This guide has been developed to assist you in seeking coverage and payment for ICD and CRT-D therapies. This guide also incorporates information regarding the use of ICDs for patients with the expanded coverage indications reflected in the SCD-HeFT and MADIT-II studies. Updated coding information and answers to frequently asked questions (FAQs) about coverage, coding and payment are also in this guide. 24 pages.