CODING AND COVERAGE RESOURCES CARDIOVASCULAR REIMBURSEMENT

REIMBURSEMENT RESOURCES

The objective of this information is to provide our customers with resources to assist with coding, coverage, and reimbursement for our therapies.

Medtronic provides this information for your convenience only. It does not constitute legal advice or a recommendation regarding clinical practice. Information provided is gathered from third-party sources and is subject to change without notice due to frequently changing laws, rules, and regulations. The provider has the responsibility to determine medical necessity and to submit appropriate codes and charges for care provided.

Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other payers as to the correct form of billing or the amount that will be paid to providers of service. Please contact your Medicare contractor, other payers, reimbursement specialists and/or legal counsel for interpretation of coding, coverage and payment policies.

This document provides assistance for FDA approved or cleared indications. Where reimbursement is sought for use of a product that may be inconsistent with, or not expressly specified in, the FDA cleared or approved labeling (e.g., instructions for use, operator’s manual or package insert), consult with your billing advisors or payers on handling such billing issues. Some payers may have policies that make it inappropriate to submit claims for such items or related service.

Quick Links to Section Categories

• C-Codes
• Cardiovascular Reimbursement Overview
• Coronary Artery Disease Management Resources
• Aortic Disease Management Resources
• Peripheral Arterial Disease Resources
• Dialysis Access Maintenance Resources
• Arteriovenous Fistula (AVF) Creation Resources
• Superficial Vein Therapies Resources
• Deep Venous Resources
• Peripheral Embolization Resources
• Structural Heart Disease Management Resources
• Cardiac Surgery Resources

C-Code Listings

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.

Below is a downloadable PDF document listing Vascular product names and their associated C-codes.

Cardiovascular Reimbursement Overview

• Cardiovascular Reimbursement Update (.pdf)

Coronary Artery Disease Management

• Coronary Diagnostic and Intervention Coding Sheet (.pdf)

Aortic Disease Management

• EVAR Coding Guide (.pdf)
• TEVAR Coding Guide (.pdf)
• EndoAnchor Coding Guide (.pdf)

Peripheral Arterial Disease Resources

• Peripheral Vascular Coding Sheet (.pdf)
• Peripheral Vascular Reimbursement Guide (.pdf)
• Lower Extremity Arterial Reimbursement Rates (.pdf)

Dialysis Access Maintenance Resources

• Dialysis Access Maintenance Coding Guide (.pdf)
• Dialysis Access Maintenance Reimbursement Guide (.pdf)

Arteriovenous Fistula (AVF) Creation Resources

• Percutaneous AV Fistula Creation Coding Guide (.pdf)
• Percutaneous AV Fistula Creation Reimbursement Guide (.pdf)

Superficial Vein Therapies Resources

• Superficial Venous Coding Guide (.pdf)
• Superficial Venous Reimbursement Guide (.pdf)

Deep Venous Resources

• Deep Venous Stenting Coding Guide (.pdf)
• Deep Venous Stenting Reimbursement Guide (.pdf)

Peripheral Embolization Resources

• Peripheral Embolization Coding Guide (.pdf)
• Peripheral Embolization Reimbursement Guide (.pdf)

Structural Heart Disease Management

Evolut

• Evolut Coding Quick Reference – for Hospitals (.pdf)
• Evolut Coding Quick Reference – for Physicians (.pdf)

Melody

• Melody Transcatheter Pulmonary Valve Reimbursement Guide (.pdf)

Harmony

• Harmony Transcatheter Pulmonary Valve Commonly Billed Codes Reimbursement Guide (.pdf)

Contacts

• Health Care Economics Field Map (.pdf)

Cardiac Surgery Resources

Surgical Valves

• Surgical Valves Coding – for Hospitals (.pdf)
• Surgical Valves Coding – for Physicians (.pdf)

Extracorporeal Membrane Oxygenation

• Extracorporeal membrane oxygenation (ECMO) Reimbursement Guide (.pdf)

Blood Management

• AutoLog IQ Autotransfusion System Reimbursement Guide (.pdf)
• HMS Plus and ACT Plus Reimbursement Information (.pdf)

Cardiothoracic Procedures

• Coding Reference (.pdf)