Friday, May 19, 2017

CPT code 36005, 36010, 36011, 33282, 33284

CPT code and Descrpiton


36005 Injection procedure for extremity venography 0.95 $328 $50

36010 Introduction of catheter, superior or inferior vena cava 2.18 $492 $114

36011 Selective catheter placement, venous system; first order branch 3.14 $842 $164

36012 Second order, or more selective, branch 3.51 $868 $181

33282 Implantation of patient-activated cardiac event recorder

33284 Removal of an implantable, patient-activated cardiac event recorder

Insertion 33282 Implantation of patient-activated cardiac event recorder Removal 33284 Removal of an implantable, patient-activated cardiac event recorder

CPT code 36005 (injection procedure for extremity venography (including introduction of needle or intracatheter)) should not be utilized to report venous catheterization unless it is for the purpose of an injection procedure for extremity venography. Some physicians have misused this code to report any type of venous catheterization.

Reimbursement and Billing Instructions

The procedure code for the implantation of the patient-activated event recorder – ILR is CPT code 33282.The code for the removal of this device is 33284. These procedure codes have a 90-day global postoperative care designation for which care related to the surgical procedure is not separately reimbursable unless such care is nonroutine, such as treatment of complications. Note that removal of a patient-activated event recorder – ILR on the same day as the insertion of a cardiac pacemaker is considered part of the pacemaker insertion procedure and is not reimbursed separately.

Table 9 illustrates billing instructions for each place of service:

* If the procedure is performed when the patient is an inpatient for a related problem, submit an institutional claim (UB-04 claim form or electronic equivalent) using a medically necessary diagnosis code.

* If the procedure is performed on an outpatient basis, submit an institutional claim (UB-04 claim form or electronic equivalent) using revenue code 360 and CPT code 33282 for implantation. The facility should bill for the device itself on a professional claim (CMS-1500 claim form or electronic equivalent) using HCPCS code E0616 with medically necessary primary diagnosis codes. Use CPT code 33284 with revenue code 360 to bill for removal of the device. Physician’s charges for the surgery should be billed by the physician on a professional claim.

* If the procedure is performed in a physician’s office, the physician should bill CPT code 33282 for implantation and E0616 for the device. Both codes are billed on a professional claim (CMS-1500 claim form or electronic equivalent). 

Type of Claim Institutional Institutional (and professional, if billing for device) Professional Revenue and

CPT Codes Revenue code 360

CPT code not needed Revenue code 360

CPT code 33282 for insertion

CPT code 33284 for removal Revenue code not applicable

CPT code 33282 for insertion

CPT code 33284 for removal

HCPCS Code Not needed On professional claim – E0616 On institutional claim – Not needed E0616

Note: Institutional claim formats include the UB-04 paper claim form, the 837I electronic transaction, and the institutional claim type on the Provider Healthcare Portal. Professional claim formats include the CMS-1500 paper claim form, the 837P electronic transaction, and the professional claim type on the Provider Healthcare Portal



Billing/Coding/Physician Documentation Information

This policy may apply to the following codes. Inclusion of a code in this section does not guarantee that it will be reimbursed. For further information on reimbursement guidelines, please see Administrative Policies on the Blue Cross Blue Shield of North Carolina web site at www.bcbsnc.com. They are listed in the Category Search on the Medical Policy search page.

Applicable codes: 93224, 93225, 93226, 93227, 93228, 93229, 93268, 93270, 93271, 93272, 33282, 33284, E0616,0295T, 0296T, 0297T, 0298T

BCBSNC may request medical records for determination of medical necessity. When medical records are requested, letters of support and/or explanation are often useful, but are not sufficient documentation unless all specific information needed to make a medical necessity determination is included.



Ambulatory Event Monitors

This policy may apply to the following codes. Inclusion of a code in this section does not guarantee that it will be reimbursed. For further information on reimbursement guidelines, please see Administrative Policies on the Blue Cross Blue Shield of North Carolina web site at www.bcbsnc.com. They are listed in the Category Search on the Medical Policy search page. Applicable codes: 93224, 93225, 93226, 93227, 93228, 93229, 93268, 93270, 93271, 93272, 33282, 33284, E0616,0295T, 0296T, 0297T, 0298T 0497T, 0498T BCBSNC may request medical records for determination of medical necessity. When medical records are requested, letters of support and/or explanation are often useful, but are not sufficient documentation unless all specific information needed to make a medical necessity determination is included.


POLICY

Continuous Recorder (Holter Monitor) (93224, 93225, 93226, 93227), External Loop Recorder (codes 93268, 93270, 93271, 93272), Implantable Loop Recorder (33282, 33284, 93285, 93291, 93297, 93298, 93299, E0616), Mobile Cardiac Outpatient Telemetry (MCOT) (93228, 93229) do not require prior authorization for all product lines.
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Long-term Continuous (>48 hours) External Cardiac Monitoring Device (0295T-0298T) does not require prior authorization for HMO, PPO, Individual Marketplace, & Elite.

Long-term Continuous (>48 hours) External Cardiac Monitoring Device (0295T-0298T) is non-covered for Advantage.

Intracardiac Ischemia Monitoring (0302T-0307T) & Other Cardiac Event Monitors (as listed below) are noncovered for all product lines. (Deleted codes 0302T-0307T effective 12/31/17)

COVERED

Continuous Recorder/ Holter Monitors

The use of 24 to 48-hour continuous external cardiac monitoring and storage [CPT codes 93224, 93225, 93226, 93227, (e.g., Holter Monitor)], are considered medically necessary when any of the following criteria are met:

1. As a diagnostic tool to evaluate symptoms suggestive of cardiac arrhythmias (e.g., frequent palpitations, unexplained dizziness, or syncope)

2. To assess pacemaker or implantable cardioverter defibrillator (ICD) function for any of the following indications:
* In patients experiencing frequent symptoms of palpitation, syncope, or near syncope
* When there is a suspected component failure or malfunction
* To assess response to drug therapy in patients with an ICD

3. To assess for myocardial ischemia in suspected variant angina or known coronary artery disease when such information will impact management

4. To assess antiarrhythmic drug therapy in individuals with a treated arrhythmia

5. For pediatric patients with ANY of the following indications:
* Hypertrophic or dilated cardiomyopathies
* Possible long QT syndromes
* Congenital heart disease accompanied by significant residual hemodynamic abnormalities when surgery is being considered
* To assess the adequacy of antiarrhythmic therapy during rapid growth
* Asymptomatic non-paced congenital complete atrioventricular (AV) block

External Loop Recorder

The external loop recorder (CPT codes 93268, 93270, 93271, and 93272) is covered when the following medical indications are met:

1. To document an arrhythmia instead of using a Holter monitor, or if a Holter monitor fails to document a suspected arrhythmia; or
2. To document ST segment depression for suspected ischemia; or
3. To document the benefit after initiating drug therapy for an arrhythmia; or
4. To document recurrence of an arrhythmia after discontinuation of drug therapy; or
5. To document the results after an ablation procedure for arrhythmia; or
6. To evaluate syncope and light-headedness

Implantable Loop Recorder

The use of implantable loop recorder (CPT codes 33282, 33284, 93285, 93291, 93297, 93298, 93299, E0616) for the evaluation of recurrent unexplained episodes of fainting are also covered services, only when ALL of the following criteria are met:

1. Cardiac arrhythmia is suspected to be the cause of fainting
2. Noninvasive ambulatory monitoring failed to establish a definitive diagnosis because the symptoms occur so infrequently and unpredictably that the length of the monitoring period may have been inadequate to capture a diagnostic electrocardiogram (ECG) rhythm disorder
3. Tilt-table testing is negative or non-diagnostic

Real-time Cardiac Monitors/Mobile Cardiac Outpatient Telemetry (MCOT) MCOT (CPT codes 93228 and 93229) is covered for 30 days as medically necessary when ALL of the following criteria are met:

1. Clinical suspicion of a significant arrhythmia

2. Symptoms of syncope, presyncope, or severe palpitations occurring less frequently than once per 24 hours are present
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3. Non-diagnostic 24-hour Holter or non-real time monitoring (eg., event monitor, pacemaker telephonic telemetry, post-symptom patient-activated recorder or auto-trigger) within 60 days prior to consideration of the use of a home-based, real-time continuous attended cardiac monitoring system Documentation Requirements

1. All documentation must be maintained in the patient’s medical record and available upon request.

2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service(s)). The record must include the physician or non-physician practitioner responsible for and providing the care of the patient.

3. The submitted medical record should support the use of the selected ICD code(s). The submitted CPT/HCPCS code should describe the service performed.

33282 Implantation of patient-activated cardiac event recorder


Coverage Status – Medicare

In the absence of a specific local coverage determination (LCD) or national coverage determination (NCD), Medicare coverage is governed by Section 1862. [42 U.S.C. 1395y] of the Social Security Act,2  which states,

“(a) Notwithstanding any other provision of this title, no payment may be made under part A or part B for any expenses incurred for items or services –

(1)(A) which, ... are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.”

We encourage providers to contact their Contractor Medical Director to seek coverage clarification for the useof Reveal ICM for monitoring arrhythmias.

Coverage Status – Non-Medicare

Coverage for implanting a Reveal ICM device to monitor patients with diagnoses other than that of unexplained syncope has generally not been addressed by third-party payers. Providers should contact their payer directly to determine coverage. Prior authorization may be required.

Prior Authorization Resource

A sample letter template for Prior Authorization is available through the Medtronic Coding Hotline at 1 (866) 877-4102, option 1 or by contacting your Medtronic representative. You can reach your representative by calling 1 (800) 633-8766.

Procedure Site of Service

Hospital

CPT 33282 is payable in the inpatient and outpatient settings of a hospital facility (Place of Service codes 21 and

22). The hospital bills for the costs associated with the device and implant procedure, and the physician bills for the professional services associated with the implant procedure and its 90-day global period.

Ambulatory Surgery Center

CPT 33282 is payable in the Ambulatory Surgery Center (Place of Service code 24). The ASC facility bills for the costs associated with the device and implant procedure, and the physician bills for the professional services associated with the implant procedure and its 90-day global period.

Physician Office

If a physician determines it is clinically appropriate to implant a Reveal ICM in his or her office (Place of Service code 11), they should be aware that the current US reimbursement system does not provide for payment of the Practice Expense RVUs associated with the implant procedure in this setting. Therefore, a physician will receive payment only for his or her professional services when implanting a Reveal device in the office setting.

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