Wiki drug coated balloon

[schmsuz]

Can anyone tell me if the billing is different when the physician is using a drug coated balloon as opposed to pta w/o the DCB? Thanks for your help!

 

[Chlrtrep]

The coding and reimbursement is the same as a non-DEB angioplasty. This will change effective April 1, 2015 - when a transitional pass-through payment (TPT) will go into effect for DCB. This will require use of a new c-code (C2623, listed on the file). The actual outpatient TPT amount is still to be determined - we are awaiting the full transmittal publication to see precisely how CMS will be calculating this. It is not a designated amount; rather, it is a case-by-case basis and specific to each hospital's cost-to-charge ratio, etc.

 

[schmsuz]

Thanks for the info! Will there be different coding for the physician professional services?

 

[Julie Allred]

Should the physician bill differently for using a drug coated balloon or does he use the regular angioplasty codes? Also, should he expect additional reimbursement?

 

[Chlrtrep]

http://www.medtronic.com/wcm/groups...nts/documents/drug-coated-balloon-tpt-faq.pdf

4. Physician professional payments are not impacted when using DCB. The physician will continue to use the same CPT code to describe the work of performing a peripheral angioplasty with a DCB or other balloon angioplasty catheter



The additional payment is for facilities. As the DCB is significantly more expensive then a regular PTA balloon.

 

[Julie Allred]

Thanks so much! That is exactly what I needed to show my cardiologists. He was determined that he would be reimbursed more.