Wiki TAVR 0256T billing & modifiers HELP


Sheridan, MI
Best answers
I am getting ready to submit our first billings for 4 separate physicians from 2 separate practices and would appreciate some feedback on this.

Per the CCI edits, 34812 does not bundle into 0256T. It does bundle the 92986 valvuloplasty (no modifier is allowed), the temporary PM insert 33210 and 93318 TEE intraop (modifiers are allowed).

Practice 1 Surgeon performing TAVR/temp PM/valvuloplasty
0256T TAVR Modifier 66 for Team surgery?
(33210 Temp PM insert unbillable per CPT) When is it allowed to add the 59 modifier?
(92986 valvuloplasty is unbillable per CCI)

Practice 1 First Assist to Surgeon performing TAVR/temp PM/valvuloplasty:
0256T,? TAVR Mod 66 for Team surgery? Or Modifier 80 for 1st assist?
(33210 Temp PM insert unbillable per CPT) When is it allowed to add the 59 modifier?
(92986 valvuloplasty is unbillable per CCI)

Practice 1 Cardiologist #3 performing TEE placement/monitoring throughout TAVR:
93318,59 TEE intraop When is it allowed to add the 59 modifier?
76376,26 3D with TEE

Practice 2 Cardio-Thoracic Surgeon performing femoral cut-down & closure only
0256T, 66 Modifier 66 for Team Surgery?
Or 34812 for cut-down Does it need a modifier?

When I looked at the Medicare policies, the Local Coverage Article (A46075) states you can NOT use modifiers 62, 66 but you can use modifier 80 for the 0256T. In LCD L25275, modifiers are not specified at all. Since the LCD did not clarify the modifiers, I called Medicare. I was directed to the “2012 National Physician Fee Schedule Relative Value File July Release” File: PPRRVU12_V0606.xlsx, which states 0256T you CAN use modifiers 80, 62, 66 and for 34812 you CAN use modifiers 51, 50, 80, and 62. :confused:

Since Medicare advised me to use the allowed modifiers on the Relative Value File shown above, these are contradicting the LCA. Since this is only a "Article", not a "Decision" in a LCD, are we required to follow the LCA over the Relative Value Files????

How is everyone else billing these? (I am in Michigan).

I would greatly appreciate any feedback you can give me on this. Thank you!!
C:\Documents and Settings\QOT8875\Local Settings\Temporary Internet Files\Content.Outlook\B8R2S2U0\medicare Billing for Transcatheter Aortic Valve Replacement (TAVR) Outside a Clinical Trial.mht

Will that help?

We bill these all the time but only with 62 or 80, depending on what doc and how the reports come to us. We don't bill for the cutdown 34812 but I code for the cardio, not the CT surgeon.

I can't open the file you are referencing. Could you please post the website or cut/paste the document for me? Thank you so much for your help, I greatly appreciate it!