TAVR & DRG

petroskek

Contributor
Messages
23
Location
Fort Myers, FL
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I have a provider who just started performing TAVRs and the hospital is questioning the provider, who is now questioning me.

Under procedures performed, the doctor is listing:
1: Left Heart cath
2: Temporary Transvenous pacemaker insertion
3: Transcatheter Aortic Valve Implantation with a 26 mm Edwards Sapien 3 Bioprosthetic
4: Rt Femoral Angiography
5: Perclose deployment x 2 in RFA

Per the documentation, he is using a percutaneous femoral artery approach, and of course he is a co-surgeon with another provider.
I am billing 33361,62,Q0 with I35.0, Z06

I have looked at what the hospital is billing and since I don't understand PCS & DRG, I was hoping someone might help me.
For all the principal procedures, they are billing 02RF38Z. For some of the procedures, they are using DRG 266 and others they are using DRG 267.

I bill for the physician, the hospital has coders/billers who bill for the facility. I guess my question is... is my code correct and is there anything that I am doing that is effecting the DRG that the hospital uses?

I know this sounds really dumb, but I am new to CV surgeries, and very new to the world of inpatient billing.
 

mk2001

Networker
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47
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You are coding it correct as long as Z06 was a typo & you meant Z00.6. Like you, I bill for the physicians but from what I can tell it looks like the difference in the 2 they are using is one is TAVR w/MCC & the other is TAVR w/o MCC.
 
Messages
2
Location
Portage, MI
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I agree that you are coding it correctly for the professional side (as long as you use diagnosis Z00.6). Are you using the clinical trial number as well? I bill TAVR procedures frequently and I was taught that I always have to use the clinical trial number 01737528 since you have the Q0 modifier. Also, the procedure always has to be an inpatient procedure. Just a tip, I always attach both surgeons' op notes to the claim to back up the 62 modifier, but I happen to bill for the cardiologist and the CV surgeon where I work.
 
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