Transcatheter Aortic Valve Replacement (TAVR)CPT???

susiemc

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Walkertown, NC
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I have researched this procedure and have not been able to determine the appropriate CPT. Any suggestions are greatly appreciated!!
 

GIBBERS

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If you are talking about the 'Corevalve' study in which my surgeons are participating in, the CPT is '0256T'...
There are several other CPT codes as well, if done 'open' 0257T, with add on codes '0258T' (transthoracic catheter delivered ) w/o CPB, or '0259T' which is with CPB
There are alot of rules to follow when billing these codes.
These are cat III codes. It takes both the Cardiac Surgeon and Intervential Cardiologist to do this procedure. Unfortunately, only one doctor can get paid. The CPT codes do not allow a 'co-surgeon'.
My surgeons take turns with the Intervential Cardiologist on billing for this procedure. If we are not charging for the procedure, you can still charge for the cutdown of the femoral arteries if done.
 

lisigirl

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Oakpark, Illinois
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As of January 2012, these codes DO allow for co-surgeons. Prior to this year, the MFSDB did not allow for the -62 modifier however, we were in the clinical trial and our Medicare medical director told us we could bill as co-surgeons - although its been a battle getting paid, we have had success.

Lisi, CPC
eharkler@nmh.org
 

carolhpolk

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Jackson, MS
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Cpc, rn

If a femoral artery cutdown is done by the surgeon, what code is being used? Edwards suggests using 36140 but that does not seem logical since that is for percutaneous placement of a needle, catheter/sheath. I was thinking something more along the line of 34812 used w/ EVAR procedures but suspect this would not be allowed.
 

jewlz0879

True Blue
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Richardson, TX
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If a femoral artery cutdown is done by the surgeon, what code is being used? Edwards suggests using 36140 but that does not seem logical since that is for percutaneous placement of a needle, catheter/sheath. I was thinking something more along the line of 34812 used w/ EVAR procedures but suspect this would not be allowed.
I wondered about that as well, Carol. I don't see why we couldn't use it. I mean, 0256T, is an Endovascular placement of prosthetic aortic heart valve. The code itself (34812) describes, "Open Femoral artery exposure for delivery of endovascular prosthesis, by groin incision, unilateral."

Does anyone know if STS has anything on this?

Let me see if this was addressed by Dr. Z in his Dallas conference back in Feb. If so, I'll post that answer.
 

Misty Dawn

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Did anyone find anything else out about using 34812 with 0256T? The only thing I could find is from WMGMA Medicare/Medicaid Workgroup. The document says that 34812 is not reported with 0256T.

5. For CPT 0256T – (Implantation of catheter-delivered prosthetic aortic heart valve; endovascular approach), a cardiovascular or general surgeon is performing an open exposure of the femoral artery. We report this with CPT 34812 - Open femoral artery exposure for delivery of endovascular prosthesis, by groin incision, unilateral. This code accurately describes the open procedure.
The coding and billing guidelines of LCD ID Number L30798, Non-coronary Vascular Stents (CV-028) indicate 34812 may reported in addition to the primary code. The list of primary codes includes CPTs 34800 - 34805, all pertinent to endovascular repair of abdominal aortic aneurysms.
Is CPT 34812 subject to the policy CV-028 for non-coronary stents, when used for exposure to place a prosthetic aortic valve?

WPS Medicare Response: CPT 34812 - Open femoral exposure is part of the TAVR procedure CPT 0256T and cannot be un-bundled. LCD L30798 (CV-028), entitled Non-coronary Vascular Stents does not apply to this procedure. A valve is not a stent. Therefore, CPT 34812 is not subject to indications and limitations of coverage identified in LCD CV-028.
 

conleyclan

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There are new codes for 2013. Please see 33361-33365 and add on codes 33367-33369. The cath codes and 34812 are integral to the main procedure. I sat in on a webinar from Medtronic last week. I am hoping that the new codes are reimbursed. I am still trying to get the claims from early 2012 paid on from Medicare.
 
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