Wiki Transfemoral & Transapical AVR

[jewlz0879]

My CT surgeons and Cardiologists have been performing the Transapical & Transfemoral AVRs. We were using the unlisted (33999) but now there are Category III codes available.

What reference code did you use or were you directed to use for pricing and RVUs? We used the 33405 for the transapical approach (0257T) but would that still be a good code as a point of reference for the Transfemoral apporach (0256T)?

Would 33405 work or would the 33411 be a better option? Is there another code all together that would make better sense as a point of reference?

Any help provided is greatly appreaciated!

Thanks~

 

[lisigirl]

Hi Julie,

I don't actually have an answer to your question but I'm glad you posted this. I have a question for you about these procedures. Our CT surgeons and cardiologists have been doing this procedure as well. Like you, we've billed with the unlisted code, however, we've billed these as co-surgeries.

The new Category III codes do not allow for co-surgeons (they do allow for assistant surgeons if the documentation supports the need for one). My surgeon insists that this procedure is a collaborative effort between the 2 specialties and he is thinking about approaching our Medicare medical director regarding this issue.

May I ask, how are you billing for this? As for the fee, I will have to get back to you. I have 7 procedures from January I still need to bill but first we need to settle this issue.

thanks,
Lisi, CPC
eharkler@nmh.org

 

[jewlz0879]

Hi Lisi,

No problem, I have answered my question now, LOL. I'm happy to help you.

We used the unlisted code just as you did, however, we billed our surgeon and PA assist with the 80 modifier and will do the same with the Category three codes 00256T & 0257T.

2010 - Transfemoral Billing; Cardiologist - 33999AV, Q0
CT surgeon - 33999AV, 80, Q0

I understand where your physician is coming from; on our reports the Cardiologist and CT Surgeon are specifically documented as "assistant" and we use the 80 modifier. I'm not sure if this is because a manager decided to go with the 80 since 62 is not applicable or if our physicians agree they are acutally an 'assist' during these procedrues.

Maybe if he goes to his Medicare Director and explains it, they will allow the 62, that would be great. Maybe there is information out there as to why it can't be billed with an 80? You have peeked in my interest. I have a call into the representative with Edwards Sapien (they make the valves) and when I get a call back I will be happy to ask.

 

[lisigirl]

Thanks Julie. Yes, if the Edwards rep gives you any info, please let me know. My physician wanted me to check with them as well. (By the way, you may have just written it incorrectly above but the Category III codes DO allow the -80 modifier, its the -62 we can't use).

What did you find out about pricing and RVUs?

Feel free to email me directly at work, it would be easier.

thank you!

Lisi
eharkler@nmh.org