Wiki Urolift - Payment for Failed Clips

[Crawlspace324]

One of our physicians recently started doing Urolift procedures on some of his BPH patients. Things were rolling along smoothly for him until this last week when several of his procedures are documented as having what he calls "pull-throughs" or clips that he attempted to place that didn't hold and were pulled out during the course of the procedure. I'm not familiar enough with the billing for the procedure to know if I can charge for the failed clips, and I haven't been able to find anything on-line. Does anyone know if it is appropriate to bill for the clips that didn't hold?

Scenario: Physician uses a total of 6 clips. Four clips were successfully placed, two more were deployed but failed to hold and were "pull-throughs".

Codes(?): 52441, 52442 x 3 OR 52441, 52442 x 5

 

[drewvinson23]

We have been instructed in our office that you can bill for the failed implants.

Here is the relevant info--

"Although there is nothing specific to this scenario in regard to medical devices on the Medicare/CMS website, we have received verbal confirmation from Medicare/CMS nationally that if a product is opened, and every attempt has been made to deliver the implant (the product has come in contact with the patient), the implant is billable to Medicare by the facility and the physician who attempted delivery of the implant. The unsuccessful delivery of the implant, and reason why, should be fully documented in the patient’s chart. Anything that is billed to Medicare must be documented. A few comments:
Ø Opened delivery devices/implants that have been erroneously dropped on the floor, or otherwise compromised and unusable, are not billable to Medicare/CMS under any circumstances.
Ø The total number of implants should always be reported using L8699 in the “units” box on the hospital claim form with hospital specific charges assigned. No additional reimbursement is available for L8699 but as a reminder, claims using C9740 will be denied if L8699 is not also reported. Encourage your facilities to use L8699 when billing C9739 as well.
Ø We were instructed that no modifier is needed to report the unsuccessfully delivered implant.
Ø Customers who need more reassurance, should check with their local Medicare carrier (MAC) regarding their position on attempted, but unsuccessfully delivered, medical devices. The customer should always follow their MAC’s instruction, even if it differs from this guidance."

Drew Vinson
CPC
NW Urology

 

[aefiner@gmail.com]

2019 MUE changed for V9740, but need the CMS guidance rhetoric for management

Our hospital surgeons have been billed (facility) using L8699 and V9740 for some time. Recently, I googled these codes together and found the following exciting link:

https://community.auanet.org/blogs/...tient-and-asc-edit-in-effect-for-prostatic-ur

In this article, we are told that we can rebill for the implants past the 2018 MUE of 4 starting from April (?) of 2018.
Understandably, management wants the link to the CMS.gov website subpage where this information was found.

Does anyone know where I should look? Or have that link?

I am very grateful for any information you have.

Allison Finer, CPC