Physician Reimbursement Primer for Cardiac ... - Boston Scientific

Contents
Chapter 1: Introduction .................................... 1
� How This Guide Is Organized .................................................................................. 1
� Terminology Used in This Guide.............................................................................. 1
Chapter 2: Overview of Coding
and Payment Systems .................................. 3
� The Reimbursement Process................................................................................... 3
� Hospital Outpatient and Ambulatory Surgical Center Services ............................... 4
Hospital Outpatient Prospective Payment System ................................................ 4
Payment for Ambulatory Surgical Centers............................................................. 5
� Inpatient Procedure and Diagnosis Coding ............................................................. 5
In-Patient Admission General Rules...................................................................... 5
ICD-9-CM Procedure Codes.................................................................................. 6
MS-DRG Basics..................................................................................................... 6
MS-DRG Payments ............................................................................................... 6
� MS-DRG Logic for CRM Procedures ....................................................................... 8
Pacemakers or Cardiac Resynchronization Therapy Pacemakers ....................... 8
ICD or Cardiac Resynchronization Therapy Defibrillator....................................... 8
Electrophysiology Study and Ablation ................................................................... 9
Chapter 3: Indications and
Coverage Determinations ........................... 11
� National Coverage Determinations ........................................................................ 11
Medicare NCD for Cardiac Pacemakers.............................................................. 11
Pacemaker—Evaluation Services ....................................................................... 15
Medicare NCD for Implantable Cardioverter Defibrillators (ICDs) ....................... 16
Medicare NCD for Cardiac Resynchronization Therapy Pacemakers (CRT-Ps) 19
Medicare NCD for Cardiac Resynchronization Therapy Defibrillators (CRT-Ds) 19
Medicare NCD for Intracardiac Electrophysiology and Related Procedures....... 20
� ICD National Coverage .......................................................................................... 20
� National Coverage for Device Follow-up ............................................................... 20
� Local Coverage Determinations............................................................................. 21
Cardiac Resynchronization Therapy Pacemakers (CRT-Ps) .............................. 22
Cardiac Resynchronization Therapy Defibrillators (CRT-Ds) .............................. 22
Intracardiac Electrophysiology and Related Procedures..................................... 22
Physician Reimbursement Primer for Cardiac Rhythm Management iii