BARD ACCESS SYSTEMS, INC. 2018 Medicare Final Rule Procedural Payment Guide Physician Payment Outpatient Hospital Table of Contents Non-Tunneled Venous Access... 2 Tunneled Venous Access... 3 PICC... 4 Repair/Removal... 5 Hemodialysis Access... 7 Guidance... 8 1
NON-TUNNELED VENOUS ACCESS NOTE: listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation. MS- 36555 Insert non-tunnel catheter (<5yrs) 36556 Insert non-tunnel catheter (>5yrs) 36580 Replace nontunneled central venous catheter w/o port $209 $190-9.1% $110 $90-18.2% $684 $983 43.7% $369 $512 38.8% 86.07 579 - Other with MCC $238 $215-9.7% $125 $102-18.4% $684 $983 43.7% $369 $512 38.8% 86.07 580 - Other with CC $218 $219 0.5% $69 $69 0.0% $684 $983 43.7% $369 $512 38.8% 86.07 581 - Other without CC/ MCC $14,805 $14,632-1.2% $8,972 $8,557-4.6% $6,895 $6,732-2.4% Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS code sets replaced coding. Access to ICD-10 code cross reference for diagnosis and codes at: http://www.icd10data.com/convert 2
TUNNELED VENOUS ACCESS NOTE: listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation. MS- 36557 Insert tunneled catheter w/o port (<5yrs) 36558 Insert tunneled catheter w/o port (>5yrs) 36581 Replace tunneled centrally inserted access device w/o port $937 $959 2.3% $326 $330 1.2% $3,923 $4,265 8.7% $2,119 $2,222 4.9% N/A Inclusive $730 $731 0.1% $274 $273-0.4% $2,360 $2,493 5.6% $1,274 $1,299 2.0% N/A Inclusive $717 $722 0.7% $191 $191 0.0% $2,360 $2,493 5.6% $1,274 $1,299 2.0% 86.07 579 - Other with MCC 580 - Other with CC $14,805 $14,632-1.2% $8,972 $8,557-4.6% Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS code sets replaced coding. Access to ICD-10 code cross reference for diagnosis and codes at: http://www.icd10data.com/convert 3
PICC PROCEDURES NOTE: listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation. MS- 36568 Insert picc (<5yrs) $252 $223-11.5% $88 $77-12.5% $684 $613-10.4% $369 $319-13.6% N/A Inclusive 36569 Insert picc (>5yrs) $255 $253-0.8% $95 $89-6.3% $684 $983 43.7% $369 $512 38.8% N/A Inclusive 36584 Replace picc w/o port $209 $210 0.5% $69 $69 0.0% $684 $983 43.7% $369 $512 38.8% N/A Inclusive Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS code sets replaced coding. Access to ICD-10 code cross reference for diagnosis and codes at: http://www.icd10data.com/convert 4
REPAIR / REMOVAL PROCEDURES NOTE: listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation. MS- 36575 Repair of tunneled or non-tunneled access device w/o port 36576 Repair tunneled catheter w/port 36578 Replace, catheter only, non-tunneled centrally inserted access device w/ port 36589 Removal tunneled catheter w/o port $169 $169 0.0% $36 $36 0.0% $684 $613-10.4% $369 $319-13.6% 86.09 $322 $323 0.3% $192 $192 0.0% $684 $983 43.7% $369 $512 38.8% 86.09 579 - Other with MCC $458 $460 0.4% $211 $211 0.0% $2,360 $2,493 5.6% $1,274 $1,299 2.0% 86.09 580 - Other with CC $168 $168 0.0% $142 $142 0.0% $684 $613-10.4% $369 $319-13.6% 86.09 581 - Other without CC/ MCC $14,805 $14,632-1.2% $8,972 $8,557-4.6% $6,895 $6,732-2.4% Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS code sets replaced coding. Access to ICD-10 code cross reference for diagnosis and codes at: http://www.icd10data.com/convert 5
REPAIR / REMOVAL PROCEDURES cont. NOTE: listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation. MS- 36590 Removal tunneled catheter w/port 36596 Mech remov tunneled central venous catheter 36597 Reposition venous catheter under fluoro $228 $228 0.0% $198 $198 0.0% $684 $613-10.4% $369 $319-13.6% 86.09 $134 $134 0.0% $46 $46 0.0% $684 $983 43.7% $369 $512 38.8% 86.09 $130 $131 0.8% $64 $63-1.6% $684 $983 43.7% $369 $512 38.8% N/A Inclusive Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS code sets replaced coding. Access to ICD-10 code cross reference for diagnosis and codes at: http://www.icd10data.com/convert 6
HEMODIALYSIS ACCESS NOTE: listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation. MS- 36800 Insertion of cannula for hemodialysis vein-vein 36810 Insertion of cannula for hemodialysis artery-vein $128 $127-0.8% $3,923 $4,265 8.7% $2,119 $2,222 4.9% 39.27 264 - Other Circulatory System O.R. 39.93 673 - Other Kidney and Urinary Tract with MCC $225 $221-1.8% $2,360 $2,493 5.6% $1,274 $1,299 2.0% 674 - Other Kidney and Urinary Tract with CC 675 - Other Kidney and Urinary Tract without CC/ MCC $16,078 $17,696 10.1% $18,196 $19,384 6.5% $12,274 $12,741 3.8% $8,425 $9,022 7.1% Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS code sets replaced coding. Access to ICD-10 code cross reference for diagnosis and codes at: http://www.icd10data.com/convert 7
GUIDANCE PROCEDURES NOTE: listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation. MS- 76937 Ultrasound guidance for vascular access with permanent recording $32 $32 0.0% $15 $15 0.0% 88.79 Inclusive 77001 Flouroscopic guidance for central venous access device placement or removal $85 $86 1.2% $19 $19 0.0% 87.39 Inclusive 88.16 Inclusive Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS code sets replaced coding. Access to ICD-10 code cross reference for diagnosis and codes at: http://www.icd10data.com/convert 8
605 North 5600 West Salt Lake City, Utah 84116 USA Phone: (801) 522-5000 Fax: (801) 595-5975 Customer Service: (800) 545-0890 www.bardaccess.com DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services, 42 CFR Parts 414, 416, and 419, [CMS-1678-FC], RIN: 0938-AT03: Medicare Program: Hospital Outpatient Prospective Payment and Surgical Center Payment Systems and Quality Reporting Programs; Final Rule DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services, 42 CFR Parts 405, 410, 414, 424, and 425, [CMS-1676-F], RIN 0938-AT02: Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program; Final Rule DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services, 42 CFR Parts 405, 412, 413, 414, 416, 486, 488, 489, and 495, [CMS 1677 F], RIN 0938 AS98: Medicare Program; Hospital Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR) Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Provider-Based Status of Indian Health Service and Tribal Facilities and Organizations; Costs Reporting and Provider Requirements; Agreement Termination Notices: Final Rule DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services, 42 CFR Parts 405, 412, 413, 414, 416, 486, 488, 489, and 495, [CMS 1677 CN], RIN 0938 AS98 : Medicare Program; Hospital Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR) Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Provider-Based Status of Indian Health Service and Tribal Facilities and Organizations; Costs Reporting and Provider Requirements; Agreement Termination Notices; Correction to MDHs and Low-Volume Hospitals; Final Rule American Medical Association s Physician s Current Procedural Terminology 2017, www.ama-assn.org World Health Organization. International Classification of Diseases, 9th revision. Geneva: WHO, 2015. All Rights Reserved. C. R. Bard, Inc. does not guarantee that use of any of the codes provided will ensure coverage or payment at any particular level. Medicare may implement policies differently in various sections of the country. Physicians and hospitals should confirm with a particular payor or coding authority, such as the American Medical Association or medical specialty society, which codes or combinations of codes are appropriate for a particular or combination of s. Reimbursement for a product or can be different depending upon the setting in which the product is used. Coverage and payment policies also change over time, so that information provided here may at some point need to be revised. DAV/CORP/1217/0055 9