CRT-D Coding

Cardiac Resynchronization System (CRT-D) Vol.3 Procedure Codes

Hospital Inpatient:

ICD-9-CM Volume 3 Procedure Code Options:

Implantation or Replacement of Total System

00.51 Implantation of cardiac resynchronization defibrillator, total system [CRT-D]

Implantation or Replacement of CRT-D Generator Only

00.54 Implantation or replacement of cardiac resynchronization defibrillator, pulse generator only [CRT-D]

Implantation or Replacement of LV Lead Transvenous

00.52 Implantation or replacement of transvenous lead [electrode] into left ventricular coronary venous system

Implantation or Replacement of RA, RV or LV Lead, Epicardial

37.74 Insertion or replacement of epicardial lead (electrode) into epicardium*

Insertion or Replacement of RA or RV Lead, Transvenous

37.95 Implantation of automatic cardioverter/defibrillator lead(s) only

37.97 Replacement of automatic cardioverter/defibrillator lead(s) only

Revision or Repositioning of RA, RV or LV lead

37.75 Revision of lead (electrode)**

Revision or Relocation of Pocket

37.79 Revision or relocation of cardiac device pocket

Removal of CRT-D Device Without Replacement

37.99 Other operations on heart and pericardium

Diagnostic Electrophysiologic Procedure and Intracardiac Device Testing with Induction of Arrhythmia

37.26 Cardiac electrophysiologic stimulation and recording studies (including NIPS)

Device Checks Without Induction of Arrhythmia

89.49 Automatic implantable cardioverter/defibrillator (AICD) check

AV Optimization of Biventricular Devices

88.72 Diagnostic ultrasound of the heart

CRT-P Procedures

Cardiac Resynchronization System (CRT-P) Vol.3 Procedure Codes

Hospital Inpatient:

ICD-9-CM Volume 3 Procedure Code Options:

Implantation or Replacement of Total System

00.50 Implantation of cardiac resynchronization pacemaker without mention of defibrillation, total system [CRT-P]

Implantation or Replacement of CRT-P Generator Only

00.53 Implantation or replacement of cardiac resynchronization pacemaker, pulse generator only  [CRT-P]

Implantation or Replacement of LV Lead, Transvenous

00.52 Implantation or replacement of transvenous lead [electrode] into left ventricular coronary venous system

Implantation or Replacement of RA, RV or LV Lead, Epicardial

37.74 Insertion or replacement of epicardial lead (electrode) into epicardium**

Insertion or Replacement of Other (RA and RV) Lead

37.70 Initial insertion of lead [electrode], not otherwise specified

37.71 Initial insertion of transvenous lead [electrode] into ventricle

37.72 Initial insertion of transvenous leads [electrodes] into atrium and ventricle

37.73 Initial insertion of transvenous lead [electrode] into atrium

37.74 Insertion or replacement of epicardial lead [electrode] into epicardium

37.76 Replacement of transvenous atrial and/or ventricular lead(s) [electrode]

Unspecified Insertion or Replacement of Lead

37.70 Initial insertion of lead [electrode], not otherwise Specified

Revision or Repositioning of RA, RV or LV lead

37.75 Revision of lead (electrode)

Revision and Removal of Lead

37.75 Revision of lead [electrode]

37.77 Removal of lead(s) [electrode] without replacement

Revision or Relocation of Pocket

37.79 Revision or relocation of cardiac device pocket

Revision or Removal of CRT-P Generator

37.89 Revision or removal of pacemaker device

Device Checks

89.45 Artificial pacemaker rate check

89.46 Artificial artifact waveform check

89.47 Artificial pacemaker electrode impedance check

89.48 Artificial pacemaker voltage or amperage threshold Check

Intracardiac Device Testing with Induction of Arrhythmia

37.26 Cardiac electrophysiologic stimulation and recording studies (including NIPS)

AV Optimization of Biventricular Devices

88.72 Diagnostic ultrasound of the heart

Cardiac Resynchronization Therapy

Types of Cardiac Resynchronization Therapy(CRT-P / CRT-D) Coding

What is CRT?

Cardiac resynchronization therapy (CRT) is a newer generation of pacemakers and AICDs. Its distinguishing feature is an extra lead at the left ventricle, in addition to the leads at the right atrium and/or the right ventricle used with conventional pacemakers and AICDs.

CRT is also known as biventricular therapy because, with one lead at the right ventricle and another at the left ventricle, it coordinates the pumping action of the ventricles.

There are two types of cardiac resynchronization devices:

·        CRT-pacemaker (CRT-P)

·        CRT-defibrillator (CRT-D)

A cardiac resynchronization therapy pacing (CRT-P) system utilizes conventional pacing technology, but takes it one step further by adding a third lead, or electrode, to sense and pace the left ventricle.

The pacing device can then simultaneously stimulate both ventricles in synchrony with atrial activity. The synchronous contraction of both ventricles facilitates more adequate filling of the left ventricle and less backflow to the left atrium, resulting in more oxygenated blood being pumped to the body.

Cardiac resynchronization therapy has also been incorporated into automatic internal cardioverter-defibrillator devices (CRT-D), allowing for the simultaneous treatment of congestive heart failure with intraventricular conduction delays and the prevention of sudden cardiac death caused by life-threatening ventricular arrhythmias.

In physician’s operative notes, you may see CRT devices referred to as one of the following:

CRT-P

·        Cardiac resynchronization therapy pacemaker

·        Biventricular pacemaker

·        Bi-V pacemaker

·        Low power CRT

·        Heart failure pacemaker

CRT-D

·        Cardiac resynchronization therapy defibrillator

·        Biventricular ICD

·        Biventricular pacemaker with defibrillator

·        Biventricular pacing with defibrillation

·        High power CRT

·        Heart failure pacemaker with defibrillator

·        Heart failure pacemaker with ICD

HAC List

List of Inpatient Hospital Acquired Conditions (HAC)-Coding

The categories of HACs include:

1.      Foreign Object Retained After Surgery

2.      Air Embolism

3.      Blood Incompatibility

4.      Stage III and IV Pressure Ulcers

5.      Falls and Trauma

6.      Fractures

- Dislocations

- Intracranial Injuries

- Crushing Injuries

- Burns

- Electric Shock

7.      Manifestations of Poor Glycemic Control

- Diabetic Ketoacidosis

- Nonketotic Hyperosmolar Coma

- Hypoglycemic Coma

- Secondary Diabetes with Ketoacidosis

- Secondary Diabetes with Hyperosmolarity

8.      Catheter-Associated Urinary Tract Infection (UTI)

9.      Vascular Catheter-Associated Infection

10. Surgical Site Infection Following:

- Coronary Artery Bypass Graft (CABG) – Mediastinitis

- Bariatric Surgery

·         Laparoscopic Gastric Bypass

·         Gastroenterostomy

·         Laparoscopic Gastric Restrictive Surgery

11. Orthopedic Procedures

- Spine

- Neck

- Shoulder

- Elbow

12. Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)

- Total Knee Replacement

- Hip Replacement

Outpatient Reimbursement

Hospital Outpatient Coding and Reimbursement Process

Similar to physicians, hospitals use ICD-9-CM codes for diagnoses and CPT or HCPCS II codes for procedures for outpatient encounters. For Medicare, hospital outpatient reimbursement is under the Ambulatory Payment Classification (APC) system.

Each CPT and HCPCS II code is assigned to an APC group with a unique relative weight, which is then converted into the payment amount. Unlike DRGs, multiple APCs can be assigned and paid for each outpatient encounter, depending on the procedure performed. Additional amounts may also be available for specific pass-through devices.

Medicare has used APCs for hospital outpatient reimbursement since 2000.

Changes to APCs and CPT procedure codes are effective January 1^st

Inpatient Reimbursement

Hospital Inpatient Coding and Reimbursement Process

Hospitals assign ICD-9-CM codes for both diagnoses and procedures for inpatient admissions. For Medicare, inpatient hospital reimbursement is under the Diagnosis Related Group (DRG) system.

For each admission, the ICD-9-CM diagnosis and procedure codes are grouped into one of more than 800 DRGs. Regardless of the number of codes, only one DRG is assigned per admission. Each DRG has a unique relative weight, which is then converted into the payment amount.

Medicare has used DRGs for hospital inpatient reimbursement since 1983.

Changes to ICD-9-CM procedure and diagnosis codes as well as DRGs are effective October 1st of each year.

POA Documents

            Documents to capture POA Indicators in Inpatient reports/charts

         

Coders can use several documents to decipher POA information:

1.      ED notes: ED notes may state the patient’s condition in the workup.

2.      History and physical (H&P): A patient’s condition may be diagnosed or found in the workup of the H&P portion of the physician exam notes. Past medical history, as well as current medications, may be found here as well.

3.      Progress notes: Progress notes are a follow-up on a patient’s initial condition diagnosis. These notes may also reveal new fi ndings of existing conditions.

4.      Consults: Reports from a consulting physician may yield information for management of other conditions that need surgery.

5.      Admission forms: A nursing admission, an operating room admission, or an anesthesia workup may contain useful POA information.

6.      Laboratory and x-ray reports: Coders can look for information in the workup of both laboratory and  x-ray reports.

Coders should remember that admission forms, lab reports, and x-ray reports don’t support a POA indicator. To assign POA, coders must rely on a treating physician’s documentation.

Assuming physician documentation is accurate and complete, a coder can consider these tips when assigning the POA indicator:

·        Look in the history and physical, as well as the emergency room physician documentation and admitting progress note and orders. The cut-off point in determining whether the condition was POA, is when the admit order was written.

·        Look for confi rming diagnoses. Perhaps the physician documented a sign or symptom on admission, but didn’t render a diagnosis until two or three days later. The physician may have documented a diagnosis as “possible” or “probable,” but didn’t confi rm it until later in the progress notes. Only code a diagnosis listed as “possible” or “probable” if the condition is later confi rmed or still qualifi ed as uncertain at the time of discharge. Since the diagnosis is based on signs or symptoms that were POA, the coder would assign a “yes” indicator. Note that an uncertain diagnosis would be POA only when that diagnosis had related signs or symptoms that were present at the time of admission. Otherwise, if the signs and symptoms developed after the physician order, the diagnosis is not POA.

POA Indicators

          

           

           Present on Admission (POA) Indicators in Inpatient Coding

The present-on-admission (POA) indicator is a new data element that CMS requires hospitals to report as of October 1, 2007, as part of the Defi cit Reduction Act of 2005.

POA refers to conditions that are present at the time an order for inpatient admission occurs. Conditions that develop during an outpatient encounter, including emergency department (ED), observation, and outpatient surgery, are considered POA.

Coders should report a POA indicator for a principal diagnosis, as well as any secondary diagnoses or E codes. POA ties in with MS-DRGs because even though a condition may be classifi ed as a CC or MCC, that doesn’t mean that it will affect the MS-DRG assignment.

This is because as of October 1, 2008, hospitals will not receive additional payments for cases in which one of eight conditions develops but was not POA.

CMS will reimburse these cases as though the secondary diagnoses were not clinically present. The eight hospital-acquired conditions CMS targets in the 2008 IPPS fi nal rule (see the August 22 Federal Register) include:

·        Serious preventable event (object left in surgery)

·        Serious preventable event (air embolism)

·        Serious preventable event (blood incompatibility)

·        Catheter-associated urinary tract infection (CAUTI)

·        Pressure ulcers (decubitus ulcers)

·        Vascular catheter (associated infection)

·        Surgical site infection (e.g., mediastinitis after coronary artery bypass graft)

·        Hospital-acquired injuries, fractures, dislocations, intracranial injuries, crushing injuries, burns, and other unspecifi ed effects of external causes

Consider the following example:

A patient was admitted with acute atrial fi brillation and developed a decubitus ulcer during the hospitalization, which is identifi ed by a POA of “N.”

The DRG assignment would be MS-DRG 309; however, because the decubitus ulcer was not POA, CMS will calculate this case as though it were not present. This would result in MS-DRG 310.

The UB-04 includes an indicator fi eld specifi cally designed for POA assignment. Coders have to determine whether a condition was POA when the patient was admitted to the hospital or whether it developed during the hospital stay. Once coders fi nd this information, they can report one of the following indicators in the proper field:

POA Indicators:

Y/Yes: Present at the time of inpatient admission

N/No: Not present at the time of inpatient admission

U/Unknown: The documentation is insuffi cient to determine if the condition was present at the time of inpatient admission

W/Clinically Undetermined: The provider is unable to clinically determine whether the condition was present at the time of inpatient admission

1 - Unreported/Not Used (for electronic claims filing)

Chronic Diseases List

List of Chronic Systemic Diseases

CENTRAL NERVOUS SYSTEM
1. Depression
2. Psychosis/Schizophrenia
3. Obsessive Compulsive Disorder
4. Epilepsy
5. Parkinson's Disease
6. Anxiety (Panic Disorder and Generalised Anxiety Disorder only)
7. Attention Deficit Hyperactivity Disorder
8. Narcolepsy
9. Bipolar Mood Disorder


CARDIOVASCULAR SYSTEM
10. Cardiac Arrythmias
11. Hypertension
12. Heart failure and Cardiomyopathy
13. Coronary Artery Disease
14. Angina
15. Hyperlipidaemia
16. Peripheral Vascular Disease
17. Endocarditis


BLOOD / CLOTTING DISORDERS
18. Thrombocytopaenia
19. Cryoglobinaemia
20. Haemophilia
21. Deep Vein Thrombosis
22. Treatment of Iron/B12 Deficiency Anaemia


RESPIRATORY SYSTEM
23. Asthma
24. Chronic Obstructive Airways Disease (Emphysema, Chronic Bronchitis)
25. Bronchiectasis
26. Cystic Fibrosis


ENDOCRINE SYSTEM
27. Addisons Disease
28. Diabetes Mellitus
29. Diabetes Insipidus
30. Hypoparathyroidism
31. Pituitary Adenomas
32. Thyroid Disorder
33. Menopause (HRT)
34. Cancer


MUSCULOSKELETAL DISORDERS
35. Gout / Hyperuricaemia
36. Osteoporosis
37. Rheumatoid Arthritis
38. Organ Transplants
39. Systemic Lupus Erythematosus
40. Dystonia
41. Motor Neuron Disease
42. Paget's Disease
43. Myasthenia Gravis
44. Sjogren's Disease
45. Para/Quadraplegia
46. Ankylosing Spondylitis
47. Multiple Sclerosis


EAR, NOSE AND THROAT
48. Allergic Rhinitis


GASTRO INTESTINAL TRACT
49. Peptic Ulcers
50. Gastro-oesophageal Reflux Disorder (GORD)
51. Inflammatory Bowel Disease (Crohn's Disease / Ulcerative Colitis)
52. Pancreatic Disease
53. Post Bowel Surgery


DERMATOLOGICAL CONDITIONS
54. Psoriasis
55. Pemiphigus
56. Scleroderma
57. Dermatomyocitis


EYE
58. Dry Eye Syndrome
59. Glaucoma


GENITO-URINARY DISORDERS
60. Chronic Renal Failure
61. Chronic Urinary Tract Infection
62. Benign Prostate Hypertrophy

DRG Coding Companies in Chennai

INPATIENT (DRG) CODING COMPANIES IN CHENNAI

1.     Dell                                               -           Ambattur

           Webesit: www.dell.com/services

2. Ajuba                                           -           Taramani

     Website: www.ajubanet.net

3. E4E                                              -           Kovilambakkam

   Website: www.e4e.com

DRG Coding Companies in Hyderabad

INPATIENT (DRG) CODING COMPANIES IN HYDERABAD

1.Genpact                                 -           Uppal

      Webesit: www.genpact.com

2.Apollo Health Street          -           Jubilihills

Website: www.apollohealthstreet.com

3. Niha                                       -           Ameerpet

Website: www.niha.net

4.Onemed Space                     -           Habsiguda

Website: www.onemedspace.com

5.Omega                                   -           Banjarahills, Visakhapatnam

Website: www.omega-hits.com

Inpatient (DRG) coding Jobs

INPATIENT (DRG) CODING JOBS IN INDIA

1.GLOBAL SEARCH SERVICES

Exp: 2-5Yrs

Position: Quality Assurance/ Quality Control Executive

Salary: As per company norms

Qualification: Graduation or PG

Recruiter Name: Anshuman Das

Contact Company:  Careernet Technologies Pvt Ltd

Address: Trichy, Tamilnadu

Email Address: kshitij.kumar@careernet.co.in

Telephone: 91-

Reference Id:

Website: