Coding Dilemma for Treatment of Atrial Fibrillation
Published on Sat Sep 01, 2001
The use of internal cardioverter defibrillators (ICDs) to treat atrial fibrillation (AF) is relatively new. Medicare has not issued national coverage guidelines on the subject, and local Medicare and private carriers have yet to publish local medical review policies (LMRPs) governing the use of these devices for atrial fibrillation, which until now has been treated using drugs (e.g., anticoagulants and beta-blockers). As a result, coding for AF using ICDs has not yet been clearly defined.
On May 25, 2001, Minneapolis-based Medtronics received approval for its GEM III AT internal cardioverter-defibrillator, which, among its many functions, treats and controls atrial fibrillation. The AT is the second device approved to treat atrial and ventricular arrhythmias. Until May 2001, the Jewel-AF, also manufac-tured by Medtronics, was the only ICD that could treat AF and ventricular fibrillation (VF).
Until now, atrial fibrillation (427.31, irregular, rapid atrial contractions) has not been considered an indication for the implantation of an ICD-device, which is usually associated with ventricular tachycardia (VT) or VF, conditions that affect cardiac output more directly and often require immediate treatment. AF's major potential complication is thrombosis, and it is typically managed pharmacologically (e.g., with anticoagulation drugs). In some cases (for instance, if the patient also has ventricular tachycardia), cardiologists may implant the combined ventricular/atrial arrhythmia ICD. Carriers may cover the AF/VF ICD, even though AF on its own is not yet a recognized diagnosis for ICD implantation. As is often the case with new technologies, coverage and payment decisions for ICDs that control atrial arrhythmias have been left to local carriers, many of whom are likely to pay for the device and its implantation, says Linda Laghab, CPC, a practice coder with Foothill Cardiology and California Heart, a 26-physician practice with offices throughout the Los Angeles area.
"Medicare national coverage policy for ICDs does not address A-fib. I don't expect that there are other local payment policy guidelines out there, because the FDA has just recently approved the device," she says. "Coverage seems to be determined on a carrier-by-carrier basis." This applies both to Medicare and private payers, Laghab says, noting that her first attempt at preauthorization for the implantation of the GEM III AT was with Blue Cross Blue Shield and was successful.
ICD Implantation and Evaluation Coding
The same codes that are used to report the implantation and follow-up evaluation (including reprogram-ming) of any dual-chamber ICD apply to this device as well.
For implantation only, use 33249 (insertion or repositioning of electrode lead[s] for single or dual chamber pacing cardioverter-defibrillator and insertion of pulse generator), says Diane Elvidge, CPC, a coding specialist with Princeton Reimbursement Group in Minneapolis, which runs a Medtronics' reimbursement hotline. If the GEM III AT is replacing a previous ICD, [...]
