Cardiology Coding Alert
Keep Clinical Trial in Mind for LAAC
Question: We’re researching how to report percutaneous LAAC services. Can you provide any insights on coding?
Michigan Subscriber
Answer: CMS covers percutaneous left atrial appendage closure (LAAC) through Coverage With Evidence Development (CED), meaning in an approved clinical study or with additional clinical data collection. The National Coverage Determination for LAAC describes many other conditions required for coverage, including requirements for the device and the providers involved.
In terms of coding, MLN Matters MM9638 provides instructions for professional claims with dates of service on or after Feb. 8, 2016. The implementation date is Oct. 3, 2016.
CPT®: To report the service, use 0281T (Percutaneous transcatheter closure of the left atrial appendage with implant, including fluoroscopy, transseptal puncture, catheter placement[s], left atrial angiography, left atrial appendage angiography, radiological supervision and interpretation).
Modifier: Append modifier Q0 (Investigational clinical service provided in a clinical research study that is in an approved clinical research study) to 0281T.
ICD-10-CM: The patient must have non-valvular atrial fibrillation (NVAF) to support the service, so choose one of the following primary diagnosis codes, based on the documentation:
Add secondary diagnosis code Z00.6 (Encounter for examination for normal comparison and control in clinical research program). A note with the code lets you know it’s appropriate for “Examination of participant or control in clinical research program.”
POS: Use place of service code 21 for inpatient hospital.
Trial number: Put the clinical trial number in item 23 of the CMS-1500 form (or electronic equivalent).
Resource: Check out Medicare guidance available at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9638.pdf.
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