Wiki Procedures similar to TAVR (0256T)

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crhunt78

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We have a new provider who is going to be performing the TAVR procedure and we are trying to find procedures that are similiar to the category III CPT codes 0256T and 0257T. If anyone can help lead me in the right direction in order to find CPT codes that are somewhat similar to these procedures, I would really appreciate it. Does anyone know what Medicare pays for these procedures?
 
Hi Chrissy,

You're about to get more info than you asked for. LOL! We priced these similar to 33405 as well but I can tell you that our Medicare provider (WPS) said they are reimbursing 0256T at 130% of allowable for 92986. We were part of the Partner trial so we've been doing this procedure for awhile but I can tell you that as soon as the transfemoral approach (0256T) received FDA-approval on 11/3/11, we've had alot of trouble getting paid for these.

I hope to get this all straightened out soon but as of right now, we have not been paid, they keep denying for multiple physicians not allowed although the MFSDB clearly states you can bill for co-surgeons or assistants. CMS did release a NCD about this procedure so it should be reimbursed.

There are alot of hoops to jump through (it seems) to get these paid and you may want to contact me directly if you have questions. I can tell you that the documentation should be clear that the patient is "inoperable" (and the provider should use this verbiage) and all of the co-morbidities should be documented as well. Our Medicare provider told us all claims should have modifier -Q0 attached and a 2nd dx code of V70.7 regardless of whether they are in a clinical trial, the reason being that all of these cases are being reported to a registry, so you may want to check with your Medicare provider directly.

Can you tell that I've had to deal with this alot lately?? LOL.

Lisi, CPC
eharkler@nmh.org
 
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