Wiki TAVR converted to open heart

[dvance4210]

Can anyone clarify that if a TAVR converts to an open heart what can be billed. I was under the understanding that once it is converted that the open heart is only billed. Can the TAVR be billed as well? I was given this info from a Medtronic rep. Could someone clarify.

Thanks,
DVance, CPC, CCVTC

 

[cpc2007]

I would report only the successful open valve in this scenario for professional coding (for the physician). The NCCI Policy Manual, Chapter 5 which covers codes in the cardiovascular/lymphatic sections of CPT states "If a failed percutaneous vascular procedure is followed by an open procedure by the same physician at the same patient encounter (e.g., percutaneous transluminal angioplasty, thrombectomy, embolectomy, etc. followed by a similar open procedure such as thromboendarterectomy), only the HCPCS/CPT code for the completed procedure which is usually the more extensive open procedure may be reported." In the NCCI Policy Manual, Chapter 1 (general correct coding principles), the guidelines cover this topic more broadly and state that any procedure that begins with one approach and converts to another should be coded only with the successful approach: "If a procedure using one approach fails and is converted to a procedure using a different approach, only the completed procedure may be reported. For example, if a laparoscopic hysterectomy is converted to an open hysterectomy, only the open hysterectomy procedure code may be reported."

Based on those guidelines, I would report only the open surgical replacement. If you are billing for the hospital by chance, the hospital should be able to bill supplies during the attempted TAVR (including the TAVR valve if deployed unsuccessfully).

I hope that helps.
Kim
www.codingmastery.com

 

[fwnewbie]

I'm glad you added the part about coding for the facility. How do you capture the use of the scope or do most facilities have that on their Charge Master list?