Wiki TAVR & DRG

[petroskek]

I have a provider who just started performing TAVRs and the hospital is questioning the provider, who is now questioning me.

Under procedures performed, the doctor is listing:
1: Left Heart cath
2: Temporary Transvenous pacemaker insertion
3: Transcatheter Aortic Valve Implantation with a 26 mm Edwards Sapien 3 Bioprosthetic
4: Rt Femoral Angiography
5: Perclose deployment x 2 in RFA

Per the documentation, he is using a percutaneous femoral artery approach, and of course he is a co-surgeon with another provider.
I am billing 33361,62,Q0 with I35.0, Z06

I have looked at what the hospital is billing and since I don't understand PCS & DRG, I was hoping someone might help me.
For all the principal procedures, they are billing 02RF38Z. For some of the procedures, they are using DRG 266 and others they are using DRG 267.

I bill for the physician, the hospital has coders/billers who bill for the facility. I guess my question is... is my code correct and is there anything that I am doing that is effecting the DRG that the hospital uses?

I know this sounds really dumb, but I am new to CV surgeries, and very new to the world of inpatient billing.

 

[mk2001]

You are coding it correct as long as Z06 was a typo & you meant Z00.6. Like you, I bill for the physicians but from what I can tell it looks like the difference in the 2 they are using is one is TAVR w/MCC & the other is TAVR w/o MCC.

 

[Kara Smith]

I agree that you are coding it correctly for the professional side (as long as you use diagnosis Z00.6). Are you using the clinical trial number as well? I bill TAVR procedures frequently and I was taught that I always have to use the clinical trial number 01737528 since you have the Q0 modifier. Also, the procedure always has to be an inpatient procedure. Just a tip, I always attach both surgeons' op notes to the claim to back up the 62 modifier, but I happen to bill for the cardiologist and the CV surgeon where I work.

 

[TBRITTAIN]

I have a provider who just started performing TAVRs and the hospital is questioning the provider, who is now questioning me.

Under procedures performed, the doctor is listing:
1: Left Heart cath
2: Temporary Transvenous pacemaker insertion
3: Transcatheter Aortic Valve Implantation with a 26 mm Edwards Sapien 3 Bioprosthetic
4: Rt Femoral Angiography
5: Perclose deployment x 2 in RFA

Per the documentation, he is using a percutaneous femoral artery approach, and of course he is a co-surgeon with another provider.
I am billing 33361,62,Q0 with I35.0, Z06

I have looked at what the hospital is billing and since I don't understand PCS & DRG, I was hoping someone might help me.
For all the principal procedures, they are billing 02RF38Z. For some of the procedures, they are using DRG 266 and others they are using DRG 267.

I bill for the physician, the hospital has coders/billers who bill for the facility. I guess my question is... is my code correct and is there anything that I am doing that is effecting the DRG that the hospital uses?

I know this sounds really dumb, but I am new to CV surgeries, and very new to the world of inpatient billing.

You've almost got it ! For the TF approach, use the 33361-Q0, 62 and include the Clinical Trial # 01737528 in your billing. There is a particular spot in one of the ailment screens in my Intergy to put this CT # so you'll just have to determine where in your billing system it should go so that it transmits on your claim. For your diagnoses, use your I35.0 (or other AS code) + Z00.6. Works like a charm ! All those separate procedures you mention above are all included in the CPT for the TAVR.

 

[empalagiglass]

Hello,
I have a TAVR denial from Medicare, I coded 33361, 62, q0 with I35.0. Does it require Z00.6 for them to pay? I had submitted one to BCBS without Z00.6 and they did process and pay. OF course, I know different insurances but need some guidance. We are new to performing TAVRs at my clinic.

TIA

 

[mk2001]

Hello,
I have a TAVR denial from Medicare, I coded 33361, 62, q0 with I35.0. Does it require Z00.6 for them to pay? I had submitted one to BCBS without Z00.6 and they did process and pay. OF course, I know different insurances but need some guidance. We are new to performing TAVRs at my clinic.

TIA

We have to attach Z00.6 on all our Medicare TAVR charges.

 

[carelitz]

We have to attach Z00.6 on all our Medicare TAVR charges.

Same. Along with some other necessary info attached to the claim.



I just started posting TAVRs as well and here are some things i learned:

• DX must be I35.0 and Z00.6
• Must be POS 21
• Must have modifier 62 and Q0
• Must have the clinical trial number attached to the claim: 01737528
• 33361 has 0 global days
• Left heart cath and supervavular aortogram should not be billed with TAVR as they are included and necessary for the placement of the valve

We got paid $673.90 by Medicare Part B primary and $165 from BCBS secondary. YMMV