US Lead Management Coding and Reimbursement Information

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This information was generously provided as a courtesy by Medical Affairs at Spectranetics.

Important Notes
All codes supplied in the guide are for information purposes only and represent no statement or guarantee by LEADconnection.org that these codes will be appropriate or that reimbursement will be made in a particular situation. It is always the provider’s responsibility to determine and submit appropriate codes, charges, and modifiers for services that are rendered.

All coding and reimbursement information is subject to change without notice, and specific payers may have their own coding and reimbursement requirements and policies. Before filing any claims, providers should verify current requirements and policies with the payer. It is always the provider’s responsibility to determine and submit appropriate codes, charges, and modifiers for services that are rendered. All admissions must be medically necessary. It is the provider’s sole responsibility to determine whether a patient satisfies the criteria for admission for inpatient care and/or vascular intervention therapies.
− ICD-9 code descriptors presented in the document represent examples of conditions/procedures that may be reported with the noted codes, and do not represent an exhaustive list of all possible conditions/procedures. Medical record documentation must support coding practices.
− It is recommended that providers reference and stay current with NCCI coding manual narratives and edits.
− Listed Medicare payments are unadjusted national rates, and actual rates will vary by locality and provider characteristics. Payments may be subject to multiple procedure discounting.

Sources
− International Classification of Diseases (ICD-9-CM) 2015, Hospital Volumes 1, 2, and 3, 9th Revision-Clinical Modification.
− National physician payment rates were calculated using RVUs and conversion factor published in the CMS 2015 RVU file (35.8228).
− Outpatient Prospective Payment System CY 2015 Final Rule, January 2015 Addendum B Update.
− Inpatient Prospective Payment System FY 2015 Final Rule.
− CPT Copyright 2015 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.