2018 PHYSICIAN CODING GUIDE ENB PROCEDURE
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1 2018 PHYSICIAN CODING GUIDE ENB PROCEDURE The following coding scenarios are intended for illustrative purposes only and do not reflect every ENB coding scenario available, therefore, reimbursement will vary depending on services rendered and billed for. Providers may choose to perform multiple procedures on the same date of service and packaging and multiple endoscopy rules are applied based on the procedures performed. Providers should report all procedures performed. Please consult your facilities internal coding and compliance guidelines. Scenario 1 Physician Coding Bronchoscopy Biopsy Using the superdimension TM Navigation System guidance, when performed; with computer-assisted, imageguided navigation (List separately in addition to code for primary procedure[s]) * 2018
2 Scenario 2 Physician Coding Bronchoscopy Biopsy Using the superdimension TM Navigation System and Placement of Fiducial or Dye Markers PLACEMENT OF FIDUCIAL OR DYE MARKERS guidance, when performed; with placement of fiducial markers, single or multiple guidance, when performed; with computer-assisted, image-guided navigation (List separately in addition to code for primary procedure[s]) * $ $
3 Scenario 3 Physician Coding Bronchoscopy Biopsy Using the superdimension TM Navigation System and Percutaneous Biopsy BIOPSY * Biopsy, lung or mediastinum, percutaneous needle $ $47.16 guidance, when performed; with computer-assisted, image-guided navigation (List separately in addition to code for primary procedure[s]) 2018 Other Codes that May be Used Contouring Code Thoracic stereotactic body radiation therapy (SRS/SBRT) is a distinct procedure which may involve collaboration between a surgeon and radiation oncologist. The surgeon identifies and delineates the target for therapy. The radiation oncologist reports the appropriate code(s) for clinical treatment planning, physics and dosimetry, treatment delivery and management from the Radiation Oncology section (see 77295, 77331, 77370,77373, 77435). The same physician should not report target delineation services with radiation treatment management codes ( ). The surgeon and radiation oncologist work together to perform this procedure which involves radiation treatment targeted to a malignant tumor. The provider may also place fiducial markers to ensure that radiation is delivered correctly to the targeted site. Fiducial markers are gold seeds that are implanted in or around the point of surgery which help to identify the exact target point of radiation therapy. Report placement of fiducial markers separately with or Thoracic target(s) delineation for stereotactic body radiation therapy (SRS/SBRT), (photon or particle beam), entire course of treatment * $ Notes: Do not report in conjunction with For placement of fiducial markers, see 31626, 32553
4 EBUS In some cases, ENB may be performed with EBUS. When this occurs the hospital payment is subject to comprehensive APCs and no additional payment is made to the facility. The physician payment is subject to the multiple procedure reduction and endoscopy rule. The information below dose not take into account any reduction in payment. For specific questions related to payment for ENB and EBUS performed at the same surgical encounter, please contact your field reimbursement manager Bronchoscopy with EBUS guided transcheal and/or transbronchial sampling, one or more mediastinal and/or lymph node stations or structures Bronchoscopy with EBUS guided transtracheal and/or transbronchial sampling, three or more mediastinal and/or lymph node stations or structures Bronchoscopy with transedoscopic EBUS during bronchoscopy diagnostic or therapeutic intervention for peripheral lesions. (List separately in addition to code for primary procedure[s]) * $ $ $ CoreCath 2.7S Electrosurgical Device RF ablation and hemostasis of soft tissue obstructions in upper airways and tracheobronchial tree guidance, when performed; with destruction of tumor or relief of stenosis by any method other than excision (eg, laser therapy, cryotherapy) * $ Multiple Lobes guidance, when performed; with transbronchial lung biopsy(s), each additional lobe (List separately in addition to code for primary procedure) guidance, when performed; with transbronchial needle aspiration biopsy(s), each additional lobe (List separately in addition to code for primary procedure) * $ $ Notes: * The Work RVU reflects the relative time and intensity associated with furnishing a Medicare PFS service. When multiple endoscopic procedures are performed, Medicare applies multiple endoscopy adjustments to the Medicare Physician Fee Schedule amount, not RVU values. The work RVUs in this billing guide do not take into account any multiple procedure reduction or the multiple endoscopy rule. Payment Indicator Definitions: **MPPI Multiple Procedure Payment Indicator 0: No payment adjustment rules apply. If the procedure is reported on the same day as another procedure, the procedure is paid at the lower of the actual charge or the fee schedule amount for the procedure 2: Standard payment rules apply. If the procedure is reported on the same day as another procedure with a numeric designation of 2 or 3, rank each procedure by the fee schedule amount and take the appropriate reduction: Highest valued procedure: 100%, Second, third, fourth, and fifth valued procedures: 50% Each procedure beyond the fifth: By report 3: Special rules for multiple endoscopic procedures apply when the procedure is performed with another endoscopic procedure in the same family.
5 REFERENCES: Physician Coding: RVU17A ( ) File. 2. All Medicare Physician Fee Schedules calculated using CF $ effective January 1, December 31, The new CF is reflected in the January PFS update available at: 3. Subject to multiple endoscopy rule. Highest value paid at 100%. Subsequent procedures are paid at allowable rate minus the base rate for (2018 facility RVU is 3.79). 4. CPT is only billed when fiducial markers (e.g., gold or dye) are placed. Although more than one marker may be used, CPT is not reported for each marker placed (AMA CPT Assistant, Feb 2010:6). 5. CPT code includes 3D reconstruction. Do not report in conjunction with and Use in conjunction with 31615, , , 31635, 31636, CPT code is an add on code and not subject to multiple procedure discount. This information is from materials published by the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA). This information is for educational purposes only. It is not intended as reimbursement advice, guarantee of coverage or to increase or maximize reimbursement by any payer. Medtronic makes no other representations as to selecting codes for procedures or compliance with any other billing protocols. Providers are responsible for exercising their independent clinical judgment in selecting the codes that most accurately reflect the patient s condition and procedures performed. Providers should refer to current and authoritative publications such as AMA coding resources when selecting billing codes. Providers may wish to contact individual carriers, fiscal intermediaries, or other third-party payers as needed. In all cases, services must be medically necessary, actually performed and appropriately documented. *CPT copyright 2018 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. Rx only. Refer to product instruction manual/package insert for instructions, warnings, precautions and contraindications. For further information consult Medtronic.com Medtronic. All rights reserved. Medtronic, Medtronic logo, and Further, Together are trademarks of Medtronic.TM* Third party brands are trademarks of their respective owners. All other brands are trademarks of a Medtronic company. Medtronic 161 Cheshire Lane Plymouth, MN USA Tel: (763) Fax: (866) medtronic.com DMK00857 Rev B
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