coding & reimbursement simplified
Monthly educational webinars offered on billing and coding for Inari Thrombectomy Procedures
*Intended for invited customers of Inari Medical
Market Access & Reimbursement
HOW CAN WE HELP?
Inari’s dedicated team of Area Reimbursement Managers are ready to answer all of your coding and billing questions. Here’s a few ways we can partner with you:
Educate and train on the current reimbursement landscape for the Inari Mechanical Thrombectomy procedures
Discuss relevant medical documentation, coding, payment and coverage trends
Perform regular coding and billing reviews with your providers and hospitals to ensure appropriate medical documentation, coding and reimbursement
Single point of contact for all of your coding and billing needs
frequently asked questions
What is the Medicare 2-Midnight Stay Rule?
Based on the Medicare 2-Midnight Stay Rule, there is a requirement that hospital inpatient stays must be greater than or equal to 2 midnight stays in order to be eligible for Medicare inpatient reimbursement. A physician order to admit the patient is required, based on clinical necessity and documentation. If the patient stays less than two midnights and is discharged same day or next day, in most cases, this is considered a hospital outpatient stay
Which HCPCS Code should I utilize for the FlowTriever® System when loading into our Chargemaster?
There are no specific HCPCS codes that describes the FlowTriever® System, but C1757 is a generic C-code for thrombectomy catheters.
The FlowTriever® System is based on one Price Per Procedure (PPP) for the entire system (FT-PPP), and includes all individual components, regardless of what is utilized in each patient case.
Adding products to the Chargemaster can vary depending on your facility’s purchase price, standard device mark-ups, revenue code choice and billing/charging protocols.
When adding the FlowTriever System to the Chargemaster, we have seen facilities create a dummy code “FT-PPP” (FlowTriever® Price Per Procedure) charge for the cost of the entire system, whether you use one component of the FlowTriever or multiple components of the FlowTriever® in each case, while including each individual component at a no charge.
Always consult your local billing/charging requirements, but in addition to creating a custom code such as “FT-PPP” to capture the cost of the system, additional potential solutions may include:
- Scanning “FT-PPP” bar code
- Revenue code
- Purchasing department product/charge sticker
- CPT® code for mechanical thrombectomy
Should you have any further questions in regards to setting up your Chargemaster, please reach out to the Inari Reimbursement Team at: firstname.lastname@example.org.
Does my provider need to state “Extirpation of Matter” when dictating for the Inari Mechanical Thrombectomy procedures?
The definition for the root operation Extirpation is “taking or cutting out solid matter from a body part.”
While it is not necessary for a physician to say the term “extirpation” when describing a thrombectomy, it accurately describes the root operation for the inpatient procedure performed. Hospital inpatient coders use the definition of the root operation as well as the dictation and procedure documentation to determine that a thrombectomy is a type of extirpation, and that you are “removing” or “taking out” clot or thrombus from the respective body part.
Which CPT Code should I utilize when coding for a Clot in Transit (CIT) in the Right Atrium using FlowTriever®?
The current guidance is to utilize the unlisted CPT® Code 33999 (unlisted procedure, cardiac surgery) when coding for the Physician Professional Services. When submitting an unlisted procedure code, a concise description of the procedure must be included in Item 19 of the CMS-1500 paper form or the electronic media claim (EMC) form. Choose a comparison code that is similar to the unlisted procedure performed. This code should represent surgery on the same body area. A copy of the operative report should be submitted, along with supporting information outlining the decision-making process and the medical rationale for performing the procedure.
There is established ICD-10 PCS Procedure Coding for extirpation of matter from the right atrium, along with associated MS-DRG assignment, for the hospital.
Which HCPCS or CPT code should I utilize for the FlowStasis® Suture Retention Device?
For most vascular procedures, physician & facility payment for closure devices are packaged into the primary procedure performed (i.e.: no separate, line-item payment). To capture cost resource utilization during a procedure (especially outpatient), this Level II HCPCS code may be used for FlowStasis:
- G0269 = Placement of occlusive device into either a venous or arterial access site, post-surgical or interventional procedure (e.g., Angioseal plug, vascular plug).
Disclaimer: The coding and payment information contained is publicly available from third party sources, and Inari Medical is providing it for general informational purposes only. The procedure codes are not an all-inclusive list, and it is not intended, and does not constitute legal, reimbursement, or business advice. The information is not a promise or guarantee by Inari Medical regarding actual payment rates that providers will receive for any given service. Similarly, all CPT®, ICD-10 and HCPCS codes are supplied for informational purposes only and represent no statement or guarantee by Inari Medical that these codes are appropriate to specific circumstances or products or services provided to an individual patient or that the services will be covered. It is the health care provider’s responsibility to accurately report the patient diagnosis, the services provided, and the procedures performed, consistent with the payer’s guidelines. Likewise, site of service decisions (e.g., inpatient or outpatient) are based on medical necessity and should be determined by the physician in consultation with the patient and consistent with any payer guidelines or licensing provisions. If providers have questions about coverage, coding, or payment, providers should consult the specific payers. The Centers for Medicare and Medicaid Services (CMS) website is available at https://www.cms.gov/Medicare/Medicare.html. Reimbursement is dynamic – payment rates change. New codes are added, and existing codes may be revised. Coverage policies also change. The information contained in this document is current as of the date of publication. CPT® Copyright 2021 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.
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