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
Does an Inari Mechanical Thrombectomy procedure have a HCPCS (Level II) or C-Code?
Inari utilizes established Coding (CPT, ICD-10 PCS, ICD-10 CM) for our arterial and venous mechanical thrombectomy procedures.
An Inari FlowTriever® or ClotTriever® procedure is typically performed as a hospital inpatient procedure and reporting of a HCPCS or C-Code for billing purposes is not required, as is typical with “outpatient” services. Device reimbursement is included as part of the DRG payment.
If an Inari procedure is performed as an outpatient procedure, C1757 (thrombectomy catheter) and C1894 (sheath) can be used to account for the device, in addition to the respective CPT Code for the thrombectomy procedure (i.e.: CPT Code 37184/37185 for an arterial mechanical thrombectomy or CPT Code 37187 for a venous mechanical thrombectomy). However, there is no additional payment for C1757 and C1894, as they are included within the overall Medicare Comprehensive APC payment for the thrombectomy procedure.
As for entering FlowTriever into the chargemaster, we have seen facilities create a “FT-PPP” (FlowTriever Price Per Procedure) charge for the cost of the FlowTriever, whether you use one component of the FlowTriever or multiple components of the FlowTriever.
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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