2017 Medical Coding Guidelines for Vascular Surgeons

1
www.outsourcestrategies.com
2

• Vascular surgeons perform a comprehensive range
  of procedures and the adoption of new
  endovascular techniques has led to reduced
  hospital stays. Under Medicares value-based
  program, health care providers are rewarded with
  incentive payments for the quality of care rather
  than the quantum of services provided.
  Outsourcing medical coding to a company that has
  certified coders with expertise in CPT, HCPCS and
  ICD-10 coding is crucial to ensure appropriate
  reimbursement.

www.outsourcestrategies.com
3
Comprehensive Ambulatory Payment Classifications
(C-APCs)

• APCs are an outpatient prospective payment
  system applicable only to hospitals
• C-APCs are package payments for services and
  supplies
• The goal of C-APCs is to pay providers for
  quality, rather than the quantity of
  services provided
• Many coronary and endovascular procedures
  qualify for Comprehensive Ambulatory Payment
  Classifications (C-APCs)
• Under the policy, a HCPCS code is assigned as a
  primary service allotted to a C-APC
• Providers are reimbursed for all other items and
  services reported on the claim as being
  integral, ancillary, supportive, depending, and
  adjunct to the primary service

www.outsourcestrategies.com
4
VASCX Clinical Family Changes and Complexity
Adjustments in 2017

• In 2017, CMS adds 25 new C-APCs, though the
  C-APC policies established in CY 2015 remain
  unchanged
• The number of clinical families has been
  increased from 14 to 21
• With diagnostic catheters and angiographies
  newly classified as a C-APC, the PCI
  vascular family has expanded from three C-APC
  levels to four
• Complexity criteria are applied for multiple
  procedure combinations performed on the same
  date of service to permit mapping to a higher APC
  within that clinical family of procedures
• Code combinations are pairs of HCPCS
• C-APC 5194 Level 4 Endovascular Procedures is
  the highest level of payment for the
  vascular family

www.outsourcestrategies.com
5
CY2017 VASCX C-APCs Changes
2017 C-APC Primary procedure description HCPCS Codes for Primary Procedure
5191 (formerly 5188) Level 1 Endovascular Procedure 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93530, 93531, 93532, 93533
5192 (formerly 5191) Level 2 Endovascular Procedures 0338T, 0339T, 36902, 36904, 37183, 37220, 37224, 37246, 37248, 92920, 92986
www.outsourcestrategies.com
6
CY2017 VASCX C-APCs Changes
2017 C-APC Primary procedure description HCPCS Codes for Primary Procedure
5193 (formerly 5192)) Level 3 Endovascular Procedures 0234T, 0236T, 0237T, 36903, 36905, 37221, 37225, 37226, 37228, 37236, 37238, 37241, 37242, 37243, 37244, 61623, 61626, 92924, 92928, 92937, 92941, 92943, 92987, 92990, 92997, C6900, C6904
5194 (formerly 5193) Level 4 Endovascular Procedures 0238T, 0387T, 36906, 37227, 37229, 37230, 37231, 92933, 93580, 93581, 93582, 93590, 93591, C9602, C9606, C6907
www.outsourcestrategies.com
7
Maximize Reimbursement with Expert Vascular
Medical Billing and Coding Services

• Services of certified coders with expertise in
  CPT, HCPCS and ICD-10 coding
• Error-free coding in compliance with the latest
  medical codes and individual payer policies
• Efficient revenue cycle management - from
  enrolment and insurance authorization to
  billing, claim submission and collections
• Quick turnaround time

www.outsourcestrategies.com
8
Maximize Reimbursement with Expert Vascular
Medical Billing and Coding Services

• Timely appeals process for denials/incorrect
  claims
• Weekly/monthly reports
• Cost savings of 30-40
• HIPAA-compliant service
• Appropriate reimbursement for coronary and
  endovascular procedures

www.outsourcestrategies.com
9
CONTACT

• Headquarters8596 E. 101st Street, Suite
  HTulsa, OK 74133Main [phone]Fax
  [phone]E-mail info_at_managedoutsource.comU
  RL http//www.outsourcestrategies.com