By: Carrie Pfeifle, BS, RHIT | Coding Audit Manager @ MRA
Transcatheter Aortic Valve Replacement (TAVR) is also known as Transcatheter Aortic Valve Implantation (TAVI). Medicare officially refers to this as TAVR/TAVI, but either single acronym is correct. TAVR is a transcatheter surgical procedure in which an aortic valve replacement is performed without removing the damaged native valve. In simple terms, it is similar to stent placement in that a fully collapsible valve is inserted through a catheter followed by the use of an angioplasty balloon to expand and seat the new valve. Once the new valve is seated, it pushes the old valve leaflets out of the way and the new valve takes control of the blood flow.
MEDICARE APPROVED TAVR FACILITIES
TAVR is covered for the treatment of symptomatic aortic valve stenosis. However it is only covered when provided under a specific clinical trial in a hospital that has been pre-certified as a Medicare Approved TAVR/TAVI Facility.
TAVR PROCEDURE CHARGES
The clinical staff selection of the correct TAVR charge is a critical element in the hospitals’ documentation and reimbursement process. As inpatient procedures, the TAVR/TAVI charges are set up in the Chargemaster as a soft-coded charge, meaning the actual CPT code is not attached to the charge. When necessary, the CPT code will be attached to the charge by the coder. When performed in the Cardiac Catheterization Lab, TAVR is usually reported as a single all-inclusive procedure charge. The charge includes virtually everything required to implant the valve successfully. This includes access, catheter placements, valve deployment, angiography during and after the procedure, arteriotomy closure, balloon valvuloplasty and a temporary pacemaker.
ADDITIONAL TAVR PROCEDURE CHARGES
There are three specific ancillary services that can be charged separately. These separate charges include, moderate sedation and peripheral arterial/venous Cardiopulmonary bypass. Peripheral cardiopulmonary bypass would be charged as either Percutaneous (33367) or Open (33368) bypass support. Although it is highly unlikely, it is possible to report a separate and distinct diagnostic cardiac catheterization and/or coronary angiogram during a TAVR patient encounter. CAUTION: It would be highly unlikely for a patient to undergo a valve replacement without having a prior diagnostic cardiac cath. If the patient has already had a diagnostic cardiac catheterization it is not permitted to charge for a repeated cath during the TAVR.
ICD-10 PCS Procedure Coding for TAVR
All inpatient procedures are reported as ICD-10-PCS codes, which are determined and assigned by the medical coders. The ICD-10-PSC coding is also relatively simple with only two ICD-10-PCS codes to choose from, based on the surgical approach, either Open Artery Exposure or Percutaneous access. There are two main FDA approved suppliers of TAVR valves, Edwards and Medtronic. Both suppliers employ zooplastic tissue in their manufacturing process. Although Medtronic uses porcine (pig) and Edwards uses bovine (cow) both are zooplastic tissues, so the same ICD-10-PCS procedure code is reported for implantation of either brand. Although this is a very complex procedure, the ICD-10-PCS code is simply determined by the fifth digit which designates the procedure by its open or percutaneous arterial approach.
TAVR ICD-10-CM DIAGNOSIS CODING
The principal diagnosis coding for TAVR patients is standard. These patients are all being treated for aortic valve stenosis. I35.0 is normally always coded as principal.
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