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Guidelines for reporting CRT-D pacemaker implantation

Briefings on Coding Compliance Strategies, January 1, 2009

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Be aware of new Coding Clinic advice

Cardiac resynchronization therapy defibrillator (CRT-D) implantation is a technology that prolongs and improves quality of life, exercise capacity, and functional status of heart failure patients with a prolonged QRS interval resistant to optimal therapy.

But it’s also an expensive technology, costing approximately $24,000–$30,000 per device, plus more for hospital time and personnel.

Guidance in late 2008 from the American Hospital Association’s (AHA) Coding Clinic changed aspects of inpatient coding and reimbursement for CRT-D under MS-DRGs.

Previously, coders could use ICD-9-CM procedure code 88.52 (angiocardiography of right heart structures) to denote an angiography of the coronary sinus usually performed to place the left ventricular lead. Now, they must use code 88.63, phlebography of other intrathoracic veins using contrast material.

As a result, many hospitals could lose $10,000–$14,000 of MS-DRG reimbursement per inpatient case admitted with heart failure or myocardial infarction and $7,000–$9,000 for those admitted with other cardiac diagnoses, says James S. Kennedy, MD, CCS, director at FTI Healthcare in Atlanta.

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