Health Information Management

Q&A: Does CMS have a code for new wireless heart sensors?

APCs Insider, January 23, 2015

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Q: Our physicians want us to purchase a new wireless sensor to monitor pulmonary artery pressure and heart rate. This sensor is expensive and we need to know if there is a HCPCS code to report this item. Our finance department is hesitant to make the purchase, although the physicians say the monitor is great for patient care.
A: Under Section 1833(t)(6)(B)(ii)(IV) of the Social Security Act, CMS is required to create a new device category for transitional pass-through payment for any new medical devices that are not described by existing or previously existing categories of devices. 
There is a new sensor that is designed to be implanted into the pulmonary artery to monitor the pressure in the patient’s pulmonary artery and also his or her heart rate. The sensor is permanently implanted and designed to allow transmission of data through a bedside electronic unit. Clinical studies have shown that this is an effective way to monitor the status of a patient’s heart failure so clinicians can intervene more quickly when problems arise. 
Per Transmittal 3156, CMS has created HCPCS Level II code C2624 (implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components). This code is assigned pass-through status as of January 1, 2015, and is assigned to APC 2624. This code must be reported with C9741 (right heart catheterization with implantation of wireless pressure sensor in the pulmonary artery, including any type of measurement, angiography, imaging supervision, interpretation and report).
CMS is also required to create a device offset to reflect the portion of the APC payment determined to be related to the cost of the device. The creation of the device offset is required under Section 1833 (t)(6)(D)(ii) of the Act. For 2015, the device offset for C2624 is $310.33. This will be deducted from the APC payment for APC 0080 (diagnostic cardiac catheterization). 
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Florida, answered this question.

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