CPT and ICD Coding for Transcatheter Aortic Valve Replacement (TAVR)

Hey all, this is Loralee Kapp, the Solutions Manager with Managed Outsourced Solutions. Today, I want to talk to you about cardiac surgery coding for Transcatheter Aortic Valve Replacement (TAVR) and for a full list of CPT and ICD 10 codes associated with this podcast, please see the attached document.

00:17 What is Transcatheter Aortic Valve Replacement (TAVR)

Transcatheter Aortic Valve Replacement (TAVR) (also called Transcatheter Aortic Valve Implantation (TAVI) is a procedure which involves replacement of a thickened and narrowed aortic valve of the heart through the blood vessels. Located between the left lower heart chamber, also known as the left ventricle and the body’s main artery (aorta), the aortic valve regulates the blood flow from the heart to the body. If the aortic valve doesn’t open correctly, blood flow from the heart to the body gets reduced. Billing and coding for this cardiac condition can be challenging. Outsourcing these tasks to a reputable cardiology medical coding company is a great option for cardiologists to document TAVR as well as other treatment options and get reimbursed on-time.

01:03 TAVR Procedure – How Is It Performed and What Does it Involve?

TAVR is generally an option for people who have aortic stenosis (that causes signs and symptoms), have an intermediate or high risk of complications from surgical aortic valve replacement, have an existing biological tissue valve (but it isn’t working well anymore) and those who can’t undergo open-heart surgery. Potential risks for TAVR may include – blood vessel complications, problems with the replacement valve (such as the valve slipping out of place or leaking), severe bleeding and infections, stroke, heart rhythm problems (arrhythmias) or even death.

There are two different types of approaches – Transfemoral approach and Transapical approach. Transfemoral approach does not require a surgical incision in the chest and therefore involves entering through the femoral artery (the large artery in the groin). Transapical approach, on the other hand, is a minimally-surgical procedure wherein small incisions are made in the chest area. The incisions are made through a large artery in the chest or through the tip of the left ventricle (the apex). Physicians in certain cases may use other approaches to access the heart. Imaging techniques may be used to guide the catheter through the blood vessel, to the heart and into the aortic valve. Upon positioning the new valve, a balloon is inflated on to the catheter’s flip (to expand the replacement valve in the correct position) and the catheter is removed. The procedure can cause infections (from bacteria in the mouth), therefore it is extremely important to maintain adequate dental and personal hygiene.

02:45 Medicare Coverage for TAVR

Transcatheter Aortic Valve Replacement (TAVR) is covered for the treatment of symptomatic aortic valve stenosis. CMS offers coverage for TAVR under Coverage with Evidence Development. In 2012, CMS released a National Coverage Determination (NCD) that provides details of the qualification of the physicians who perform TAVR and the patients who benefit from the procedure. Below listed are the top coverage criterions specified in the National Coverage Determination (NCD) –

• The procedure is furnished with a complete aortic valve and implantation system that has received FDA premarket approval (PMA) for that system’s and FDA-approved indication.
• All TAVR cases must be enrolled in the national transcatheter valve therapy (TVT) registry and
• The patient who is planning to undergo the TAVR must be under the care of a multi-disciplinary team of cardiologists both preoperatively and postoperatively.
• Both a cardiac surgeon and the interventional cardiologist must independently examine the patient face-to-face and evaluate the patient’s suitability for surgical aortic valve replacement.
• IVR cardiologists and cardiac surgeons must jointly participate in the intra-operative technical aspects of the TAVR.
• Hospitals must perform at least 50 TAVRs and more than 300 percutaneous coronary interventions per year

04:15 Applicable Medical Codes for TAVR

Billing and coding for cardiac procedures involves the use of procedure codes and diagnosis codes on the medical claims submitted to the health insurers for reimbursement. Relying on the services of a professional and reputable medical coding company that is well-versed in the changing coding guidelines for the cardiology specialty can help in on-time reimbursement.

In general, transcatheter aortic valve replacement (TAVR) may provide relief to the symptoms of aortic valve stenosis. However, adopting a healthy lifestyle like – regular exercise, quitting the habit of smoking, making healthy diet choices, controlling stress and maintaining a healthy body weight can help prevent the reoccurrence of cardiac disorders in the long run. As mentioned above, cardiology medical billing and coding can be challenging. IVR cardiologists and cardiac surgeons and other specialists performing a TAVR procedure can consider the support of a reputable physician billing company to report their services accurately on the medical claims.