Coding and reimbursement are highly specialized and extremely complex topics. This report provides an overview of coding and reimbursement for procedures performed to diagnose and treat lower limb arterial occlusive disease, which we term peripheral arterial disease (PAD).

 

PAD is also known as peripheral vascular disease (PVD) or peripheral arterial occlusive disease (PAOD).

 

In addition to providing an understanding of the general concepts and principles involved, the discussion and analysis demonstrates the relationship between ICD-9 codes and the various inpatient and outpatient reimbursement systems.

 

The report should assist new entrants into the PAD diagnostic and device markets with product analysis and planning.  The analysis should also be useful to executives of companies already positioned in other cardiovascular market segments contemplating entry into the PAD diagnostic and treatment markets.

 

ICD-9 diagnostic and procedure codes are required for reimbursement. The report identifies and describes all diagnostic and procedure codes that are commonly employed to designate peripheral arterial disease. Case examples, demonstrating the use of ICD-9 diagnostic and procedure codes for treatment of PAD are included.

 

Medicare employs two different reimbursement systems for hospital inpatient and outpatient procedures. Inpatient hospital service reimbursement is based on diagnosis related groups (DRGs) while outpatient services are reimbursed based on Ambulatory Payment Classification (APC) groups.

 

For fiscal 2008 the DRG system underwent major modifications to account for severity of illness. The new MS-DRGs for reimbursement of diagnostic, endovascular and surgical procedures PAD procedures are described in detail together with the qualifying conditions known as Major Complications and Comorbidities (MCC) and Complications and Comorbidities (CC). Examples of procedures and related codes are included.

 

Outpatient reimbursement also underwent major modifications in fiscal 2008. In addition to describing the new APC codes for diagnosing and treating PAD, these modifications are discussed and analyzed.

 

Hospital inpatient and outpatient codes and reimbursement rates are compared for several PAD revascularization and diagnostic procedures. These include angioplasty, atherectomy, stenting, thrombectomy, angiography and IVUS.

 

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Contact witherspoon@thesagegroup.us