CEU Quiz - Shockwave

CEU Quiz Answers and Rationales

1. The supply item HCPCS code of C1761 should be assigned to “all” types of IVL catheters in your current inventory system.

 ▫️ True   ▫️ False

Answer: False

 

Rationale: The HCPCS code C1761 is specific to “catheter, transluminal intravascular lithotripsy, coronary.” This HCPS code should only be associated with the coronary line of catheters and directly correlates to eligibility of the Transitional Pass-Through Payment (TPT). The recommended HCSPS supply code for our peripheral catheters is C1725.

2. The TPT guidelines allow for reimbursement to cover the cost of the IVL catheter only if the device is used as part of specific coronary stenting procedures?

 ▫️ True   ▫️ False

Answer: True

 

Rationale: The TPT guidelines clearly state that the Shockwave IVL catheter needs to be used as mechanism for prepping the vessel prior to coronary stenting. The 6 procedure codes listed as eligible for the TPT payment when billed with C1761 are:

  • CPT code 92928 (Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch)
  • CPT code 92933 (Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch)
  • CPT code 92943 (Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel)
  • CPT code C9600 (Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch)
  • CPT code C9602 (Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch)
  • CPT code C9607 (Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluding intracoronary stent, atherectomy and angioplasty; single vessel)
3. How is the TPT payment calculated.
  1. The charge for the catheter is multiplied by a hospital specific Cost to Charge Ratio (CCR) to determine the payment
  2. For hospitals, the payment is determined by showing invoice cost associated the catheter.
  3. A procedural conversion factor is used to determine final payment.
  4. A hospital is automatically paid for what they charge for the catheter.

Answer: a

 

Rationale: The Transitional Pass-Through (TPT) payment is calculated by a specific formulation. (Charge for C2 catheter C1761) X (Hospital Cost to Charge Ratio (CCR) for Revenue Center 278) It is important for hospitals to identify what their specific CCR is as they set their charges. This information is part of the organization’s Cost Report filed annually with CMS.

4. Which one of the following must occur in order for an Inpatient claim to be eligible for the New Technology Add-On Payment (NTAP)

  1. A drug eluting stent must be used
  2. The appropriate IVL specific ICD-10-PCS code needs to be on the claim.
  3. The is a special modifier that is required on the claim.
  4. The NTAP payment needs to be negotiated with CMS prior to the procedure
Answer: b

 

Rationale: There are 4 IVL specific ICD-10-PCS codes recently established by CMS. When coronary IVL is performed as part of the overall procedure it needs to be recognized on the claim by assignment of one of these new codes. This is the only mechanism associated the activation of the NTAP payment.

 

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5. Which of the following is true regarding coronary IVL specific ICD-10-PCS procedure codes?

  1. They are the principal source for activation of the NTAP payment.
  2. The ICD-10-PCS codes reference the number of coronary vessels treated.
  3. Only one of the IVL specific ICD-10-PCS codes is required on the inpatient claim, along with the associated base procedure codes.
  4. All the above.

Answer: d

Rationale: The principal source of action is ensuring that one of the appropriate IVL specific ICD-10-PCS is on the Inpatient claims. There are no other specific procedure codes associated with activation of the NTAP payment. The ICD-10-PCS codes are based upon the number of vessels treated, therefore; only 1 IVL specific code is required on the claim along with the other codes associated with the base procedure.

6. Which of the following is true regarding the Outpatient procedural HCPCS codes associated with IVL procedures performed in the lower extremities?

  1. The HCPCS codes allow for an indication of use where IVL/Shockwave can be used as a primary procedure without the requirement of being used with a stenting procedure.
  2. The HCPCS codes were assigned by CMS/ Medicare and map to specific APC payments.
  3. The IVL specific HCPCS codes are for hospital outpatient billing only.
  4. All the above

Answer: d

Rationale: There are 8 IVL specific HCPCS associate to IVL procedures performed in the lower extremities on an Outpatient basis. The codes for these HCPCS codes were assigned by CMS for the purpose of billing for IVL procedures performed on an Outpatient basis. These codes have been assigned specific APC assignment for payment. Physicians do not report these codes.

7.Which is the following is/are true regarding Inpatient coding for lower extremity IVL procedures?

  1. The ICD-10-PCS codes utilize the word “fragmentation” to describe the concept of lithotripsy.
  2. There are only 4 ICD-10-PCS codes associated with lower extremity IVL procedures.
  3. The ICD-10-PCS codes associated IVL use in the lower extremities drive additional reimbursement.
  4. All the above.

Answer: a

Rationale: CMS/Medicare uses the term “fragmentation” to describe the mechanism of action associated with lithotripsy technology. There are 17 IVL specific ICD-10-PCS codes associated with IVL utilization in the lower extremities. The DRG assignment is determined by the procedure(s) performed along with associated diagnosis codes and patient acuity.

8. Which of the following is/are true regarding the Category III CPT code +0715T?

  1. It is an “add-on” code, which means it needs to be used in combination with one of several listed base procedure codes.
  2. There are no specific RVU’s assigned to the +0715T code.
  3. The code +0715T should only be used for Inpatient billing
  4. Both a & b

Answer: d

Rationale: CPT code +0715T is considered an “add-on” code, which means it needs to be used with one of the indicated primary procedure codes. Since it is a Category III code, there are no specific RVUs assigned to this code. Consideration of payment is based on the physician’s comparator “cross walk” for an established add-on code that reflects similar physician time, expertise and resources. This new code is primarily associated with physician billing and has no impact on the TPT or NTAP associated with hospital reimbursement.

9. What should I be prepared to submit as supportive material when billing CPT code +0715T?

  1. A copy of the procedural / catheterization report.
  2. A copy of the FDA approval letter associated with the Shockwave IVL catheter.
  3. A CPT “cross walk” comparable to the IVL procedures for consideration of payment.
  4. All the above,

Answer: d

Rationale: In the absence of established RVUs, payers rely on the use of a comparator code to set an RVU rate for codes without established payment. Payers will require supporting documentation to assign payment. It will be important to document the services provided about resources and time for appropriate payment valuation. Physicians should be prepared to submit information to assist in coverage and payment decisions. Recommended items to support your Category III claims submissions include:

  • Copy of operative or procedure report
  • Letter of medical necessity
  • Clinical notes (severity of calcification)
  • Relevant crosswalk CPT code with anticipated payment indicated
  • Copy of relevant published clinical literature or Shockwave Coronary IVL bibliography
  • Copy of the FDA approval letter

10. For hospitals, the reimbursement impact of the new CPT code +0715T is?

  1. There is no overall impact, hospitals and ASCs still receive reimbursement based on the TPT and NTAP.
  2. Hospitals get paid extra since +0715T is an “add-on” code
  3. Currently the drug eluting stent codes, such as C9600, are not listed as applicable base procedure codes to use with CPT code +0715T
  4. Both a & c

Answer: d

Rationale: The current CPT code +0715T is primarily for physician reporting of the use of IVL in coronary procedures. Currently the drug eluting stent (DES) codes are not recognized as applicable base procedure codes associated with the use of CPT code +0715T. Regardless of reporting requirement, hospitals and ASCs will continue to get reimbursed from Medicare based upon the TPT and NTAP programs.