Carotid Artery Stenting Codes

Below you will find general coding information related to carotid artery stenting. If you should have additional questions, please call the reimbursement hotline at 1-800-354-9997, or email the hotline at questions@askabbottvascular.com.

ICD-9 Diagnosis Codes

ICD-9-CM Procedure Codes

CPT® Procedure Codes

C-codes for Carotid Stent and Embolic Protection Systems

Coding for Post-Approval Studies

ICD-9 Diagnosis Codes

ICD-9-CM diagnosis coding varies based on the patient's medical condition. Physicians should document patient diagnoses and procedures thoroughly. It is ultimately the provider's responsibility to submit appropriate codes. Proper coding of clinical procedures and diagnoses are dependent on the information documented in the patient's medical record without consideration of the adequacy of the reimbursement levels assigned by payers to specific codes. Coding conventions typically dictate that a patient's diagnosis and treatment be coded with the highest level of specificity possible based on the patient's medical record. Abbott Vascular recommends you contact your Medicare Fiscal Intermediary, Carrier, and/or other Third-Party payer to verify correct coverage, coding and billing for medical procedures and products.

Note: Initially, CMS listed 433.10 as the only acceptable code in the business requirements of their national coverage determination for carotid artery stenting in post-approval studies (CMS Transmittal 314). Per MLN Matters update 3811, diagnosis code 433.30 may be used, if accompanied by 433.10 as a secondary diagnosis.

ICD-9-CM Procedure Codes

Hospital Inpatient Procedures

Listed below are ICD-9-CM procedure codes for carotid stenting procedures. Carotid artery stenting is covered as an in-patient procedure only. CMS requires the use of both codes listed below when submitting claims for carotid artery stenting in order to track to the appropriate DRG. PTA alone of the carotid artery is not covered by CMS. Additionally, if 00.63, insertion of carotid stent is coded alone, the case will be assigned to a medical care DRG.

Medicare hospital inpatient information is effective for Medicare's FY 2007 (October 1, 2007 - September 30, 2008).

Adjunct Procedure Codes

Adjunct Vascular System Procedures: These codes apply to both coronary and peripheral vessels. The codes below are used in conjunction with other therapeutic procedure codes to provide additional information and to indicate the number of vessels treated and/or the placement of multiple stents.

Please note: the safety of bilateral carotid artery stenting has not been evaluated.

CPT® Procedure Codes

Physicians

Medicare physician fee schedule information is effective for CY 2008 (January 1, 2008-December 31, 2008). 

Note: For services performed on or after March 17, 2005, Medicare will not pay for carotid artery stenting (CAS) with embolic protection claims that have procedure code 37216 (Transcatheter placement of intravascular stent(s) without distal embolic protection. View MLN Matters Article 4399, released April 2006.

CPT is a trademark of the American Medical Association. Current Procedure Terminology, CPT is copyright 2006, American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

A modifier (a two-digit numerical code) may be attached to the original CPT code, if substantiated with medical documentation when a physician deems it medically necessary to perform diagnostic procedures to the contralateral carotid artery.

C-codes for Carotid Stent and Embolic Protection Systems

Hospitals are required to use Medicare (CMS) C-codes when billing for devices used in the outpatient setting. From April 1, 2005, CMS will audit for device codes based on the submitted procedure performed.

Because carotid artery stenting is covered as an in-patient procedure only, CMS has not assigned a C-code to the Acculink or Exact carotid stent systems, nor the Accunet or Emboshield embolic protection systems.

Please click here for a complete list of C-codes related to Abbott Vascular products.

Coding for Post-Approval Studies

See payment page for additional information on national CMS base payment amounts.When billing for patients who are eligible for CMS coverage of carotid artery stenting as part of a post-approval study (such as CAPTURE or EXACT) or a post-approval extension study (such as CAPTURE 2, or CHOICE) the study number must appear on the hospital and physician claim. For physicians, a –QA modifier must be used with all applicable CPT codes. Hospitals should use revenue code 624 on a claim to indicate that the patient was enrolled in a study.

Please refer to the CMS National Coverage. Determination on PTA for carotid artery stenting, or MLN Matters, article 5088, for additional information.

You may also call the Abbott Vascular Reimbursement Hotline for more information related to the coding and coverage of carotid artery stenting at 1-800-354-9997.

References:

Centers for Medicare and Medicaid Services at www.cms.hhs.gov

ICD-9-CM for Hospitals – Volumes 1,2 & 3; 2006 Professional; 6th edition; edited by Anita C. Hart, RHIA, CCS, CCS-P, Catherine A. Hopkins, Beth Ford, RHIT, CCS; Ingenix

CPT^® is a trademark of the American Medical Association.

Current Procedure Terminology (CPT) is copyright 2005. American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

American Medical Association. Current Procedural Terminology (CPT) 2005. Professional Edition. Chicago, IL: 2005.

Last Updated: June 2008

Disclaimer: The information provided on this website was obtained from third-party sources and is subject to change without notice, as a result of changes in reimbursement laws, regulations, rules and policies. All content on this website is informational only, general in nature and does not cover all situations or all payers’ rules and policies. This content is not intended to instruct medical providers on how to use or bill for healthcare procedures including new technologies outside of Medicare national guidelines. A determination of medical necessity is a prerequisite that Abbott Vascular assumes will have been made prior to assigning codes or requesting payments. Medical providers should consult with appropriate payers, including Medicare fiscal intermediaries and carriers, for specific information on proper coding, billing and payment levels for healthcare procedures.

This website represents no promise or guarantee by Abbott Vascular regarding coverage, coding, billing and payment levels. Abbott Vascular specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information on this website.

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