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 Abbott Vascular Reimbursement Hotline at 1-800-354-9997, or email the hotline at questions@askabbottvascular.com.

• ICD-9-CM Diagnosis Codes
• ICD-9-CM Procedure Codes
• CPT^® Procedure Codes
• C-codes for Carotid Stent and Embolic Protection Systems

Coverage for Carotid Artery Stenting ICD-9-CM 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 Administrator Contractor and/or other Third-Party payer to verify correct coverage, coding and billing for medical procedures and products.

Note: To correctly bill Medicare for covered bilateral carotid services, providers can bill both 433.30 or 433.31 and 433.10 or 433.11 in any order on the same claim. Code 433.30 with 433.10 or 433.31 with 433.11 to identify the multiple and bilateral condition and 433.10 or 433.11 to specifically identify the carotid artery.¹

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 fiscal year (FY) (October 1 - September 30).

Code 00.63 includes the use of any embolic protection device, distal protection device, filter device, or stent delivery system.

Coverage is limited to procedures performed using FDA-approved carotid artery stents and FDA-approved or -cleared embolic protection devices.

The use of an FDA-approved or cleared embolic protection device is required. If deployment of the embolic protection device is not technically possible, and not performed, then the procedure is not covered by Medicare.

In addition, CMS determines that carotid artery stenting with embolic protection is reasonable and necessary only if performed in facilities that have been determined to be competent in performing the evaluation, procedure, and follow-up necessary to ensure optimal patient outcomes

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 and effectiveness of concurrent treatment of lesions in patients with bilateral carotid artery disease have not been established.

CPT^® Procedure Codes

Physicians

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

Coverage is limited to procedures performed using FDA-approved carotid artery stents and FDA-approved or -cleared embolic protection devices.

The use of an FDA-approved or cleared embolic protection device is required. If deployment of the embolic protection device is not technically possible, and not performed, then the procedure is not covered by Medicare.²

In addition, CMS determines that carotid artery stenting with embolic protection is reasonable and necessary only if performed in facilities that have been determined to be competent in performing the evaluation, procedure, and follow-up necessary to ensure optimal patient outcomes.

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 edit for device codes based on the submitted procedure performed.

Although the carotid artery stenting procedure is only covered as an in-patient procedure for Medicare billing, the following C-codes are used primarily for internal charging to capture the cost of the devices.

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

Coverage for Carotid Artery Stenting

See Carotid Stenting Coverage Policies page for additional information on national Medicare and commercial payer coverage policies.

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.

¹ Centers for Medicare and Medicaid Services (CMS), Pub 100-04 Medicare Claims Processing, Transmittal 1315, August 10, 2007.http://www.cms.gov/transmittals/downloads/R1315CP.pdf

² Center for Medicare and Medicaid Services (CMS), Pub 100-3 Medicare National Coverage Determinations, Transmittal 115, March 5, 2010. http://www.cms.gov/transmittals/downloads/R115NCD.pdf

References:

Centers for Medicare and Medicaid Services at http://www.cms.gov/

ICD-9-CM for Hospitals – Volumes 1,2 & 3; 2011 Professional; 6th edition; edited by Anita C. Hart, RHIA, CCS, CCS-P, Melinda S. Stegman, MBA, CCS, Beth Ford, RHIT, CCS; Ingenix

CPT® is a trademark of the American Medical Association.

Current Procedure Terminology (CPT) is copyright 2010. 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) 2011. Professional Edition. Chicago, IL.

Last Updated: October  2011

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.