MASTER_-_MM-01256_G_Billing_and_Coding_Artix_Thrombectomy_System_Procedures

Coding, Billing, & Chargemaster Artix System

Inari Medical Overview

• Focuses on medical billing and coding specifically related to the Artix System, a revolutionary product designed for the percutaneous treatment of peripheral vascular diseases.

General Disclaimer

• Information Availability:

  • Coding information is publicly available from third-party sources and aims to provide insight into medical coding practices. It is offered for general informational purposes only and may not cover all aspects of medical billing comprehensively.

• Legal and Business Advice:

  • The information provided does not constitute legal, reimbursement, or business advice. There is no guarantee regarding payment rates or coverage for the services rendered.

• Provider Responsibilities:

  • It is the provider's responsibility to ensure accurate reporting of diagnosis, services, and procedures. Decisions on site of service must be informed by medical necessity and in accordance with payer guidelines.

Dynamic Nature of Reimbursement

• Ever-Changing Landscape:

  • Payment rates, codes, and coverage policies are subject to frequent revisions and updates. Always consult current payer websites (e.g., CMS) for the most recent information.

CPT® Information

• CPT® Codes Overview:

  • CPT® codes are trademarked by the American Medical Association (AMA), and their coding and descriptors are protected under copyright law. These codes are particularly relevant for the Medicare Physician Services Fee Schedule and the Outpatient Prospective Payment System (OPPS) Final Rule.

Artix System: CPT® Codes

• Mechanical Thrombectomy Codes:

  • 37184: Primary mechanical thrombectomy (initial vessel)

    • Work RVU: 8.41, Total RVU: 12.62

    • Payment: $408 (Physician), $17,957 (Facility), $11,943 (ASC)

  • 37185: Additional vessels in the same vascular family (add-on)

    • Work RVU: 3.28, Total RVU: 4.76

    • Payment: $154 (specific)

  • 37186: Secondary thrombectomy (non-primary)

    • Work RVU: 4.92, Total RVU: 7.16

    • Payment: $232 (specific)

Artix System: ICD-10-PCS Codes

• ICD-10-PCS Codes Overview:

  • These codes pertain to extirpation (removal) of matter from arteries through a percutaneous (minimally invasive) approach.

• Sample Codes:

  • 03C33ZZ: Right Subclavian Artery

  • 03C43ZZ: Left Subclavian Artery

  • Additional codes may apply to various arteries with similar structural and procedural intent.

Artix System: ICD-10-CM Diagnosis Codes

• Inpatient Coding and Billing:

  • Primary codes indicating medical necessity include:

    • I73.9: Peripheral vascular disease, unspecified

    • I74.5: Embolism and thrombosis of iliac artery

  • Ensure proper documentation aligns with diagnosis as CPT does not provide an all-inclusive list.

Top MCC Categories by Secondary Dx Volume

• FY2025 Analysis:

  • Ten categories account for 77% of the MCC secondary diagnosis with a primary diagnosis of Peripheral Vascular Disease (PVD). Key diagnoses within these categories must be monitored for relevant coding.

Top CC Categories by Secondary Dx Volume

• Summary of Conditions:

  • Ten categories make up 70% of CC secondary diagnosis with a primary diagnosis of Peripheral Vascular Disease (PVD). Common diagnoses include:

    • I48: Atrial Fibrillation

    • I50: Heart Failure.

Artix System: MS-DRG Inpatient Payment

• Factors for MS-DRG Assignment:

  • MS-DRG assignments are determined based on the root operation, the body part involved, and the primary diagnosis.

• Relevant MS-DRG Codes:

  • MS-DRGs 270-272: Other Major Cardiovascular Procedures

  • MS-DRGs 252-254: Other Vascular Procedures.

Artix System: FY2025 Medicare Inpatient MS-DRG Payment with MCC or CC

• MS-DRG Payments:

  • MS-DRG 252: $24,481 (With MCC)

  • MS-DRG 253: $18,219 (With CC)

  • MS-DRG 254: $12,485 (Without MCC/CC)

  • Weighted Average: $24,005

• For lower arteries:

  • MS-DRG 270: $36,632 (major procedures with MCC)

  • Weighted Average: $28,607.

Artix System Per Procedure Pricing (PPP)

• Consistent Pricing Overview:

  • Focus on providing one consistent price per Artix case, including ancillary tools and devices for the treatment of Peripheral Vascular Disease (PVD).

Equipment

• Included Devices:

  • Artix Thin-Walled Sheath

  • AX Aspiration Catheter

  • Artix MT Thrombectomy Device

  • FlowSaver® System.

Example Charge Set Up: Artix System Devices + Procedure

• Illustrative Examples:

  • Example devices, potential HCPCS/CPT codes, modifiers, and revenue codes are provided for consultancy and billing purposes.

• Operational Costs:

  • Various operational and procedure-related charges are outlined to ensure financial clarity for providers.

Indications for Use

• Artix Thin-Walled Sheath and Devices:

  • Indicated for non-surgical removal of emboli, catheterization, and assisting in guiding intravascular devices in the peripheral vasculature.

Caution

• Usage Restrictions:

  • The Artix device is intended for use only by or on the order of a physician. Full documentation should be reviewed for indications, contraindications, and warnings.