Reimbursement

Transmyocardial Revascularization is recommended by the American College of Cardiology / American Heart Association1, the Society of Thoracic Surgeons2, and the International Society of Minimally Invasive Cardiothoracic Surgeons3, and reimbursed as a primary treatment and as a secondary treatment to coronary artery bypass grafting.

Transmyocardial Revascularization MS-DRG Coding

CMS continues with the implementation of its new payment system based on Medical Severity Diagnosis Related Groups (MS-DRG) which became effective October 1, 2007.

Based on a TMR patient’s medical severity and associated resource utilization, TMR patients typically are discharged under one of the following MS-DRGs 228/229/230 (see chart below).

MS-DRG MS-DRG Description
228
Other Cardiothoracic procedures w/ MCC
229
Other Cardiothoracic procedures w/ CC
230
Other Cardiothoracic procedures w/o CC/MCC

International Classification of Diseases, 10th Rev, Clinical Modification (ICD-10-CM) Procedure Codes

021L0Z5 – Bypass Left Ventricle to Coronary Circulation, Open Approach (ICD-9: 36.31 – Open Chest TMR)

021L4Z5 – Bypass Left Ventricle to Coronary Circulation, Percutaneous Endoscopic Approach (ICD-9: 36.32 – Other TMR)

02QC4ZZ – Repair Left Heart, Percutaneous Endoscopic Approach (ICD-9: 36.33 – Endoscopic TMR)

Third-Party Coverage

See how insurance providers cover TMR in their coverage policies for reimbursement. FDA approval granted for TMR performed with the Cardiogenesis TMR System, February 1999.

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Physician Current Procedural Terminology (CPT)

33140 – Transmyocardial laser revascularization (stand-alone procedure)

33141 – Transmyocardial laser revascularization performed at the time of other open cardiac procedure(s) (list separately in addition to code for primary procedure)

The coding information provided is gathered from third-party sources and has not been verified with any entity responsible for coding policy, such as the AMA or the ICD-10 Committee, or any payer. As such, the information set forth in this document is for illustrative purposes only and does not constitute a recommendation by CardioGenesis as to how to code for TMR. CardioGenesis makes no representation or warranty that any payer will agree with the choice of codes described herein. Reasonable efforts have been made to ensure the accuracy of this information, but the ultimate responsibility for coding and claims submission lies with the physician, clinician, hospital or other facility. CardioGenesis also makes no representation or warranty regarding coverage or payment of procedures by any payer involving TMR. Reimbursement policies change frequently and can vary considerably from one insurer to another. CardioGenesis strongly recommends that you consult your payers for interpretation of pertinent coding, coverage and reimbursement policies.

Reimbursement Presentation

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References

  1. Hillis LD, et al. Circulation 2011;124:2610-2642.
  2. Bridges CR, et al. Ann Thorac Surg 2004;77:1494-1502.
  3. Diegeler A, et al. Innovations 2006;1:314-322.

Ordering Information

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