Physician BARD BIOPSY Payment 2018 Medicare Final Rule Site Images/Healthcare...Bard Biopsy 2018...
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Advancing Lives and the Delivery of Health Care TM Table of Contents Biopsy ................................................................................ 2 Breast Localization ............................................................. 4 Pleural Drainage ................................................................. 7 Peritoneal Drainage............................................................ 8 Abscesses / Cysts ............................................................... 9 Biliary Drainage ................................................................ 10 Imaging.............................................................................. 11 Sentinel Node Biopsy ....................................................... 12 Soft Tissue Biopsy Thyroid ............................................................................. 13 Pleura ............................................................................... 14 Lung.................................................................................. 15 Lymph Node ..................................................................... 16 Liver ...................................................................................17 Retroperitoneum or Abdomen ......................................... 18 Pancreas ........................................................................... 19 Kidney ............................................................................. 20 Prostate ............................................................................ 21 Prostate Saturation...........................................................22 Muscle, Soft Tissue...........................................................23 BARD BIOPSY 2018 Medicare Final Rule Procedural Payment Guide Physician Payment Inpatient Outpatient Hospital Ambulatory Surgery Center
Transcript of Physician BARD BIOPSY Payment 2018 Medicare Final Rule Site Images/Healthcare...Bard Biopsy 2018...
Advancing Lives and the Delivery of Health Care TM
1Bard Biopsy | 2018 Medicare Final Rule
Table of ContentsBiopsy ................................................................................ 2Breast Localization .............................................................4Pleural Drainage .................................................................7Peritoneal Drainage............................................................8Abscesses / Cysts ...............................................................9Biliary Drainage ................................................................ 10Imaging.............................................................................. 11Sentinel Node Biopsy ....................................................... 12Soft Tissue BiopsyThyroid ............................................................................. 13
Pleura ............................................................................... 14Lung .................................................................................. 15Lymph Node ..................................................................... 16Liver ...................................................................................17Retroperitoneum or Abdomen ......................................... 18Pancreas ........................................................................... 19Kidney ............................................................................. 20Prostate ............................................................................ 21Prostate Saturation ...........................................................22Muscle, Soft Tissue ...........................................................23
BARD BIOPSY2018 Medicare Final Rule
Procedural Payment Guide
PhysicianPayment
Inpatient
Outpatient Hospital
Ambulatory Surgery Center
Advancing Lives and the Delivery of Health Care TM
2Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
BIOPSY2018 Procedural Payment Guide
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
See page 24 for important information about the uses and limitations of this document.
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
19081 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance
$705 $707 0.3% $175 $175 0.0% $1,236 $1,348 9.1% $521 $543 4.2%
+19082 each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure) (Use 19082 in conjunction with 19081)
$582 $584 0.3% $88 $88 0.0% pack-aged
pack-aged
pack-aged
pack-aged
19083 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance
$684 $687 0.4% $165 $164 -0.6% $1,236 $1,348 9.1% $521 $543 4.2% 584 - Breast Biopsy, Local Excision and Other Breast Procedures with CC/MCC
$9,772 $10,208 4.5%
+19084 each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure) (Use 19084 in conjunction with 19083)
$559 $560 0.2% $82 $82 0.0% pack-aged
pack-aged
pack-aged
pack-aged
585 - Breast Biopsy, Local Excision and Other Breast Procedures without CC/MCC
$8,641 $8,759 1.4%
19085 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance guidance
$1,039 $1,027 -1.2% $193 $190 -1.6% $1,236 $1,348 9.1% $521 $543 4.2%
Advancing Lives and the Delivery of Health Care TM
3Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
BIOPSY cont.2018 Procedural Payment Guide
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
+19086 each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure) (Use 19086 in conjunction with 19085) (Do not report 19081-19086 in conjunction with 19281-19288, 76098, 76942, 77002, 77021 for same lesion)
$831 $832 0.1% $96 $96 0.0% pack-aged
pack-aged
pack-aged
pack-aged
19101 Biopsy of breast; open, incisional
$348 $351 0.9% $228 $229 0.4% $2,496 $2,728 9.3% $1,006 $1,030 2.4%
19125 Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion
$561 $564 0.5% $473 $475 0.4% $2,498 $2,728 9.2% $1,006 $1,030 2.4% Inclusive to main procedure DRG
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
See page 24 for important information about the uses and limitations of this document.
Advancing Lives and the Delivery of Health Care TM
4Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
BREAST LOCALIZATION2018 Procedural Payment Guide
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
19281 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including mammographic guidance
$245 $246 0.4% $105 $105 0.0% $539 $573 6.3% pack-aged
pack-aged
+19282 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including mammographic guidance (List separately in addition to code for primary procedure)
$170 $171 0.6% $53 $53 0.0% pack-aged
pack-aged
pack-aged
pack-aged
19283 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including stereotactic guidance
$276 $278 0.7% $106 $105 -0.9% $539 $573 6.3% pack-aged
pack-aged
+19284 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure)
$208 $209 0.5% $53 $54 1.9% pack-aged
pack-aged
pack-aged
pack-aged
584 - Breast Biopsy, Local Excision and Other Breast Procedures with CC/MCC
$9,772 $10,208 4.5%
19285 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance
$526 $530 0.8% $90 $90 0.0% $539 $573 6.3% pack-aged
pack-aged
585 - Breast Biopsy, Local Excision and Other Breast Procedures without CC/MCC
$8,641 $8,759 1.4%
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
See page 24 for important information about the uses and limitations of this document.
See page 24 for additional information regarding
CPT Codes 19281 - 19287
Advancing Lives and the Delivery of Health Care TM
5Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
BREAST LOCALIZATION cont.2018 Procedural Payment Guide
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
+19286 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure)
$459 $464 1.1% $45 $45 0.0% pack-aged
pack-aged
pack-aged
pack-aged
19287 Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including magnetic resonance guidance
$881 $879 -0.2% $135 $134 -0.7% $539 $573 6.3% pack-aged
pack-aged
+19288 Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure)
$709 $711 0.3% $67 $67 0.0% pack-aged
pack-aged
pack-aged
pack-aged
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
See page 24 for important information about the uses and limitations of this document.
See page 24 for additional information regarding
CPT Codes 19281 - 19287
Advancing Lives and the Delivery of Health Care TM
6Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
BREAST LOCALIZATION cont.2018 Procedural Payment Guide
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
19296 Placement of radiotherapy afterloading expandable catheter (single or multichannel) into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; on date separate from partial mastectomy
$4,018 $4,074 1.4% $219 $219 0.0% $6,484 $7,387 13.9% $3,645 $3,684 1.1% 579-Other Skin, Subcutaneous Tissue and Breast Procedures with MCC
$14,805 $14,632 -1.2%
+19297 Placement of radiotherapy afterloading expandable catheter (single or multichannel) into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; concurrent with partial mastectomy (List separately in addition to code for primary procedure)
N/A N/A N/A $99 $99 0.0% pack-aged
pack-aged
pack-aged
pack-aged
580-Other Skin, Subcutaneous Tissue and Breast Procedures with CC
$8,972 $8,557 -4.6%
581-Other Skin, Subcutaneous Tissue and Breast Procedures without CC/MCC
$6,895 $6,732 -2.4%
88305 Level IV - Surgical pathology, gross and microscopic examination - Breast, biopsy, not requiring microscopic evaluation of surgical margins; Breast, reduction mammoplasty
$70 $70 0.0% $40 $40 0.0% $40 $45 12.5% N/A N/A N/A Inclusive to main procedure DRG
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
See page 24 for important information about the uses and limitations of this document.
Advancing Lives and the Delivery of Health Care TM
7Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
PLEURAL DRAINAGE2018 Procedural Payment Guide
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
32550 Insert pleural catheter $726 $728 0.3% $217 $216 -0.5% $2,862 $2,911 1.7% $1,453 $1,333 -8.3% Inclusive to main procedure DRG
32552 Removal of indwelling tunneled pleural catheter with cuff
$189 $189 0.0% $164 $164 0.0% $684 $613 -10.4% $369 $319 -13.6% Inclusive to main procedure DRG
32554 Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance
$206 $208 1.0% $93 $93 0.0% $684 $613 -10.4% $369 $319 -13.6% Inclusive to main procedure DRG
32555 Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance
$296 $297 0.3% $117 $116 -0.9% $684 $613 -10.4% $369 $319 -13.6% Inclusive to main procedure DRG
32556 Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance
$564 $572 1.4% $128 $127 -0.8% $1,334 $1,427 7.0% $608 $628 3.3% Inclusive to main procedure DRG
32557 Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance
$521 $523 0.4% $159 $158 -0.6% $684 $983 43.7% $369 $512 38.8% Inclusive to main procedure DRG
See page 24 for important information about the uses and limitations of this document.
Advancing Lives and the Delivery of Health Care TM
8Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
PERITONEAL DRAINAGE2018 Procedural Payment Guide
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance
$197 $200 1.5% $77 $77 0.0% $699 $743 6.3% $378 $387 2.4% Inclusive to main procedure DRG
49083 Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance
$300 $302 0.7% $113 $113 0.0% $699 $743 6.3% $378 $387 2.4% Inclusive to main procedure DRG
49418 Insertion of tunneled intraperitoneal catheter (eg, dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous
$1,389 $1,394 0.4% $214 $212 -0.9% $2,862 $2,911 1.7% $1,453 $1,333 -8.3% Inclusive to main procedure DRG
49422 Removal of tunneled intraperitoneal catheter
N/A N/A $395 $396 0.3% $2,360 $2,493 5.6% $1,274 $2,097 64.6% Inclusive to main procedure DRG
See page 24 for important information about the uses and limitations of this document.
DAV/CORP/1217/0057
Advancing Lives and the Delivery of Health Care TM
9Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
ABSSCESSES/CYSTS2018 Procedural Payment Guide
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
10030 Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst), soft tissue (eg, extremity, abdominal wall, neck), percutaneous
$711 $577 -18.8% $160 $143 -10.6% $539 $573 6.3% $291 $298 2.4% Inclusive to main procedure DRG
49405 Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); visceral (eg, kidney, liver, spleen, lung/mediastinum), percutaneous
$822 $827 0.6% $207 $206 -0.5% $1,236 $1,348 9.1% N/A N/A Inclusive to main procedure DRG
49406 Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, percutaneous
$823 $826 0.4% $207 $206 -0.5% $1,236 $1,348 9.1% $521 $543 4.2% Inclusive to main procedure DRG
49423 Exchange of previously placed abscess or cyst drainage catheter under radiological guidance (separate procedure)
$557 $559 0.4% $75 $75 0.0% $1,334 $1,427 7.0% $608 $628 3.3% Inclusive to main procedure DRG
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
See page 24 for important information about the uses and limitations of this document.
Advancing Lives and the Delivery of Health Care TM
10Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
BILIARY DRAINAGE2018 Procedural Payment Guide
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
47534 Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; internal-external
$1,501 $1,506 0.3% $391 $390 -0.3% $2,862 $2,911 1.7% $1,453 $1,333 -8.3% Inclusive to main procedure DRG
47536 Exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation
$703 $705 0.3% $139 $139 0.0% $2,862 $2,911 1.7% $1,453 $1,333 -8.3% Inclusive to main procedure DRG
47537 Removal of biliary drainage catheter, percutaneous, requiring fluoroscopic guidance (eg, with concurrent indwelling biliary stents), including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation
$373 $375 0.5% $101 $101 0.0% $699 $743 6.3% $378 $387 2.4% Inclusive to main procedure DRG
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
See page 24 for important information about the uses and limitations of this document.
Advancing Lives and the Delivery of Health Care TM
11Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
IMAGING2018 Procedural Payment Guide
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
75989 Radiological guidance (ie, fluoroscopy, ultrasound, or computed tomography), for percutaneous drainage (eg, abscess, specimen collection), with placement of catheter, radiological supervision and interpretation
$123 $124 0.8% $60 $60 0.0% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
See page 24 for important information about the uses and limitations of this document.
Advancing Lives and the Delivery of Health Care TM
12Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
SENTINEL NODE BIOPSY2018 Procedural Payment Guide
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
38500 Biopsy or excision of lymph node(s); open, superficial
$341 $342 0.3% $263 $264 0.4% $2,498 $2,728 9.2% $1,006 $1,030 2.4% 579-Other Skin, Subcutaneous Tissue and Breast Procedures with MCC
$14,805 $14,632 -1.2%
38525 Biopsy or excision of lymph node(s); open, deep axillary node(s)
N/A N/A $453 $454 0.2% $2,498 $2,728 9.2% $1,006 $1,030 2.4% 580-Other Skin, Subcutaneous Tissue and Breast Procedures with CC
$8,972 $8,557 -4.6%
38530 Biopsy or excision of lymph node(s); open, internal mammary node(s)
N/A N/A $574 $580 1.0% $2,498 $2,728 9.2% $1,006 $1,030 2.4% 581-Other Skin, Subcutaneous Tissue and Breast Procedures without CC/MCC
$6,895 $6,732 -2.4%
38792 Injection procedure; radioactive tracer for identification of sentinel node
N/A N/A $41 $41 0.0% $333 $349 4.8% pack-aged
pack-aged
Inclusive to main procedure DRG
+38900 Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure)
N/A N/A $144 $144 0.0% N/A N/A pack-aged
pack-aged
Inclusive to main procedure DRG
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
See page 24 for important information about the uses and limitations of this document.
Advancing Lives and the Delivery of Health Care TM
13Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
THYROID2018 Procedural Payment Guide
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
60100 Biopsy thyroid, percutaneous core needle
$116 $116 0.0% $82 $82 0.0% $539 $573 6.3% $54 $54 0.0% Inclusive to main procedure DRG
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
$61 $61 0.0% $33 $33 0.0% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
77012 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation
$126 $127 0.8% $58 $59 1.7% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
See page 24 for important information about the uses and limitations of this document.
Advancing Lives and the Delivery of Health Care TM
14Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
PLEURA2018 Procedural Payment Guide
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
32400 Biopsy, pleura, percutaneous needle
$154 $154 0.0% $90 $90 0.0% $1,236 $1,348 9.1% $521 $543 4.2% Inclusive to main procedure DRG
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
$61 $61 0.0% $33 $33 0.0% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)
$94 $96 2.1% $29 $29 0.0% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
77012 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation
$126 $127 0.8% $58 $59 1.7% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
See page 24 for important information about the uses and limitations of this document.
Advancing Lives and the Delivery of Health Care TM
15Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
LUNG2018 Procedural Payment Guide
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
32405 Biopsy, lung or mediastinum, percutaneous needle
$396 $401 1.3% $95 $94 -1.1% $1,236 $1,348 9.1% $521 $543 4.2% Inclusive to main procedure DRG
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
$61 $61 0.0% $33 $33 0.0% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)
$94 $96 2.1% $29 $29 0.0% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
77012 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation
$126 $127 0.8% $58 $59 1.7% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
See page 24 for important information about the uses and limitations of this document.
Advancing Lives and the Delivery of Health Care TM
16Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
LYMPH NODE
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
38505 Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary)
$129 $129 0.0% $74 $73 -1.4% $1,236 $1,348 9.1% $521 $543 4.2% 579-Other Skin, Subcutaneous Tissue and Breast Procedures with MCC
$14,805 $14,632 -1.2%
580-Other Skin, Subcutaneous Tissue and Breast Procedures with CC
$8,972 $8,557 -4.6%
581-Other Skin, Subcutaneous Tissue and Breast Procedures without CC/MCC
$6,895 $6,732 -2.4%
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
$61 $61 0.0% $33 $33 0.0% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
77012 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation
$126 $127 0.8% $58 $59 1.7% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
2018 Procedural Payment Guide
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
See page 24 for important information about the uses and limitations of this document.
Advancing Lives and the Delivery of Health Care TM
17Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
LIVER
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
47000 Biopsy of liver, needle; percutaneous
$312 $314 0.6% $94 $93 -1.1% $1,236 $1,348 9.1% $521 $543 4.2% Inclusive to main procedure DRG
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
$61 $61 0.0% $33 $33 0.0% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)
$94 $96 2.1% $29 $29 0.0% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
77012 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation
$126 $127 0.8% $58 $59 1.7% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
2018 Procedural Payment Guide
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
See page 24 for important information about the uses and limitations of this document.
Advancing Lives and the Delivery of Health Care TM
18Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
RETRIPERITONEUM OR ABDOMEN
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
49180 Biopsy, abdominal or retroperitoneal mass, percutaneous needle
$167 $168 0.6% $89 $89 0.0% $1,236 $1,348 9.1% $521 $543 4.2% Inclusive to main procedure DRG
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
$61 $61 0.0% $33 $33 0.0% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)
$94 $96 2.1% $29 $29 0.0% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
77012 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation
$126 $127 0.8% $58 $59 1.7% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
2018 Procedural Payment Guide
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
See page 24 for important information about the uses and limitations of this document.
Advancing Lives and the Delivery of Health Care TM
19Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
PANCREAS
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
48102 Biopsy of pancreas, percutaneous needle
$544 $545 0.2% $252 $251 -0.4% $1,236 $1,348 9.1% $521 $543 4.2% Inclusive to main procedure DRG
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
$61 $61 0.0% $33 $33 0.0% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)
$94 $96 2.1% $29 $29 0.0% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
77012 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation
$126 $127 0.8% $58 $59 1.7% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
2018 Procedural Payment Guide
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
See page 24 for important information about the uses and limitations of this document.
Advancing Lives and the Delivery of Health Care TM
20Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
KIDNEY
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
50200 Renal biopsy; percutaneous, by trocar or needle
$546 $550 0.7% $135 $134 -0.7% $1,236 $1,348 9.1% $521 $543 4.2% Inclusive to main procedure DRG
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
$61 $61 0.0% $33 $33 0.0% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)
$94 $96 2.1% $29 $29 0.0% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
77012 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation
$126 $127 0.8% $58 $59 1.7% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
2018 Procedural Payment Guide
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
See page 24 for important information about the uses and limitations of this document.
Advancing Lives and the Delivery of Health Care TM
21Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
PROSTATE
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
55700 Biopsy, prostate; needle or punch, single or multiple, any approach
$253 $257 1.6% $136 $136 0.0% $1,644 $1,696 3.2% $792 $780 -1.5% Inclusive to main procedure DRG
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
$61 $61 0.0% $33 $33 0.0% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
2018 Procedural Payment Guide
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
See page 24 for important information about the uses and limitations of this document.
Advancing Lives and the Delivery of Health Care TM
22Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
PROSTATE SATURATION
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
55706 Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance
N/A N/A N/A $386 $388 0.5% $2,527 $2,697 6.7% $1,180 $1,206 2.2% Inclusive to main procedure DRG
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
$61 $61 0.0% $33 $33 0.0% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
2018 Procedural Payment Guide
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
See page 24 for important information about the uses and limitations of this document.
Advancing Lives and the Delivery of Health Care TM
23Bard Biopsy | 2018 Medicare Final Rule
Definitions:CC = Complications and/or ComorbidyMCC = Major Complications and/or ComorbidyDouble Digit or Greater IncreaseDouble Digit or Greater Decrease
MUSCLE, SOFT TISSUE2018 Procedural Payment Guide
NOTE: ICD-9 listings are for reference only. ICD-10PCS coding requires clinical interpretation in order to determine the most appropriate code(s) for your specific coding situation.
Effective October 1, 2015, the ICD-10 CM diagnosis and ICD-10 PCS procedure code sets replaced ICD-9 coding. Access ICD-9 to ICD-10 code cross reference for diagnosis and procedure codes at: http://www.icd10data.com/Convert
Physician Payment Outpatient Hospital Ambulatory Surgery Center Inpatient
CPT Code Description
Global: In-Office(Technical + Professional
Components)
In Hospital (Professional Component)
APC Payment ASC PaymentICD-9
Procedure Code
MS-DRG Description Nat'l Avg Payment
2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change 2017 2018 %
Change 2017 2018 % Change
20206 Biopsy, muscle, percutaneous needle
$240 $241 0.4% $61 $61 0.0% $1,236 $1,348 9.1% $521 $543 4.2% Inclusive to main procedure DRG
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
$61 $61 0.0% $33 $33 0.0% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
77012 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation
$126 $127 0.8% $58 $59 1.7% pack-aged
pack-aged
pack-aged
pack-aged
Inclusive to main procedure DRG
See page 24 for important information about the uses and limitations of this document.
Advancing Lives and the Delivery of Health Care TM
24Bard Biopsy | 2018 Medicare Final Rule
DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services, 42 CFR Parts 414, 416, and 419, [CMS-1678-FC], RIN: 0938-AT03: Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Final Rule
DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services, 42 CFR Parts 405, 410, 414, 424, and 425, [CMS-1676-F], RIN 0938-AT02: Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program; Final Rule
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services, 42 CFR Parts 405, 412, 413, 414, 416, 486, 488, 489, and 495, [CMS–1677–F], RIN 0938–AS98: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR) Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Provider-Based Status of Indian Health Service and Tribal Facilities and Organizations; Costs Reporting and Provider Requirements; Agreement Termination Notices: Final Rule
DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services, 42 CFR Parts 405, 412, 413, 414, 416, 486, 488, 489, and 495, [CMS–1677–CN], RIN–0938–AS98 : Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR) Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Provider-Based Status of Indian Health Service and Tribal Facilities and Organizations; Costs Reporting and Provider Requirements; Agreement Termination Notices; Correction
1625 West 3rd StreetTempe, AZ 85281 USA
Phone: (480) 303-2600Customer Service: (800) 321-4254
www.bardbiopsy.com
American Medical Association’s “Physician’s Current Procedural Terminology CPT 2017, www.ama-assn.org
World Health Organization. International Classification of Diseases, 9th revision. Geneva: WHO, 2015 All Rights Reserved.
C. R. Bard, Inc. does not guarantee that use of any of the codes provided will ensure coverage or payment at any particular level. Medicare may implement policies differently in various sections of the country. Physicians and hospitals should confirm with a particular payor or coding authority, such as the American Medical Association or medical specialty society, which codes or combinations of codes are appropriate for a particular procedure or combination of procedures. Reimbursement for a product or procedure can be different depending upon the setting in which the product is used. Coverage and payment policies also change over time, so that information provided here may at some point need to be revised.
CPT Codes APC Status STV-Packaged Codes19281 - 19287 5072 Q1 Paid under OPPS; Addendum B displays APC assignments
when services are separately payable.(1) Packaged APC payment if billed on the same date of service as a HCPCS code assigned status indicator “S,” “T,” or “V.”(2) In other circumstances, payment is made through a separate APC payment.
