FREE Procedures to Device Code Edits & Device to Procedure Edits

January 2010 Device to Procedures Code Edits

Medicare’s Medical Device Edits

Medicare has put in place edits that require that bills for certain procedures must also have a corresponding charge and device HCPCS Level II code for the accompanying device that would be expected to be utilized for the procedure. There are two types of edits: Device to Procedure and Procedure to Device.
 

Device to Procedure Edits

Device to procedure edits screen the Medicare bill to verify if a HCPCS code for a medical device is on the bill when there is a corresponding procedure code for a procedure that device would be used with. For example, if HCPCS code C1900, Lead, left ventricular coronary venous system, is on the bill, one of the following procedures must also be on the bill, for the bill to be paid:

33224: Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or pacing cardioverter-defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of generator)
33225: Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator (including upgrade to dual chamber system).

The device codes that trigger an edit are shown in column A (Device) of the spreadsheet. The procedures that are allowed to be billed with that device are listed in column C (Procedure). If one of these procedure codes is not on the bill with the device code driving the edit, the claim will not be paid.

Procedure to Device Edits

Procedure to Device edits work the opposite of Device to Procedure edits. These edits screen the Medicare bill to verify that if a CPT/HCPCS code for a certain procedure is on the bill that there is a corresponding device HCPCS code for the medical device that the procedure would utilize. For example, if CPT code 37205, Transcatheter placement of an intravascular stent(s), (except coronary, carotid, and vertebral vessel), percutaneous; initial vessel, is on the bill, one of the following device codes must also be on the bill, for the bill to be paid:

C1874: Stent, coated/covered, with delivery system
C1875: Stent, coated/covered, without delivery system
C1876: Stent, non-coated/non-covered, with delivery system
C1877: Stent, non-coated/non-covered, without delivery system
C2617: Stent, non-coronary, temporary, without delivery system
C2625: Stent, non-coronary, temporary, with delivery system.

The procedure codes that trigger an edit are shown in column A (CPT/HCPCS) of the spreadsheet. The device codes that are allowed to be billed with that procedure are listed in column D (Device A). If there is also a device code listed in column F (Device B), there must be two device codes on the bill; one from column D (Device A) and one from column F (Device B). If the required device code(s) are not on the bill with the procedure driving the edit, the claim will not be paid.

These edits are subject to updates every calendar quarter. However, there are not changes every quarter. The most current edits are posted for your use.

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