ASC Coding for Implants and Insertable Devices

Capturing the implantation and insertion of devices is an important aspect of coding for an ASC coder to be familiar with.

What are implantable and Insertable Devices?

Insertable devices are single-use devices that are inserted in the body but removed before the termination of the procedure. Implanted devices are items that remain in the body after the termination of the procedure and the patient exits the procedure room. If the provider uses an implant during a procedure but must remove it before the patient exits the OR, then the implant HCPCS code is not reportable and the device would be considered waste.

Common insertable devices in the ASC include:

• Single-use endoscopes: C1747, C1748, or C1738
• Certain kinds of catheters: C1726, C1727, C1750, or C1751
• Guide wires C1769, morcellators C1782, or closure devices C1760.

Common implants in the ASC include:

• Anchors and screws: C1713
• Mesh C1781 or adhesion barriers C1765
• Soft tissue grafts: C1762, C1763, or C1768
• Generators and leads: C1778, C1767, C1820, C1833, etc.
• Prostheses: C1776, C1789, or C1813
• Stents: C1784, C1875, C1876, C1877

Many other single-use, insertable or implantable devices do not have a designated HCPCS code and will be captured with C1889 Implantable/insertable device, not otherwise classified.

• Intracept probe
• VivAer stylus
• RhinAer stylus
• Ear tubes
• Artificial discs, etc.

Coding Considerations

The first step in coding a device is determining if there is a device to be reported. To identify if a device was used, reference the payment indicator for the surgical procedure you are coding. If it has a payment indicator of J8 Device-intensive procedure; paid at adjusted rate, then it is likely the surgeon used an implant or device to perform the procedure.

The next step is establishing which type of HCPCS code is appropriate for reporting. CMS and many other payors utilize HCPCS Level II C1000-C9999 Temporary Hospital Outpatient PPS codes, commonly referred to as C-codes. Some commercial or other payors may require HCPCS Level II L0000-L4999 Orthotic Procedures and devices instead, commonly referred to as L-codes, or other miscellaneous codes. Coders and billers should be familiar with a facility’s contracts with individual payors to determine which HCPCS codes they require for different implants and devices.

If you’re unsure what HCPCS code to use, many manufacturer websites provide detailed information or coding guides about their product, which can help the coder identify which HCPCS code(s) may be appropriate. You can also utilize the FDA website’s classification of a product to determine if it’s a device, implant, or supply.

The use of an implant or device must be documented by the provider in the operative report for it to be reportable. The coder may reference the implant log or intraoperative record to gain additional information about the product to assign the correct HCPCS code.

Performance of some procedures designated as “device-intensive” may not actually utilize an implant or device. For example, 63688 Revision or removal of implanted spinal neurostimulator pulse generator or receiver, with detachable connection to electrode array has a payment indicator of J8. However, if the physician is only revising the currently implanted generator and not utilizing a new one, then it is not appropriate to report a HCPCS code for a new implant. In this circumstance, the coder should consider C1890 No implantable/insertable device used with device-intensive procedures in addition to the procedure code. This notifies the payor that extra reimbursement adjustments for the use of an implant or device may not be applicable.

Payment Considerations

CMS combines payment for implantable and insertable devices and the surgical procedure into a single payment, unless the device/implant has pass-through status with payment indicator J7 OPPS pass-through device paid separately when provided integral to a surgical procedure on ASC list; payment contractor-priced, so utilization of these devices may not be separately reimbursed.

However, commercial or other payors may separately reimburse insertion of devices and implants, or at least require them to be reported on the claim, in addition to the surgical CPT code.

In summary, the ability to accurately report usage of implantable and insertable devices is crucial for ASC coders. Understanding the distinctions between these devices, and the specific HCPCS codes that apply, is essential for ensuring proper reimbursement. Whether a device is considered a temporary insertable device or a permanent implant impacts how it should be coded and reported. Coders must pay close attention to payment indicators and the specific requirements of different payors to determine reportability as well as the appropriate HCPCS codes. Additionally, clear documentation by the provider and diligent verification of device usage in the operative report are pivotal to accurate coding. By mastering these elements, coders can enhance their proficiency and contribute to the financial health of their facilities.

Health Information Associates offers medical coding services, medical auditing services, and clinical documentation audit services for hospitals, ambulatory surgery centers, physician groups and other healthcare entities in the United States.

The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.