Reimbursement and Coding

Coding Guides and Resources

MitraClip™ Hospital and Physician Coding and Payment Guide

Medicare coding and payment guide for TMVr procedures

MitraClip Appeal Template Letter

To be considered when appealing a denial of claim or pre-authorization

MitraClip Clinical Assessment of Prohibitive Risk for Mitral Valve Surgery

Use this guide to help facilitate a clinical determination of an individual patient’s surgical risk status

MitraClip Hospital Claim Checklist

Provides coding guidance for Medicare fee-for-service hospital claims

MitraClip Implanting Physician Checklist

Provides coding guidance for Medicare fee-for-service physician claims

MitraClip Echocardiographer Checklist

Provides coding guidance for Medicare fee-for-service echocardiographer claims

Centers for Medicare and Medicaid Services (CMS)

TEER National Coverage Determination

Developed through an evidence-based process, this policy provides details on required medical criteria that must be met for coverage of Medicare beneficiaries.

CMS Physician Fee Schedule Prospectus

This guide includes Medicare Physician Payment Rates for cardiovascular procedures. For more detailed information, please refer to the CY Physician Fee Schedule Final Rule on the CMS website.

CMS Inpatient Reimbursement Prospectus

This guide provides a summary of the Medicare Hospital Inpatient Prospective Payment System (IPPS). It includes information on the Readmission Reductions Program, Value Based Purchasing, and Hospital Inpatient Reimbursement Rates for select cardiovascular DRGs. For more detailed information, please refer to the FY IPPS Final Rule on the CMS website.

HE&R Disclaimer

This document and the information contained herein is for general information purposes only and is not intended, and does not constitute, legal, reimbursement, business, clinical, or other advice. Furthermore, it is not intended to and does not constitute a representation or guarantee of reimbursement, payment, or charge, or that reimbursement or other payment will be received. It is not intended to increase or maximize payment by any payer. Similarly, nothing in this document should be viewed as instructions for selecting any particular code, and Abbott does not advocate or warrant the appropriateness of the use of any particular code. The ultimate responsibility for coding and obtaining payment/reimbursement remains with the customer. This includes the responsibility for accuracy and veracity of all coding and claims submitted to third-party payers. In addition, the customer should note that laws, regulations, and coverage policies are complex and are updated frequently, and, therefore, the customer should check with its local carriers or intermediaries often and should consult with legal counsel or a financial, coding, or reimbursement specialist for any questions related to coding, billing, reimbursement or any related issues. This material reproduces information for reference purposes only. It is not provided or authorized for marketing use.