US Reimbursement – Unlisted Code Crosswalk for EDM

About EDM

Deltex Medical's CardioQ™ esophageal Doppler monitor is a minimally invasive method to optimize fluid levels in patients in intensive care or who are undergoing surgery. Medicare provides coverage for EDM for two specific patient populations:

• Monitoring of cardiac output (Esophageal Doppler) for ventilated patients in the ICU; and
• Operative patients with a need for intra-operative fluid optimization

Some commercial insurers including Aetna and Health Net, have also set positive coverage policies for this service.

Coding

The Centers for Medicare and Medicaid Services (CMS) issued a Program Transmittal to all regional Medicare contractors indicating that CPT code 76999 (Unlisted ultrasound procedure) should be used to report EDM services. Specifically:

• "When performed in a hospital setting for ventilated patients in the ICU or for operative patients with a need for ultrasound diagnostic procedures, the professional services only are separately payable when billed using CPT code 76999 with the modifier -26 to show the professional component"

The Medicare coding guidance is available at: http://www.cms.hhs.gov/transmittals/downloads/R76NCD.pdf

We recommend contacting your payers for appropriate billing instruction and documentation requirements. Payers may request additional information such as the patient's chart notes, a letter of medical necessity (LMN) and the physician's charge for the service.

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