(Medicare Claims Processing Manual)

I37.2  Nonrheumatic pulmonary valve stenosis with  insufficiency  I37.8  Other nonrheumatic pulmonary valve disorders  I37.9  Nonrheumatic pulmonary valve disorder, unspecified  I38 Endocarditis, valve unspecified   I39 Endocarditis and heart valve disorders in diseases  classified elsewhere  I42.0  Dilated cardiomyopathy  I42.2  Other hypertrophic cardiomyopathy  I42.3  Endomyocardial (eosinophilic) disease  I42.4  Endocardial fibroelastosis  I42.5  Other restrictive cardiomyopathy  I42.6  Alcoholic cardiomyopathy  I42.7  Cardiomyopathy due to drug and external agent  I42.8  Other cardiomyopathies  I42.9  Cardiomyopathy, unspecified  I43 Cardiomyopathy in diseases classified elsewhere  I46.2  Cardiac arrest due to underlying cardiac condition  I46.8  Cardiac arrest due to other underlying condition  I46.9  Cardiac arrest, cause unspecified  I47.0  Re-entry ventricular arrhythmia  I47.2  Ventricular tachycardia  I47.9  Paroxysmal tachycardia, unspecified  I47.10  Supraventricular tachycardia, unspecified Effective 10/1/23  I47.11  Inappropriate sinus tachycardia, so stated Effective 10/1/23  I47.19  Other supraventricular tachycardia Effective 10/1/23   I48.0  Atrial fibrillation  I48.11  Longstanding persistent atrial fibrillation  I48.19  Other persistent atrial fibrillation  I49.01  Ventricular fibrillation  I49.02  Ventricular flutter  I49.1  Atrial premature depolarization  I49.2  Junctional premature depolarization  I49.3  Ventricular premature depolarization  I49.40  Unspecified premature depolarization  I49.49  Other premature depolarization  I49.5  Sick sinus syndrome  I49.8  Other specified cardiac arrhythmias  I49.9  Cardiac arrhythmia, unspecified  I50.1  Left ventricular failure  I50.20  Unspecified systolic (congestive) heart failure  I50.21  Acute systolic (congestive) heart failure  I50.22  Chronic systolic (congestive) heart failure  I50.23  Acute on chronic systolic (congestive) heart failure  I50.30  Unspecified diastolic (congestive) heart failure  I50.31  Acute diastolic (congestive) heart failure  I50.32  Chronic diastolic (congestive) heart failure  I50.33  Acute on chronic diastolic (congestive) heart failure   I50.40  Unspecified combined systolic (congestive) and diastolic  (congestive) heart failure   I50.41  Acute combined systolic (congestive) and diastolic  (congestive) heart failure   I50.42  Chronic combined systolic (congestive) and diastolic  (congestive) heart failure   I50.43  Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure  I50.84  End-stage heart failure  I50.9  Heart failure, unspecified  I51.4  Myocarditis, unspecified  I51.9  Heart disease, unspecified  I52 Other heart disorders in diseases classified elsewhere  I97.0  Postcardiotomy syndrome   I97.110  Postprocedural cardiac insufficiency following cardiac  surgery   I97.111  Postprocedural cardiac insufficiency following other  surgery  I97.120  Postprocedural cardiac arrest following cardiac surgery  I97.121  Postprocedural cardiac arrest following other surgery  I97.130  Postprocedural heart failure following cardiac surgery  I97.131  Postprocedural heart failure following other surgery   I97.190  Other postprocedural cardiac functional disturbances  following cardiac surgery   I97.191  Other postprocedural cardiac functional disturbances  following other surgery  I97.710  Intraoperative cardiac arrest during cardiac surgery  I97.711  Intraoperative cardiac arrest during other surgery   I97.790  Other intraoperative cardiac functional disturbances  during cardiac surgery   I97.791  Other intraoperative cardiac functional disturbances  during other surgery   I97.88  Other intraoperative complications of the circulatory  system, not elsewhere classified   I97.89  Other postprocedural complications and disorders of the circulatory system, not elsewhere classified  M32.11  Endocarditis in systemic lupus erythematosus  R00.1  Bradycardia, unspecified  R57.0  Cardiogenic shock   T82.221A  Breakdown (mechanical) of biological heart valve graft,  initial encounter   T82.222A  Displacement of biological heart valve graft, initial  encounter  T82.223A  Leakage of biological heart valve graft, initial encounter   T82.228A  Other mechanical complication of biological heart valve  graft, initial encounter   T82.512A  Breakdown (mechanical) of artificial heart, initial  encounter   T82.514A  Breakdown (mechanical) of infusion catheter, initial  encounter   T82.518A  Breakdown (mechanical) of other cardiac and vascular devices and implants, initial encounter  T82.522A  Displacement of artificial heart, initial encounter   T82.528A  Displacement of other cardiac and vascular devices and  implants, initial encounter   T82.529A  Displacement of unspecified cardiac and vascular devices  and implants, initial encounter  T82.532A  Leakage of artificial heart, initial encounter   T82.538A  Leakage of other cardiac and vascular devices and  implants, initial encounter   T82.592A  Other mechanical complication of artificial heart, initial  encounter   T82.598A  Other mechanical complication of other cardiac and  vascular devices and implants, initial encounter  T86.20  Unspecified complication of heart transplant  T86.21  Heart transplant rejection  T86.22  Heart transplant failure  T86.23  Heart transplant infection  T86.290  Cardiac allograft vasculopathy  T86.298  Other complications of heart transplant  T86.30  Unspecified complication of heart -lung transplant  T86.31  Heart -lung transplant rejection  T86.32  Heart -lung transplant failure  T86.33  Heart -lung transplant infection  T86.39  Other complications of heart -lung transplant  Z48.21  Encounter for aftercare following heart transplant  Z48.280  Encounter for aftercare following heart -lung transplant  Z94.1  Heart transplant status  Z94.3  Heart and lungs transplant status   This policy does not address coverage of VADs for right ventricular support, biventricular support, use in beneficiaries under the age of 18, use in beneficiaries with complex congenital heart disease, or use in beneficiaries with acute heart failure without a history of chronic heart failure. Coverage under section 1862(a) (1) (A) of the Social Security Act for VADs in these situations will be made by  local Medicare Administrative Contractors (MACs) within their respective jurisdictions.  320.3.4  Replacement Accessories and Supplies for External VADs or Any VAD (Rev.10837; Issued: 06- 11-21; Effective: 12 -01-20; Implementation: 07 -27-21)  Effective April 1, 2013, claims for replacement of accessories and supplies for VADs implanted in patients who were not eligible for coverage under Medicare Part A or had other insurance that paid for the device and hospital stay at the time that the devic e was implanted, but are now eligible for coverage of the replacement supplies and accessories under Part B, should be submitted using HCPCS code Q0509. Those claims will be manually reviewed.  In rare instances it may be appropriate to pay for replacement of supplies and accessories for external VADs used by patient who are discharged from the hospital. In addition, in some rare instances, it may be necessary for a patient to have an emergency b ack-up controller for an external VAD. Coverage of these items is at the discretion of the contractor. Claims for replacement of supplies and accessories used with an external VAD that are furnished by suppliers should be billed to the Part B MACs. Claims for replacement of supplies and accessories used with an external VAD that are furnished by hospitals and other providers should be billed to the Part AMACs. Effective April 1, 2013, these items should be billed using code Q0507 so that the claims can be m anually reviewed.  Claims for replacement supplies or accessories used with VADs that do not have specific HCPCS codes and do not meet the criteria of codes Q0507 and Q0509 should be billed using code Q0508.   Claims Coding   HCPCS  Definition  Effective Date  Q0507 Miscellaneous Supply Or Accessory For Use With An External Ventricular Assist Device  April 1,  2013 Q0508 Miscellaneous Supply or Accessory For Use With An Implanted Ventricular Assist Device  April 1,  2013 Q0509 Miscellaneous Supply Or Accessory For Use With Any Implanted Ventricular Assist Device For Which Payment Was Not Made Under Medicare Part A  April 1,  2013   Q0480:Driver for use with pneumatic ventricular assist device, replacement only Q0481:Microprocessor control unit for use with electric ventricular assist device, replacement only  Q0482:Microprocessor control unit for use with electric/pneumatic combination ventricular assist device, replacement only Q0483:Monitor/display module for use with electric ventricular assist device, replacement only Q0484:Monitor/display module for use with electric or electric/pneumatic ventricular assist device, replacement only Q0485:Monitor control cable for use with electric ventricular assist device, replacement only Q0486:Monitor control cable for use with electric/pneumatic ventricular assist device, replacement only Q0487:Leads (pneumatic/electrical) for use with any type electric/pneumatic ventricular assist device, replacement only  Q0488:Power pack base for use with electric ventricular assist device, replacement only  Q0489:Power pack base for use with electric/pneumatic ventricular assist device, replacement only  Q0490:Emergency power source for use with electric ventricular assist device, replacement only  Q0491:Emergency power source for use with electric/pneumatic ventricular assist device, replacement only Q0492:Emergency power supply cable for use with electric ventricular assist device, replacement only  Q0493:Emergency power supply cable for use with electric/pneumatic ventricular assist device, replacement only  Q0494:Emergency hand pump for use with electric or electric/pneumatic ventricular assist device, replacement only Q0495:Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only  Q0496:Battery, other than lithium -ion, for use with electric or electric/pneumatic ventricular assist device, replacement only Q0497:Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only  Q0498:Holster for use with electric or electric/pneumatic ventricular assist device, replacement only  Q0499:Belt/vest/bag for use to carry external peripheral components of any type ventricular assist device, replacement only Q0500:Filters for use with electric or electric/pneumatic ventricular assist device, replacement only  Q0501:Shower cover for use with electric or electric/pneumatic ventricular assist device, replacement only  Q0502:Mobility cart for pneumatic ventricular assist device, replacement only Q0503:Battery for pneumatic ventricular assist device, replacement only, each  Q0504:Power adapter for pneumatic ventricular assist device, replacement only, vehicle type  Q0506:Battery, lithium -ion, for use with electric or electric/pneumatic ventricular assist device, replacement only  NOTE: When determined to be medically necessary, dressings used with VADs are covered under the prosthetic device benefit as a supply necessary for the effective use of the VAD/prosthetic device. Claims for dressings necessary for the effective use of a VAD should be billed using the appropriate miscellaneous VAD supply code, depending upon whether the patient was eligible for coverage under Medicare Part A at the time that the VAD was implanted. The claims processing jurisdiction for dressings used with VADs is identical to that of other VAD replacement supplies and accessories and does not fall under Durable Medical Equipment MAC jurisdiction.  330  Percutaneous Image -guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS)  (Rev.  2959, Issued: 05- 16-14, Effective: 01 -09-14, Implementation: 10- 06-14)