CODING UPDATE from ZHealth: Transvenous (Catheter) Pulmonary Embolectomy National Coverage Determination Removed

Author: ZHealth Publishing
The following decision was released by CMS effective October 28, 2021.

The main focus of this document and decision was that there will no longer be a National Coverage Determination (NCD) for this procedure and instead, coverage or non-coverage will be made at the local level by the Medicare Administrative Contractor (MAC).

Additionally, based on this change, when reporting code 37184 for pulmonary thrombectomy, modifier GZ will no longer be needed.

The document in its entirety can be found at: NCA – Transvenous (Catheter) Pulmonary Embolectomy (CAG-00457R) – Decision Memo (cms.gov)

As this NCD is effective October 28, 2021, ZHealth recommends that providers closely monitor and review claims submitted for this service, the date of service the procedure was performed, and the method in which the third party payers processed claims. We also recommend that providers take a proactive stance and initiate dialogue with those entities most likely to receive claims for this service to help payers understand current CMS policy regarding this procedure, thereby hopefully increasing or eliminating pended or denied claims based upon previous payment policy.

Following are highlights from this information:

Transvenous (Catheter) Pulmonary Embolectomy

CAG-00457R

Decision Summary

The Centers for Medicare & Medicaid Services (CMS) is removing the National Coverage Determination (NCD) for Transvenous (Catheter) Pulmonary Embolectomy (NCD § 240.6), permitting Medicare coverage determinations for Transvenous (Catheter) Pulmonary Embolectomy to be made by Medicare Administrative Contractors (MACs) under § 1862(a)(1)(A) of the Social Security Act (the Act).

See Appendix B for the expected NCD manual language.

Decision Memo

SUBJECT: Final decision memorandum to remove Transvenous (Catheter) Pulmonary Embolectomy National Coverage Determination (NCD) (§ 240.6)

DATE: October 28, 2021

I. Decision

The Centers for Medicare & Medicaid Services (CMS) is removing the National Coverage Determination (NCD) for Transvenous (Catheter) Pulmonary Embolectomy (NCD § 240.6), permitting Medicare coverage determinations for Transvenous (Catheter) Pulmonary Embolectomy to be made by Medicare Administrative Contractors (MACs) under § 1862(a)(1)(A) of the Social Security Act (the Act).

See Appendix B for the expected NCD manual language.

X. Conclusion

The Centers for Medicare & Medicaid Services (CMS) is removing the National Coverage Determination (NCD) for Transvenous (Catheter) Pulmonary Embolectomy (NCD 240.6), permitting Medicare coverage determinations for Transvenous (Catheter) Pulmonary Embolectomy to be made by Medicare Administrative Contractors (MACs) under §1862(a)(1)(A) of the Social Security Act (the Act).

See Appendix B for the expected NCD manual language.

APPENDIX B

Medicare National Coverage Determinations Manual

Draft

This draft NCD is subject to formal revisions and formatting changes prior to the release of the final NCD contractor instructions and publication in the Medicare National Coverage Determinations Manual.

Table of Contents (Rev.)

240.6

Effective October 28, 2021 the Centers for Medicare and Medicaid Services removed the national coverage determination (NCD) for Transvenous (Catheter) Pulmonary Embolectomy. In the absence of an NCD, coverage determinations will be made by the Medicare Administrative Contractors under section 1862(a)(1)(A) of the Social Security Act.

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About the Author

David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC
David Zielske is founder and President of ZHealth Publishing and primary author and editor of ZHealth publications. Dr. Z practiced as an interventional radiologist and has over twenty years experience as a coding reviewer and coding expert. He is Board Certified in Radiology and has functioned as an independent interventional radiology, vascular surgery, and cardiovascular coding consultant to a variety of physician groups and hospital providers across the country. He also served as an instructor for over 200 coding seminars.

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