Medicare Benefits Schedule - Note TN.8.214

International guidelines for chronic lead extraction state that delays from injury to open access to the heart of more than 5–10 minutes are often associated with a fatal outcome. Preparations for this procedure should provide for this rare but life threatening circumstance.

Claiming guide chronic lead extraction:

When the service to which item 38358 applies is provided to a patient by an accredited interventional cardiologist the following claiming will apply:

• Item 38358 is to be claimed by the accredited interventional cardiologist; and
• Item 90300 is to be claimed by the standby cardiothoracic surgeon.

When the service to which item 38358 applies is provided to a patient by an accredited cardiothoracic surgeon the following claiming will apply:

• Item 38358 is to be claimed by the accredited cardiothoracic surgeon only

Claiming guide leadless pacemaker extraction (for an interventional cardiologist):

When the service to which item 38374 or 38375 applies is provided to a patient by an accredited interventional cardiologist the following claiming will apply:

• Item 38374 is to be claimed by the accredited interventional cardiologist; and
• Item 90300 is to be claimed by the standby cardiothoracic surgeon.

When the service to which item 38375 applies is provided to a patient by an accredited cardiothoracic surgeon the following claiming will apply:

• Item 38375 is to be claimed by the accredited cardiothoracic surgeon only

Claiming guide TAVI intermediate risk (38514) or TAVI low risk (38522):

When the service to which item 38514 or 38522 applies is provided to a patient by an accredited interventional cardiologist the following claiming will apply:

• Item 38514 or 38522 is to be claimed by the accredited interventional cardiologist; and
• Item 90300 is to be claimed by the standby cardiothoracic surgeon.

When the service to which item 38514 or 38522 applies is provided to a patient by an accredited cardiothoracic surgeon the following claiming will apply:

• Item 38514 or 38522 is to be claimed by the accredited cardiothoracic surgeon only

Related Items: 38358 38373 38374 38514 38522 90300

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Multiple Operation Rule

Extraction of one or more chronically implanted transvenous pacing or defibrillator leads, by percutaneous method, with locking stylets and snares, with extraction sheaths (if any), if:

(a) the leads have been in place for more than 6 months and require removal; and

(b) the service is performed:

(i) in association with a service to which item 61109 or 60509 applies; and

(ii) by a specialist or consultant physician who has undertaken the training to perform the service; and

(iii) in a facility where cardiothoracic surgery is available and a thoracotomy can be performed immediately and without transfer; and

(c) if the service is performed by an interventional cardiologist—a cardiothoracic surgeon is in attendance during the service

(H) 

(Anaes.) (Assist.)

Fee: $3,345.75 Benefit: 75% = $2,509.35

(See para TN.8.64, TN.8.214 of explanatory notes to this Category)

Multiple Operation Rule

Leadless permanent cardiac pacemaker, single‑chamber ventricular, percutaneous retrieval and replacement of, including cardiac electrophysiological services, during the same percutaneous procedure, if:

(a) the service is performed by a specialist or consultant physician who has undertaken training to perform the service; and

(b) if the service is performed at least 4 weeks after the pacemaker was inserted—the service is performed in a facility where cardiothoracic surgery is available and a thoracotomy can be performed immediately and without transfer; and

(c) if the service is performed by an interventional cardiologist at least 4 weeks after the pacemaker was inserted—a cardiothoracic surgeon is in attendance during the service;

other than a service associated with a service to which item 38350 applies

(H)

(Anaes.)

Fee: $879.95 Benefit: 75% = $660.00

(See para TN.8.214 of explanatory notes to this Category)

Multiple Operation Rule

Leadless permanent cardiac pacemaker, single‑chamber ventricular, percutaneous retrieval of, if:

(a) the service is performed by a specialist or consultant physician who has undertaken training to perform the service; and

(b) if the service is performed at least 4 weeks after the pacemaker was inserted—the service is performed in a facility where cardiothoracic surgery is available and a thoracotomy can be performed immediately and without transfer; and

(c) if the service is performed by an interventional cardiologist at least 4 weeks after the pacemaker was inserted—a cardiothoracic surgeon is in attendance during the service

(H)

(Anaes.)

Fee: $879.95 Benefit: 75% = $660.00

(See para TN.8.214 of explanatory notes to this Category)

Multiple Operation Rule

TAVI, for the treatment of symptomatic severe aortic stenosis, performed via transfemoral delivery, unless transfemoral delivery is contraindicated or not feasible, if:

(a)  the TAVI Patient is at intermediate risk for surgery; and

(b)  the service:

1. is performed by a TAVI Practitioner in a TAVI Hospital; and
2. includes all intraoperative diagnostic imaging that the TAVI Practitioner performs upon the TAVI Patient; and
3. includes valvuloplasty, if required; and
4. is performed in a facility where cardiothoracic surgery is available and a thoracotomy can be performed immediately and without transfer; and
5. if performed by an interventional cardiologist, a cardiothoracic surgeon is in attendance during the service;

not being a service which has been rendered within 5 years of a service to which this item or item 38495 or 38522 applies

(H)

(Anaes.) (Assist.)

Fee: $1,670.80 Benefit: 75% = $1,253.10

(See para AN.33.1, TN.8.135, TN.8.214, TN.8.278 of explanatory notes to this Category)

Multiple Operation Rule

TAVI, for the treatment of symptomatic severe native calcific aortic stenosis, performed via transfemoral delivery, unless transfemoral delivery is contraindicated or not feasible, if:

(a)   the TAVI Patient is at low risk for surgery; and

(b)   the service:

1. is performed by a TAVI Practitioner in a TAVI Hospital; and
2. includes all intraoperative diagnostic imaging that the TAVI Practitioner performs upon the TAVI Patient; and
3. includes valvuloplasty, if required; and
4. is performed in a facility where cardiothoracic surgery is available and a thoracotomy can be performed immediately and without transfer; and
5. if performed by an interventional cardiologist, a cardiothoracic surgeon is in attendance during the service;

not being a service which has been rendered within 5 years of a service to which this item or item 38495 or 38514 applies

(H)

(Anaes.) (Assist.)

Fee: $1,670.80 Benefit: 75% = $1,253.10

(See para AN.33.1, TN.8.135, TN.8.214, TN.8.278 of explanatory notes to this Category)

Professional attendance by a cardiothoracic surgeon in the practice of the surgeon’s speciality, if:

(a) the service is:

1. performed in conjunction with a service (the lead extraction service) to which item 38358 applies; or
2. performed in conjunction with a service (the leadless pacemaker extraction service) to which item 38373 or 38374 applies; or
3. performed in conjunction with a service (the TAVI intermediate or low surgical risk service) to which item 38514 or 38522 applies); and

(b) the surgeon:

1. is providing surgical backup for the provider (who is not a cardiothoracic surgeon) who is performing the lead extraction service, the leadless pacemaker extraction service or the TAVI intermediate or low surgical risk service; and
2. is present for the duration of the lead extraction service, the leadless pacemaker extraction service or the TAVI intermediate or low surgical risk service, other than during the low risk pre and post extraction or transcatheter aortic valve implantation phases; and
3. is able to immediately scrub in and perform a thoracotomy if major complications occur

(H)

Fee: $1,003.65 Benefit: 75% = $752.75

(See para TN.8.214 of explanatory notes to this Category)