Q&A: Choosing the appropriate revenue code for catheters

Q: It appears that CMS allows for HCPCS codes such as C1730 (catheter, electrophysiology, diagnostic, other than 3D mapping [19 or fewer electrodes]) to be associated with revenue code 272 (Supplies) or 278 (Implants). I searched for documentation form CMS and found vague references to both. Many charge description master software (CDM) systems give both 272 and 278  as options. Do you know where we can find definitive documentation from CMS on which revenue code to associate with these HCPCS codes?

A: CMS guidance can be vague. For these types of billing decisions, it is up to the provider to make the appropriate choice to assign the revenue code that most closely represents the item or service. While many CDM resources recommend 272 or 278 for these types of devices, the definitive regulatory resource is the FDA.

According to AccessData.FDA.gov, the FDA does not classify “Catheter, Percutaneous, Cardiac Ablation, For Treatment Of Atrial Flutter” as “implants.” The best practice recommendation is to assign UB-04 revenue code 272 (sterile supply) to these devices. Introducer sheaths are typically used only during the procedure and then removed and would not be considered an implant.

Editor's note: Randy Wiitala, director of revenue integrity for Navigant, answered this question. 

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate action.

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