Payment and Reimbursement Guidelines

REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is a minimally invasive technique used by the Trauma, Critical Care and Emergency Medicine community to temporarily occlude large vessels using a balloon.

This guide has been developed to assist you in obtaining the appropriate hospital reimbursement and physician payment for services rendered to patients having large vessel occlusion. We strongly suggest that you consult your payer organizations with regard to local coverage, coding and reimbursement policies.

To comply with Medicare and third-party payer requirements, all physician claim forms must indicate the International Classification of Diseases, 10th Revision (ICD-10) codes that identify diagnoses, symptoms, conditions, problems, complaints, or other reason(s) for the encounter/visit. A partial list of common diagnoses for patients who may require a REBOA balloon occlusion include:

ICD-10-CM Diagnosis Codes

S35.02XA Major Laceration of Abdominal Aorta, Initial Encounter
S35.222A Major Laceration of Superior Mesenteric Artery, Initial Encounter
S35.212A Major Laceration of Celiac Artery, Initial Encounter

ICD-10-PCS Procedure Codes

ICD-10 codes that may be used to describe REBOA procedures (Effective October 1, 2017):

04L03DJ Occlusion of Abdominal Aorta with Intraluminal Device, Temporary, Percutaneous Approach
02LW3DJ Occlusion of Thoracic Aorta with Intraluminal Device, Temporary, Percutaneous Approach

Below is a chart showing the typical MS-DRGs and respective hospital reimbursement rates, assuming the occlusive balloon is the only procedure.  Depending on the patient’s diagnosis and whether or not the patient receives a subsequent surgical correction, the DRG assignment may be different.

MS-DRG MS-DRG Description** FY 2017 National Average Hospital Reimbursement for Inpatient Procedures*
907 Other O.R. procedures for injuries w MCC $23,100
908 Other O.R. procedures for injuries w CC $12,300
909 Other O.R. procedures for injuries w/o CC/ MCC $7,800

*Does not include any hospital-specific adjustments for location, teaching status or charity care.

** MCC = Major complication or co-morbidity
CC=Complication or co-morbidity

CPT Procedure Code

Current Procedural Terminology (CPT-4) Codes are uniformly accepted by all payers and may be used to describe services rendered by the physician or hospital outpatient department.  The following code may be appropriate to describe REBOA procedures.

37244 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation

CPT Code CY 2017 National Average Physician Professional Fee* Hospital Outpatient APC CY 2017 National Average Hospital Outpatient Reimbursement
37244 $700 $193 $9750

CPT codes and nomenclature are Copyright 2016 American Medical Association

Disclaimer –We strongly suggest that you consult your payer organization with regard to local reimbursement policies.  The information contained in this document is provided for information purposes only and represents no statement, promise or guarantee by Prytime Medical, Inc. concerning levels of reimbursement, payment or charge.  Similarly, all ICD-10 and CPT codes are supplied for information purposes only and represent no statement; promise or guarantee by Prytime Medical, Inc. that these codes will be appropriate or that reimbursement will be made.