MKT 075 R5 aprevoLumbarCodingCard.pdf
aprevo lumbar
What Hospitals Need to Know:
- Cases using the aprevo® Custom-Made Anatomically Designed Interbody Fusion Devices will be assigned to MS-DRGs based on ICD-10-PCS and ICD-10-CM codes.
- Update charge masters to appropriately account for acquisition costs.
- Commercial payer reimbursement varies by contract.
To Support Claims Processing, the Surgeon’s Operative Notes May Indicate the Following:
- The use of aprevo® Custom-Made Anatomically Designed Interbody Fusion Devices.
- All applicable primary and secondary diagnoses.
- All procedures performed.
ICD-10-PCS Codes for aprevo® Lumbar Custom-Made Anatomically Designed Interbody Fusion Devices (CMADIFD)
| ICD-10-PCS CODE | DESCRIPTION |
|---|---|
| XRGB0R7 | Fusion of lumbar vertebral joint using custom-made anatomically designed interbody fusion device, open approach, new technology group 7 |
| XRGB3R7 | Same as above with percutaneous approach |
| XRGB4R7 | Same as above with percutaneous endoscopic approach |
| XRGC0R7 | Fusion of 2 or more lumbar vertebral joints using custom-made anatomically designed interbody fusion device, open approach, new technology group 7 |
| XRGC3R7 | Same as above with percutaneous approach |
| XRGC4R7 | Same as above with percutaneous endoscopic approach |
| XRGD0R7 | Fusion of lumbosacral joint using custom-made anatomically designed interbody fusion device, open approach, new technology group 7 |
| XRGD3R7 | Same as above with percutaneous approach |
| XRGD4R7 | Same as above with percutaneous endoscopic approach |
Hospital Coding Tips:
- Specific ICD-10-PCS codes have been created to describe the procedures using the aprevo® Custom-Made Anatomically Designed Interbody Fusion Device.
- Hospitals have the ability to set charges for items properly so that charges converted to costs can appropriately account fully for their acquisition and overhead costs.
- The Centers for Medicare & Medicaid Services (CMS) stated, "there is nothing that precludes hospitals from setting their charges consistent with their CCRs."
- Hospitals may consider the cost of the aprevo® Custom-Made Anatomically Designed Interbody Fusion Devices to their facility when setting charges for the procedures that use aprevo® devices.
Abbreviations:
- FY = Fiscal Year
- MS-DRG = Medicare Severity Diagnosis Related Group
- ICD-10-PCS = International Classification of Diseases, Tenth Revision, Procedure Coding System
CMS Finalized Assignment of the ICD-10-PCS Codes Describing the Procedure in Which aprevo® Is Used to the Following MS-DRGs for FY 2025, Effective October 1, 2024:
| MS-DRG CODE | DESCRIPTION |
|---|---|
| MS-DRG 426 | Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device* |
| MS-DRG 447 | Multiple Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device |
| MS-DRG 450 | Single Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device |
For Coding Questions, Contact the aprevo® Coding Hotline
866-aprevo1 (866-277-3861) | aprevocoding@jdlaccess.com
Disclaimer - It is the responsibility of the provider to determine and report appropriate codes, modifiers, and charges for healthcare services rendered to patients in their care. This document is made available to U.S. customers and prospective customers of Carlsmed, Inc. Similarly, all codes are referenced herein for informational purposes only and represent no statement, promise or guarantee by Carlsmed® that these code selections are appropriate for any given prospective service, or that reimbursement will be made to the provider reporting these services. Carlsmed® strongly recommends consulting your respective contracted payor organizations regarding its coding and coverage medical policies.