Corporate

Device-Intensive Procedure and Device Code Search

The use of a device, or multiple devices, is necessary to the performance of certain outpatient procedures. Conversely, some devices are allowed only with certain procedures, whether or not the specific device is required. The Outpatient Code Editor (OCE) will return to the provider (RTP) any claim submitted with:

  • A device-intensive procedure code billed without at least one device code required for the procedure on the same claim with the same date of service
  • A device code billed without the procedure code that is necessary for the device to have therapeutic benefit to the patient on the same claim with the same date of service

If a claim RTPs with reason code W7092, the hospital will need to either correct the procedure/device code or ensure that one of the required device/procedure codes is on the claim before resubmission.

Code Search

Use the code search to determine the appropriate code to submit on your claim:

Enter one procedure code or view a list of all procedure codes included on the device-intensive procedure list.

Procedure Code:

View all Procedure Codes:

Enter one device code or view a list of all device codes included on the device code list.

Device Code:

View all Device Codes:

Additional Billing Guidance

To prevent and/or correct the edit (reason code W7092), verify the following:

  1. The procedure and device code(s) reported on the claim are correct.
  2. The procedure/device code(s) are submitted on the same claim with the same date of service.
  3. Was the procedure discontinued?
    • If so, a device code is not required, but one of the following modifiers should be reported with the procedure code:
      • 52 (Reduced services)
      • 73 (Discontinued outpatient procedure prior to anesthesia administration)
      • 74 (Discontinued outpatient procedure after anesthesia administration)
    • If not, at least one of the required device codes must be submitted on the claim.
  4. Was the device revised or replaced?
    • At least one of the required device codes must be submitted on the claim.
    • If there is no applicable HCPCS code for the device, C1889 (Implantable/insertable device, not otherwise classified) may be reported.
    • If a device is furnished without cost, or with a credit of 50 percent or more, the hospital must report:
      • Value code FD (Credit received from the manufacturer for a medical device) and the device credit amount
      • One of the following condition codes:
        • 49 (Product replacement within product lifecycle)
        • 50 (Product replacement for known recall of a product)
        • 53 (Initial placement of a medical device provided as part of a clinical trial or free sample)
    • When a device is furnished at no cost, report a token charge for the device (e.g., $0.01).

References:


Two Vantage Way, Nashville, TN 37228 © CGS Administrators, LLC. All Rights Reserved