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Ask a Rev Cycle Expert: Cardiac Implant Charging?

Question:

Seeking clarification on chargeable implant/explant charging – in the following scenario:

Pacer lead or some other chargeable “implanted” supply goes in the body. We try in earnest to implant the supply based on clinical decision making, but for whatever reason the implantable supply is removed from the body before the procedure is completed. Patient ultimately gets an implant, but we have one that went in and had to come out.

If the implant is introduced to the body, but has to come out, said “explanted” or “wasted” implant supply is chargeable in addition to the ultimate implant?

Answer:

Because the implant supply was inserted into the patient but had to come out, the implant may be charged in addition to the permanent implant. When the device fails or is otherwise defective, the implant is not chargeable, as the Centers for Medicare & Medicaid Services (CMS) expects facilities to contact the vendor or manufacturer of the device for replacement.

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