AXIUM™

DETACHABLE
COILS (FAMILY)
CODING AND
REIMBURSEMENT
GUIDE
Axium ™
Detachable Coils
(Family)

Axium™ detachable coils consist of a platinum Axium™ detachable coils and Axium™
embolization coil attached to a delivery pusher. Prime detachable coils are intended for
When activated, a hand-held device detaches the endovascular embolization of intracranial
the coil from the delivery pusher tip. Some aneurysms. Axium™ and Axium™ Prime
models of Axium™ detachable coils are bioactive detachable coils are also intended for the
and some are non-bioactive: embolization of other neurovascular
abnormalities such as arteriovenous
Axium™ coils non-bioactive (bare metal) malformations and arteriovenous fistulae.
Axium MicroFX
™ ™
bioactive Embolization with Axium coils is typically
3D PGLA coils
Axium™ MicroFX™ performed in the inpatient setting.
bioactive
Helix PGLA coils
Axium™ MicroFX™
non-bioactive (nylon)
Helix nylon coils
Axium™ Prime
detachable coils
non-bioactive (bare metal)
(Frame) (Soft)
(Super Soft)

1
 DIAGNOSIS
CODING

Medtronic provides this information for your convenience only. It does not constitute legal advice or a recommendation regarding
clinical practice. Information provided is gathered from third-party sources and is subject to change without notice due to frequently
changing laws, rules and regulations. Medtronic makes no guarantee that the use of this information will prevent differences of opinion
or disputes with Medicare or other payers as to the correct form of billing or the amount that will be paid to providers of service. Please
contact your Medicare contractor, other payers, reimbursement specialists and/or legal counsel for interpretation of coding, coverage
and payment policies. This document provides assistance for FDA approved or cleared indications. Where reimbursement is sought
for use of a product that may be inconsistent with, or not expressly specified in, the FDA cleared or approved labeling (eg, instructions
for use, operator’s manual or package insert), consult with your billing advisors or payers on handling such billing issues. Some payers
may have policies that make it inappropriate to submit claims for such items or related service.
The following information is calculated per the footnotes included and does not take into effect Medicare payment
reductions resulting from sequestration associated with the Budget Control Act of 2011. Sequestration reductions
went into effect on April 1, 2013.
For questions please contact us at neuro.us.reimbursement@medtronic.com
ICD-10-CM DIAGNOSIS CODES1 – effective October 1, 2017
ICD-10-CM diagnosis codes are used by both physicians and hospitals to report the indication for the procedure.
ICD-10-CM CODE2 CODE DESCRIPTION
ANEURYSM
CEREBRAL ANEURYSM, RUPTURED, WITH SUBARACHNOID HEMORRHAGE3
I60.00 Nontraumatic subarachnoid hemorrhage from unspecified carotid siphon and bifurcation
I60.01 Nontraumatic subarachnoid hemorrhage from right carotid siphon and bifurcation
I60.02 Nontraumatic subarachnoid hemorrhage from left carotid siphon and bifurcation
I60.10 Nontraumatic subarachnoid hemorrhage from unspecified middle cerebral artery
I60.11 Nontraumatic subarachnoid hemorrhage from right middle cerebral artery
I60.12 Nontraumatic subarachnoid hemorrhage from left middle cerebral artery
I60.2 Nontraumatic subarachnoid hemorrhage from anterior communicating artery
I60.30 Nontraumatic subarachnoid hemorrhage from unspecified posterior communicating artery
I60.31 Nontraumatic subarachnoid hemorrhage from right posterior communicating artery
I60.32 Nontraumatic subarachnoid hemorrhage from left posterior communicating artery
I60.4 Nontraumatic subarachnoid hemorrhage from basilar artery
I60.50 Nontraumatic subarachnoid hemorrhage from unspecified vertebral artery
I60.51 Nontraumatic subarachnoid hemorrhage from right vertebral artery
I60.52 Nontraumatic subarachnoid hemorrhage from left vertebral artery
I60.6 Nontraumatic subarachnoid hemorrhage from other intracranial arteries
I60.7 Nontraumatic subarachnoid hemorrhage from unspecified intracranial artery
I60.9 Nontraumatic subarachnoid hemorrhage, unspecified
CEREBRAL ANEURYSM, NON-RUPTURED4
I67.1 Cerebral aneurysm, nonruptured
CEREBRAL ANEURYSM, CONGENITAL, NON-RUPTURED5
Q28.3 Other malformations of cerebral vessels
ICD-10-CM CODE CODE DESCRIPTION
ARTERIOVENOUS FISTULA
CEREBRAL ARTERIOVENOUS FISTULA, RUPTURED, WITH SUBARACHNOID HEMORRHAGE6
I60.8 Other nontraumatic subarachnoid hemorrhage
CEREBRAL ARTERIOVENOUS FISTULA, NON-RUPTURED4
I67.1 Cerebral aneurysm, nonruptured (includes acquired cerebral arteriovenous fistula, nonruptured)
CEREBRAL ARTERIOVENOUS FISTULA, CONGENITAL, NON-RUPTURED7
Q28.2 Arteriovenous malformation of cerebral vessels (includes congenital cerebral arteriovenous fistula, nonruptured)

2
HOSPITAL INPATIENT
PROCEDURE CODING
AND DRG PAYMENT

ICD-10-PCS PROCEDURE CODES8 – effective October 1, 2017

ICD-10-PCS procedure codes are used by hospitals to report surgeries and procedures performed in the inpatient setting.
ICD-10-PCS CODE CODE DESCRIPTION
PLACEMENT OF AXIUM DETACHABLE EMBOLIZATION COILS9, 10, 11
FOR ANEURYSM
03VG3BZ Restriction of intracranial artery with bioactive intraluminal device, percutaneous approach
03VG3DZ Restriction of intracranial artery with intraluminal device, percutaneous approach
FOR ARTERIOVENOUS FISTULA
03LG3BZ Occlusion of intracranial artery with bioactive intraluminal device, percutaneous approach
03LG3DZ Occlusion of intracranial artery with intraluminal device, percutaneous approach
CEREBRAL ARTERIOGRAPHY
B31R1ZZ Fluoroscopy of intracranial arteries using low osmolar contrast
B31RYZZ Fluoroscopy of intracranial arteries using other contrast12

DRG ASSIGNMENT FY2018 – effective October 1, 2017

Under Medicare’s MS-DRG methodology for hospital inpatient payment, each inpatient stay is assigned to one of about 750
diagnosis-related groups, based on the ICD-10 codes assigned to the diagnoses and procedures. MS-DRG has a relative
weight that is then converted to a flat payment amount. Implanted devices are typically included in the flat payment and are
not paid separately. Only one MS-DRG is assigned for each inpatient stay, regardless of the number of procedures performed.
MS-DRGs shown are those typically assigned to the following scenarios.

FY 2018 FY 2018
FY 2018 FY 2018
GEOMETRIC MEDICARE
MS-DRG13 MS-DRG TITLE13,14 RELATIVE MEAN LENGTH SUBJECT NATIONAL
WEIGHT13 TO PACT13,15
OF STAY13 AVERAGE16
RUPTURED INTRACRANIAL ANEURYSM, RUPTURED CEREBRAL ARTERIOVENOUS FISTULA
Intracranial Vascular Procedures
020 9.9991 13.5 No $60,259
W Principal Diagnosis of Hemorrhage W MCC
Intracranial Vascular Procedures
021 7.5363 11.9 No $45,417
W Principal Diagnosis of Hemorrhage W CC
Intracranial Vascular Procedures
022 5.7171 7.0 No $34,454
W Principal Diagnosis of Hemorrhage WO CC/MCC
NON-RUPTURED INTRACRANIAL ANEURYSM, RUPTURED CEREBRAL ARTERIOVENOUS FISTULA
025 Craniotomy and Endovascular Intracranial Procedures W MCC 4.3064 7.0 Yes $25,952
026 Craniotomy and Endovascular Intracranial Procedures W CC 2.9971 4.2 Yes $18,062
027 Craniotomy and Endovascular Intracranial Procedures WO CC/MCC 2.3665 2.2 Yes $14,262

HCPCS DEVICE CODES17

HCPCS device codes are assigned by the entity that purchased and supplied the device to the patient. In the case of Axium
detachable embolization coils, that is the hospital. However, hospitals assign HCPCS device codes only when the device is
provided in the hospital outpatient setting. HCPCS device codes cannot be assigned or billed for procedures performed in the
inpatient setting. If a hospital requires a HCPCS device code for an inpatient case for internal purposes only, such as for tracking,
please refer to the HCPCS addendum for references.

3
 PHYSICIAN
PROCEDURE CODING
AND PAYMENT

PHYSICIAN PROCEDURE CODING AND RBRVS PAYMENT FOR AXIUM DETACHABLE EMBOLIZATION COILS
Physicians use CPT® codes for all services.
Under Medicare’s Resource-Based Relative Value Scale (RBRVS) methodology for physician payment, each CPT® code is
assigned a point value, the relative value unit (RVU), which is then converted to a flat payment amount.

CPT® CODES18 – effective January 1, 2018 CY 2018 RBRVS FACTORS20 – effective January 1, 2018
MULTIPLE CY2018 MEDICARE CY2018 MEDICARE
CPT®
CODE18 CODE DESCRIPTION
PROCEDURE RVUS NATIONAL AVERAGE
DISCOUNTING21 (FACILITY SETTING)22 (FACILITY SETTING)22,23

PLACEMENT OF AXIUM DETACHABLE EMBOLIZATION COILS24,25

Transcatheter permanent occlusion or embolization (eg, for
tumor destruction, to achieve hemostasis, to occlude a vascular
61624 Yes 33.58 $1209
malformation), percutaneous, any method, central nervous
system (intracranial, spinal cord)

Transcatheter therapy, embolization, any method, radiological

75894-26 Yes 2.05 $74
supervision and interpretation

PRE-PROCEDURAL BALLOON OCCLUSION TEST26

Endovascular temporary balloon arterial occlusion, head or neck
(extracranial/ intracranial) including selective catheterization
of vessel to be occluded, positioning and inflation of occlusion
61623 Yes 16.80 $605
balloon, concomitant neurological monitoring, and radiologic
supervision and interpretation of all angiography required for
balloon occlusion and to exclude vascular injury post occlusion

CEREBRAL ANGIOGRAPHY27,28
Selective catheter placement, internal carotid artery, unilateral,
with angiography of the ipsilateral intracranial carotid circulation
36224 and all associated radiological supervision and interpretation, Yes 10.37 $373
includes angiography of the extracranial carotid and
cervicocerebral arch, when performed

Selective catheter placement, vertebral artery, unilateral,

with angiography of the ipsilateral vertebral circulation and all
36226 Yes 10.28 $370
associated radiological supervision and interpretation, includes
angiography of the cervicocerebral arch, when performed

Selective catheter placement, each intracranial branch of the

internal carotid or vertebral arteries, unilateral, with angiography
+36228 of the selected vessel circulation and all associated radiological No 6.99 $252
supervision and interpretation (eg, middle cerebral artery,
posterior inferior cerebellar artery)

CATHETERIZATION29,30
Selective catheter placement, arterial system, initial second
36216 order or more selective thoracic or brachiocephalic branch, Yes 7.95 $286
within a vascular family

Selective catheter placement, arterial system, initial third

36217 order or more selective thoracic or brachiocephalic branch, Yes 9.49 $342
within a vascular family

COMPLETION ANGIOGRAPHY31
Angiography through existing catheter for follow-up study
75898-26 for transcatheter therapy, embolization, or infusion other No 2.56 $92
than thrombolysis

4
REFERENCES
1. ICD-10-CM: Department of Health and Human Services, Centers for Disease Control and
Prevention. International Classification of Diseases, 10th Revision, Clinical Modification
(ICD-10-CM). http://www.cdc.gov/nchs/icd/icd10cm.htm
2. For codes in I60.-- and code I67.1, note that the first digit is the letter “I” and other digits are the
number “1”.
3. Codes in I60.-- are used for ruptured aneurysms, even when the aneurysm is specified
as congenital.
4. According to the Index and Tabular instructional notes, code I67.1 includes the intracranial
portion of the internal carotid artery. Aneurysm of the extracranial portion of the internal carotid
artery is coded elsewhere.
5. Code Q28.3 includes non-ruptured congenital cerebral aneurysm, among other congenital
malformations.
6. According to the Index, code I60.8 includes rupture of arteriovenous fistula of the brain, even
when the fistula is specified as congenital.
7. Code Q28.2 includes non-ruptured congenital arteriovenous fistula of the brain, among other
congenital arteriovenous malformations.
8. ICD-10-PCS: Department of Health and Human Services, Centers for Medicare & Medicaid
Services. International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-
10-PCS). https://www.cms.gov/Medicare/Coding/ICD10/2018-ICD-10-CM-and-GEMs.html
9. In the coiling codes, the fourth character represents the body part : G-Intracranial Artery. There
are other body part values for internal carotid artery, but these are not shown. From the petrous
to the superior hypophyseal segment, the internal carotid artery lies within the cranial vault and
is intracranial by definition (see also Coding Clinic, 1st Q 2016, p.19).
10. The difference between the two sets of codes for placement of Axium embolization coils is
the third character for the root operation, which is assigned according to the objective of the
procedure. Although the same devices may be used, the objective is different depending on the
diagnosis. For coils placed for aneurysm, the root operation is V-Restriction which is defined
as partially closing an orifice or the lumen of a tubular body part. When an aneurysm is repaired
by placing a device such as a coil into the lumen of an artery, allowing blood to flow through the
rest of the artery while excluding the aneurysmal portion, the procedure is coded to this root
operation (Coding Clinic, 1st Q 2014, p.9). In contrast, for coils placed for arteriovenous fistula,
the root operation is L-Occlusion which is defined as completely closing an orifice or the lumen
of a tubular body part. This is the proper root operation because the objective in treating an
arteriovenous fistula is to prevent blood flow between vein and artery by completely closing
the unnatural connection, ie, sacrificing the vessel (Coding Clinic, 4th Q 2014, p.37).
11. The use of balloon-assisted coiling and stent-assisted coiling techniques does not alter the
ICD-10-PCS codes assigned. Ballooning is considered an integral step in coil placement and is
not coded separately. In stent-assisted coiling, both the implanted stent and the coils are being
used at the same site for the same objective, and a single code suffices (Coding Clinic, 1st Q
2016, p.19).
12. Fifth character Y-Other Contrast can be used for iso-osmolar contrast, eg, Visipaque. Coding
Clinic 3rd Q 2016, p.36.
13. Centers for Medicare & Medicaid Services. Medicare Program: Hospital Inpatient Prospective
Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective
Payment System Changes and FY2018 Rates Final Rule, 81 Fed. Reg. 37990-38589. https://www.
gpo.gov/fdsys/pkg/FR-2017-08-14/pdf/2017-16434.pdf . Published August 14, 2017. Final
Rule Correction, 82 Fed. Reg. 46138-46163. https://www.gpo.gov/fdsys/pkg/FR-2017-10-04/
pdf/2017-21325.pdf . Published October 4, 2017.
14. W MCC in MS-DRG titles refers to secondary diagnosis codes that are designated as major com-
plications or comorbidities. MS-DRGs W MCC have at least one major secondary complication
or comorbidity. Similarly, W CC in MS-DRG titles refers to secondary diagnosis codes designated
as other (non-major) complications or comorbidities, and MS-DRGs W CC have at least one
other (non-major) secondary complication or comorbidity. MS-DRGs WO CC/MCCs have no
secondary diagnoses that are designated as complications or comorbidities, major or otherwise.
Note that some secondary diagnoses are only designated as CCs or MCCs when the conditions
were present on admission, and do not count as CCs or MCCs when the conditions are acquired
in the hospital during the stay.
15. Post-Acute Care Transfer (PACT) status refers to selected DRGs in which payment to the
hospital may be reduced when the patient is discharged by being transferred out. The DRGs
impacted are those marked “Yes” and the patient must be transferred out before the geometric
mean length of stay to certain post-acute care providers, including rehabilitation hospitals, long
term care hospitals, skilled nursing facilities, or to home under the care of a home health agency.
When these conditions are met, the DRG payment is converted to a per diem and payment is
made as double the per diem rate for the first day plus the per diem rate for each remaining day
up to the full DRG payment.
16. Payment is based on the average standardized operating amount ($5,572.53) plus the capital
standard amount ($453.95). Centers for Medicare & Medicaid Services. Medicare Program:
Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term
Care Hospital Prospective Payment System Changes and FY2018 Rates; Correction, 82 Fed. Reg.
46146. Tables 1A-1D. https://www.gpo.gov/fdsys/pkg/FR-2017-10-04/pdf/2017-21325.pdf .
Published October 4, 2017. The payment rate shown is the standardized amounts for facilities
with a wage index greater than one. The average standard amounts shown also assume facilities
receive the full quality update. The payment is also adjusted by the Wage Index for specific
geographic locality. Therefore, payment for a specific hospital will vary from the stated Medicare
national average payment levels shown. Also note that any applicable coinsurance, deductible,
and other amounts that are patient obligations are included in the national average payment
amount shown.
17. HCPCS Level II codes are maintained by the Centers for Medicare and Medicaid Services. Health-
care Common Procedure Coding System. https://www.cms.gov/Medicare/Coding/HCPCSRe-
lease-CodeSets/Alpha-Numeric-HCPCS.html . HCPCS II codes are updated once per quarter.
Updates are available at https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/
HCPCS-Quarterly-Update.html
18. CPT copyright 2018 American Medical Association. All rights reserved. CPT® is a registered
trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to
Government Use. Fee schedules, relative value units, conversion factors and/or related compo-
nents are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their
use. The AMA does not directly or indirectly practice medicine or dispense medical services. The
AMA assumes no liability for data contained or not contained herein.
19. Modifier -26 is appended to certain imaging codes to show that the physician is reporting only
the professional interpretation, because the hospital is providing the imaging equipment
and technicians.
20. Centers for Medicare & Medicaid Services. Medicare Program; Payment Policies Under the
Physician Fee Schedule and Other Revisions to Part B for CY 2018 Final Rule; 82 Fed. Reg.
52976-53371. https://www.gpo.gov/fdsys/pkg/FR-2017-11-15/pdf/2017-23953.pdf .
Published November 15, 2017.
21. For codes marked “Y”, multiple procedure discounting indicates that when a procedure code is
reported on the same day as another higher-weighted procedure code, the highest-weighted
code is paid at 100% of the fee schedule amount and additional codes are paid at 50% of the
fee schedule amount. Procedure codes marked “N” are always paid at 100% of the fee schedule
amount regardless of whether they are submitted with other procedure codes. January 2018
release of the PFS Relative Value File RVU18A at http:/www.cms.gov/Medicare/Medicare-
Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html. Released
November 15, 2017.
22. The total RVU as shown here is the sum of three components: physician work RVU, practice
expense RVU, and malpractice RVU. RVUs and the Medicare National Average are shown for
the facility setting only because the Pipeline embolization procedure is always performed in the
hospital, rather than the non-facility (physician office) setting.
23. Medicare national average payment is determined by multiplying the sum of the three RVUs by
the conversion factor. The conversion factor for CY 2018 is $35.9996 per 82 Fed. Reg. 53344.
https://www.gpo.gov/fdsys/pkg/FR-2017-11-15/pdf/2017-23953 . Published November 15,
2017. See also the January 2018 release of the PFS Relative Value File RVU18A at http:/www.
cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Val-
ue-Files.html. Released November 15, 2017. Final payment to the physician is adjusted by the
Geographic Practice Cost Indices (GPCI). Also note that any applicable coinsurance, deductible,
and other amounts that are patient obligations are included in the payment amount shown.
24. Component coding conventions apply to code 61624, so radiological supervision and interpreta-
tion is coded separately. Code 75894 represents the radiologic service linked to code 61624.
25. The use of balloon-assisted coiling and stent-assisted coiling techniques does not alter the
CPT codes assigned. Ballooning is considered an integral step in coil placement and is not coded
separately (see also NCCI Policy Manual, 01/01/2018, Chapter VIII, C-28). In stent-assisted coil-
ing, when the stent and the coils are placed during the same operative encounter, code 61624
encompasses both and the stent is not coded separately (ACR Bulletin, March 2007, p.3; see also
CPT Assistant, July 2016, p.6).
26. A balloon occlusion test may be performed immediately prior to coil embolization, particularly
with arteriovenous fistula, to assess the neurological risks of permanently occluding the vessel.
When performed, this may be coded and reported separately.
27. Codes 61624 and 75894 for Axium detachable coil embolization include intraprocedural road-
mapping and fluoroscopic guidance necessary to perform the intervention. However, cerebral
angiography may be coded separately with 61624 when it is truly diagnostic. According to
CPT manual instructions (Radiology section, Vascular Procedures heading), a truly diagnostic
study means that no prior angiography is available and the decision to intervene is based on
the current angiography or, if angiography was previously performed, the patient’s condition
has changed since the prior angiography, there is inadequate visualization of the anatomy or
pathology on prior angiography, or there is a clinical change during the procedure requiring new
evaluation. See also CPT manual instructions (Surgery section, Cardiovascular System chapter,
Diagnostic Studies of Cervicocerebral Arteries heading) and NCCI Policy Manual, 01/01/2018,
Chapter V, D12.
28. A 4-view cervical and cerebral angiography, from catheter placement in the internal carotid
arteries and vertebral arteries bilaterally, is coded 36224-50 and 36226-50. Add-on code +36228
would also be assigned if additional angiography was performed from catheter placement in, for
example, the superior hypophyseal artery.
29. Catheter placement may be coded separately with 61624. Code 36216 would typically represent
catheterization of the left internal carotid artery. Code 36217 would typically represent cathe-
terization of the right internal carotid artery or higher level, eg, the middle cerebral artery
on either side.
30. If diagnostic cerebral angiography is also performed during the same operative encounter,
catheterization is not coded at all. According to CPT manual instructions (Surgery section,
Cardiovascular System chapter, Diagnostic Studies of Cervicocerebral Arteries heading),
catheterization is already included in the diagnostic cerebral angiography codes and
catheterization for the intervention 61624 would then be subsumed into the codes for the
angiography. See also 2011 Interventional Radiology Coding Update, SIR and ACR, p.22 FAQ-4.
31. Code 75898 can be assigned multiple times, once for each completion or follow-up angiogram
performed during the embolization. However, physicians are advised to assign 75898 judiciously
and to maintain clear documentation on the medical necessity for each angiography.
5
Indications, Contraindications, Warnings and instructions for use can be found in the product labeling supplied with each device.
CAUTION: Federal (USA) law restricts this device to sale by or on the order of a physician.

Axium™ and Axium™ Prime detachable coils are intended for the endovascular embolization of intracranial aneurysms. Axium™ and Axium™
Prime detachable coils are also intended for the embolization of other neurovascular abnormalities such as arteriovenous malformations and
arteriovenous fistulae. Axium™ Prime Detachable Coil (Frame): The Axium™ Prime detachable coil system is indicated for the endovascular
embolization of intracranial aneurysms and other neurovascular abnormalities, such as arteriovenous malformations and arterio-venous
fistulae. The Axium™ Prime detachable coils are also indicated for arterial and venous embolizations in the peripheral vasculature.

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