Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR), also known as Transcatheter Aortic Valve Implantation (TAVI), is used to treat aortic stenosis. A bioprosthetic valve is inserted percutaneously using a catheter and implanted in the orifice of the aortic valve.

TAVRs are performed in a cardiac catheterization lab or a hybrid operating room/cardiac catheterization lab with advanced quality imaging and with the ability to safely accommodate complicated cases that may require conversion to an open surgical procedure. The interventional cardiologist and cardiothoracic surgeon jointly participate in the intra-operative technical aspects of TAVR.

A cardiothoracic (CT) surgical consult is required prior to the performance of the procedure. This consult has the additional benefit of increasing the likelihood of a successful outcome. The patient (preoperatively and postoperatively) is under the care of a heart team. The heart team's interventional cardiologist(s) and cardiac surgeon(s) must jointly participate in the intra-operative technical aspects of TAVR and must be furnished in a hospital with the appropriate infrastructure that includes but is not limited to:

• On-site heart valve surgery and interventional cardiology programs
• Post-procedure intensive care facility with personnel experienced in managing patients who have undergone open-heart valve procedures
• Appropriate volume requirements per the applicable qualifications

The heart team concept embodies collaboration and dedication across medical specialties to offer optimal patient-centered care, and includes a cardiac surgeon and an interventional cardiologist experienced in the care and treatment of aortic stenosis who have: 

• Independently examined the patient face-to-face, evaluated the patient’s suitability for surgical aortic valve replacement (SAVR), TAVR or medical or palliative therapy
• Documented and made available to the other heart team members the rationale for their clinical judgment
• Providers from other physician groups as well as advanced patient practitioners, nurses, research personnel and administrators

Always double check your documentation to ensure that all secondary diagnoses have been documented to the highest possible level of specificity to facilitate coders in accurate DRG assignment, as patient selection and preparation are an intricate part of the process. 

TAVR procedures are not covered for patients in whom existing co-morbidities would preclude the expected benefit from correction of the aortic stenosis. Addressing patient health issues prior to the procedure greatly lowers readmissions. Collaboration between your care team, interventional cardiologists and surgeons is key and submitting documentation to substantiate this continuum of care is critical in preventing your claims from denying. 

Note: The beneficiary must be assessed prior to a TAVR procedure to ensure the beneficiary’s stability.

Resources

• Registry and Clinical Study Approvals by CMS can be found on the CMS Coverage with Evidence Development TAVR web page
• How to Avoid Denials for Inpatient Transcatheter Aortic Valve Replacement (TAVR) Services
• Transcatheter Aortic Valve Replacement 
• Medicare Learning Network (MLN) Matters Article, MM 11660, NCD (20.32) Transcatheter Aortic Valve Replacement (TAVR) (PDF)
• Decision Memo for Transcatheter Aortic Valve Replacement (TAVR) (CAG00430R) (06/21/2019)
• National Coverage Determination (NCD) for Transcatheter Aortic Valve Replacement (TAVR) (20.32)
• Comprehensive Error Rate Testing (CERT): Cardiac Procedures Checklist (PDF, Palmetto GBA website)