Get Pumped for CPT 2017 Cardiology Updates

Get Pumped for CPT 2017 Cardiology Updates

Correct coding requires you to know what’s changed for the is medical specialty.

By Amy C. Pritchett

CPT® 2017 codes are in effect and February is American Heart Month; it’s a perfect time to give you the rundown of the significant changes to the Cardiology section that will affect your coding this year.

Anesthesia and Pain Management CANPC

New Code for Watchman® Type Implants

New code 33340 Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation replaces deleted Category III code 0281T. CPT 33340 describes transcatheter placement of an implant (e.g., Watchman® Implant) to close the left atrial appendage. A cardiologist may recommend this procedure as an alternative to long-term oral anticoagulants to deter emboli formation and prevent stroke. The procedure includes fluoroscopy, as well as radiological supervision and interpretation (S&I).

Do not separately report left heart catheterization (+93462 Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure)) with 33340. CPT also instructs:

  • Do not report 33340 with catheterization procedures 93452, 93453, 93458, 93459, 93460, 93461, 93531, 93532, or 93533, unless catheterization of the left ventricle is performed by a non-transseptal approach for indications distinct from the left atrial appendage closure procedure.
  • Do not report 33340 with 93451, 93453, 93456, 93460, 93461, 93530, 93531, 93532, 93533, unless complete right heart catheterization is performed for indications distinct from a left atrial appendage closure procedure.

Revised Valvuloplasty Coding

Previous valvuloplasty codes 33400, 33401, and 33403 are deleted and replaced by two new codes, which are classified as either simple or complex, depending on the details of the procedure.

33390 Valvuloplasty, aortic valve, open, with cardiopulmonary bypass; simple (ie, valvotomy, debridement, debulking, and/or simple commissural resuspension)

33391 complex (eg, leaflet extension, leaflet resection, leaflet reconstruction, or annuloplasty)

The provider repairs an aortic valve (to treat aortic valve stenosis or narrowing) via an open approach with the patient on cardiopulmonary bypass. Code 33390 describes a “simple” procedure, such as one involving valvotomy, debridement, debulking, and/or simple commissural resuspension. Code 33391 describes a “complex” procedure, such as one involving leaflet extension, leaflet resection, leaflet reconstruction, or annuloplasty.

As CPT® 2017 Changes: An Insider’s View explains, “The revision of codes 33405, 33406, and 33410 [aortic valve replacement] was necessary to indicate that these are now open procedures.”

Note: A Nov. 29, 2016 corrections document to CPT® 2017 Changes: An Insider’s View revises the description of the procedure for codes 33390 and 33391 to clarify that the patient was heparinized (treated with heparin).

Code Added for Partial Exchange Transfusion

A partial exchange transfusion removes and replaces the patient’s blood (or components of it) with other blood or blood products. Partial exchange may be used to treat polycythemia (an abnormally increased concentration of hemoglobin in the blood) or anemia. CPT® 2017 adds 36456 Partial exchange transfusion, blood, plasma, or crystalloid necessitating the skill of a physician or other qualified health care professional, newborn to report partial exchange transfusion for a newborn. Requiring the “skill of a physician or other qualified healthcare professional” allows nurses to perform this procedure.

Do not report 36456 with transfusion services 36430, 36440, or 36450. For complete exchange transfusions in a neonate, report 36450 Exchange transfusion, blood; newborn.

Mechanochemical Is an Option for Varicose Veins

Endovenous ablation therapy is performed to eliminate varicose veins, which are incompetent veins typically visible just below the surface of the legs and feet. New codes 36473 Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated and +36474 Subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to the code for primary procedure) involve a combination of mechanical and chemical methods to ablate the compromised veins. An intraluminal device is used to disrupt blood flow and “scratch” the interior surface of a vein into which medication is then infused. Per CPT® 2017 Changes: An Insider’s View, “… to report codes 36473 and +36474, both mechanical and chemical modalities … must be performed.” The use of sclerosant injected by either needle or catheter, followed by a compression technique, does not qualify for 36473 or +36474.

Code 36473 describes the first vein treated and add-on code +36474 describes each subsequent vein treated in the same extremity through a different access site. The physician must document the use of separate access sites to report +36474. The procedures are performed under local anesthesia, and include all imaging guidance, monitoring, and — when preformed in the office setting — all required supplies and equipment.

For catheter injection of sclerosant without concomitant endovascular mechanical disruption of the vein intima, or for catheter injection of an adhesive, CPT instructs you to report 37799 Unlisted procedure, vascular surgery.

Per CPT instructions, do not report 36473 or +36474 with 29581, 29582, 36000, 36002, 36005, 36410, 36425, 36475, 36476, 36478, 36479, 37241, 75894, 76000, 76001, 76937, 76942, 76998, 77022, 93970, or 93971 in the same surgical field.

Transluminal Balloon Angio
Codes Include Radiological S&I

CPT® 2017 deletes eight codes to report transluminal balloon angioplasty, plus the related radiological S&I codes, and replaces them with four new codes that include all necessary imaging and radiological S&I.

37246 Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery

This new code, which is listed out of sequence, describes transluminal balloon angioplasty in an initial artery — except for those arteries in the lower extremities for occlusive disease, intracranial arteries, coronary arteries, or pulmonary arteries.

+37247 Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure)

This new add-on code, also listed out of sequence, describes transluminal balloon angioplasty in each additional artery beyond an initial artery — except for those arteries in the lower extremities for occlusive disease, intracranial arteries, coronary arteries, or pulmonary arteries. Report in addition to 37246 (initial artery).

37248 Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein

This new code, listed out of sequence, describes transluminal balloon angioplasty in an initial vein — except for those veins in the lower extremities for occlusive disease, intracranial veins, coronary arteries, or pulmonary veins.

37249 Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure)

This new add-on code, listed out of sequence, describes transluminal balloon angioplasty in each additional vein beyond an initial vein — except for those veins in the lower extremities for occlusive disease, intracranial veins, coronary arteries, or pulmonary veins. Report in addition to 37248 (initial vein).

Per CPT® 2017 Changes: An Insider’s View, “Codes 37246 (artery) and 37248 (vein) should be reported for the primary vessel treated, as appropriate, and codes 37247 (artery) and 37249 (vein) are add-on codes that should be reported for each additional vessel treated.”

Conscious Sedation Changes Affect Coding

CPT no longer bundles conscious sedation as part of any procedure; beginning in 2017, moderate sedation may be reported separately (using new codes 99151-99157) when it is appropriately provided and documented. Codes affected by this change in the Cardiology section include:

33010-33011 (pericardiocentisis)

33206-33223 (pacemaker procedures)

33233-33235 (removal of pacemaker generator and lead(s))

33240-33264 (defibrillator procedures)

33244 (removal of defibrillator electrodes by transvenous extraction)

33249 (insert or replace defibrillator system)

33282, 33284 (patient activated event recorder, implantation and removal)

Editor’s note: Look for a separate article in a future Healthcare Business Monthly for a full rundown of the new Dialysis Circuit codes 36901-36909.

Amy Pritchett

Amy Pritchett

Amy C. Pritchett, BSHA, CPC, CPMA, CPC-I, CANPC, CASCC, CEDC, CRC, CDEO, CCS, ICDCT-CM/PCS, C-AHI, has been a coder/auditor for over 20 years with her most recent position being held at Change Healthcare as a Manger of the Facility Coding Services Division. She has many years of experience in several different areas of coding and serves as an interim instructor in her hometown of Mobile, Ala. She shares her expertise in publications and as a lecturer at conferences such as Coding-Con for The Coding Institute. She has served as President and Vice President of the Mobile, Ala., local chapter and serves as Secretary for the 2017 year.
Amy Pritchett

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Amy C. Pritchett, BSHA, CPC, CPMA, CPC-I, CANPC, CASCC, CEDC, CRC, CDEO, CCS, ICDCT-CM/PCS, C-AHI, has been a coder/auditor for over 20 years with her most recent position being held at Change Healthcare as a Manger of the Facility Coding Services Division. She has many years of experience in several different areas of coding and serves as an interim instructor in her hometown of Mobile, Ala. She shares her expertise in publications and as a lecturer at conferences such as Coding-Con for The Coding Institute. She has served as President and Vice President of the Mobile, Ala., local chapter and serves as Secretary for the 2017 year.

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