Explore 2020 Cardiovascular System Code Changes
Familiarize yourself with the 2020 CPT® code updates for the cardiovascular system using this simplified guide.
During these uncertain times, it’s necessary to keep ourselves engaged in activities that help relieve stress and anxiety. And what’s better than learning? There are several 2020 CPT® code changes for the cardiovascular (CV) system; in the Category I section alone, there are 11 new codes, eight deletions, and two revisions. This article will help you to either explore cardiovascular coding or update your coding know-how for this specialty.
Pericardiocentesis is an invasive procedure that uses a needle and catheter to remove the fluid that has built up in the sac that surrounds the heart, the pericardium. In 2019, CPT® 33010 and 33011 were used to report pericardiocentesis. These codes were categorized based on the encounter type — initial or subsequent — and did not include any imaging guidance. If the physician performed the procedure using imaging guidance, CPT® 76930 was coded separately. These codes became obsolete in 2020.
Transformation of Pericardiocentesis Codes
Four new CV codes, along with new guidelines, were added for 2020 to describe pericardiocentesis and pericardial drainage with insertion of an indwelling catheter. The table below makes it easy to understand how the older codes have been transformed into new codes, which take into account imaging guidance, the presence of a congenital cardiac anomaly, and age.
When to Report 33017, 33018, and 33019
Look to CPT® 33017, 33018, and 33019 when a catheter is left in place following pericardial drainage. Identify the key elements that differentiate these codes by asking:
- Does a catheter remain in place after completion of the procedure?
- What is the age of the patient?
- Does the patient have a congenital cardiac anomaly, or have they undergone repair of a congenital cardiac defect?
|Deleted codes||New Codes|
|33010 Pericardiocentesis; initial|
33011 Pericardiocentesis; subsequent
|33016 Pericardiocentesis, including imaging guidance, when performed|
Ultrasonic guidance for pericardiocentesis, imaging supervision and interpretation
|33015 Tube pericardiostomy||33017 Pericardial drainage with insertion of indwelling catheter, percutaneous, including fluoroscopy and/or ultrasound guidance, when performed; 6 years and older without congenital cardiac anomaly|
|33018 … birth through 5 years of age or any age with congenital cardiac anomaly|
*report this code if postop within 90 days of repairing the congenital cardiac defect
|33019 Pericardial drainage with insertion of indwelling catheter, percutaneous, including CT guidance|
Highlights of Pericardiocentesis Coding
Placement of an indwelling catheter is an important element in 2020 pericardiocentesis coding. If pericardiocentesis is performed to aspirate fluid and the catheter is removed at the conclusion of the procedure, report 33016. Only report 33017, 33018, and 33019 if a catheter is left in place.
Remember: It is inappropriate to separately report imaging guidance with 33016-33019 as these new codes include imaging guidance.
Three new codes were added for grafts of the ascending and transverse aorta.
Ascending Aorta Graft: New Codes 33858-33859
Ascending aorta graft code 33860 was deleted and replaced with two new codes:
33858 Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed; for aortic dissection
33859 for aortic disease other than dissection (eg, aneurysm)
Obsolete code 33860 denoted an ascending aortic graft with cardiopulmonary bypass, but the descriptor did not indicate the reason for the procedure. The new codes were introduced to differentiate the reason for the graft. Report 33858 if the procedure is performed due to aortic dissection. Report 33859 if the graft is placed because of aortic disease other than dissection.
Transverse Arch Graft: New Code 33871
Transverse arch graft code 33870 was deleted and replaced with one new code:
33871 Transverse aortic arch graft, with cardiopulmonary bypass, with profound hypothermia, total circulatory arrest and isolated cerebral perfusion with reimplantation of arch vessel(s) (eg, island pedicle or individual arch vessel reimplantation)
Obsolete code 33870 was reported only for a transverse arch graft and did not include any additional procedures. New code 33871 includes additional procedures, such as reimplantation of arch vessels.
Iliac Artery Endovascular Repair
The Food and Drug Administration (FDA) has approved branched (bifurcated) endografts to repair iliac artery disease, and the procedures to implant the devices are now sufficiently described in the literature, warranting Category I codes.
The Category III code that previously described this service (0254T) was deleted, and two new codes were added for iliac branch endograft (IBE):
+34717 Endovascular repair of iliac artery at the time of aorto-iliac artery endograft placement by deployment of an iliac branched endograft including pre-procedure sizing and device selection, all ipsilateral selective iliac artery catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation and distally in the internal iliac, external iliac, and common femoral artery(ies), and treatment zone angioplasty/stenting, when performed, for rupture or other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation, penetrating ulcer, traumatic disruption), unilateral (List separately in addition to code for primary procedure)
34718 Endovascular repair of iliac artery, not associated with placement of an aorto-iliac artery endograft at the same session, by deployment of an iliac branched endograft, including pre-procedure sizing and device selection, all ipsilateral selective iliac artery catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation and distally in the internal iliac, external iliac, and common femoral artery(ies), and treatment zone angioplasty/stenting, when performed, for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation, penetrating ulcer), unilateral
These codes describe placement of a bifurcated endograft in the common iliac artery with extensions into both the internal and external iliac arteries.
When to Report +34717 and 34718
Report CPT® +34717 when this service is performed at the time of aortic endograft repair (for example, at the time of placement of either an aorto-bi-iliac or aorto-uni-iliac device). The base codes for this add-on code are 34703, 34704, 34705, and 34706.
Report CPT® 34718 when this service is performed as a standalone procedure, either to repair isolated iliac disease or to extend a previous endograft repair of the aortoiliac vessels performed during a separate session.
Modifier usage: Codes +34717 and 34718 represent unilateral procedures. If +34717 is performed bilaterally, report +34717 twice. If 34718 is performed bilaterally, report 34718 for the first procedure and 34718 with modifier -50 appended for the contralateral procedure. This difference in reporting is because +34717 is an add-on code and is already valued as an additional service. It is not subject to the 50 percent reduction rule that applies to non-add-on surgical codes.
One revised code (35701) and two new codes (35702 and 35703) specify the exploration of an artery without any other surgical repair:
35701 Exploration not followed by surgical repair, artery; neck (eg, carotid, subclavian)
35702 upper extremity (eg, axillary, brachial, radial, ulnar)
35703 lower extremity (eg, common femoral, deep femoral, superficial femoral, popliteal, tibial peroneal)
These codes are categorized by arteries of the neck, upper extremity, or lower extremity. The older codes (35721, 35741, and 35761), which were used to specify the exact artery explored, were deleted.
Heart Valve Repairs
New emerging technologies have been introduced for heart valve repairs. Below are the five new Category III codes added for mitral and tricuspid valve repairs and a short description of the novel technologies.
Transapical Mitral Valve Repair:
0543T Transapical mitral valve repair, including transthoracic echocardiography, when performed, with placement of artificial chordae tendineae
The NeoChord DS1000 is the first device clinically approved for mitral valve repair by implantation of neo-chordae in patients with degenerative mitral valve regurgitation.
Transcatheter Mitral Valve Repair:
0544T Transcatheter mitral valve annulus reconstruction, with implantation of adjustable annulus reconstruction device, percutaneous approach including transseptal puncture
The MitraClipTM and the Cardioband techniques are effective alternatives for repairing the mitral valve in high-risk patients with mitral regurgitation.
Transcatheter Tricuspid Valve Repair:
0545T Transcatheter tricuspid valve annulus reconstruction with implantation of adjustable annulus reconstruction device, percutaneous approach
Use this code to report tricuspid valve repair using one of these devices:
- Trialign: applied to the annulus
- TricinchTM: applied to the annulus
- MitraClipTM: applied to the tricuspid leaflets
- Forma: balloon attachment across the tricuspid valve
- Tric valve®: self-expanding valve designed for implantation in the superior and inferior vena cava
CPT® +0569T and +0570T are new add-on codes referring to the initial and any additional prostheses implanted percutaneously during the same session, respectively.
+0569T Transcatheter tricuspid valve repair, percutaneous approach; initial prosthesis
+0570T Transcatheter tricuspid valve repair, percutaneous approach; each additional prosthesis during same session (List separately in addition to code for primary procedure)
New codes 0544T, 0545T, +0569T, and +0570T include vascular access, cardiac catheterization, deployment, adjustment of the device(s), and access vessel closure.
Cardioverter-Defibrillator With Substernal Electrode
There are now three types of implantable cardioverter-defibrillators (ICDs). In addition to the existing codes for transvenous and subcutaneous ICDs, CPT® has added new codes for substernal ICDs. The substernal cardioverter-defibrillator system consists of a pulse generator and at least one substernal electrode. The 10 new Category III codes range from 0571T to 0580T.
- Transvenous ICD (TV-ICD): Use existing codes 33216, 33217, 33249, 33262, 33263, and 33264; there are no changes for 2020.
- Subcutaneous ICD (S-ICD): Use existing codes 33270, 33271, 33272, 33273, 93260, and 93261; there are no changes for 2020.
- Substernal ICD: Use new Category III codes 0571T-0580T for the insertion, removal, repositioning, programming, interrogation, etc., of a substernal ICD.
ICD code selection is based on two key elements:
- Type: TV-ICD, S-ICD, or substernal ICD
- Service rendered: insertion, removal, repositioning, etc.
Read the operative report carefully to make sure you are coding the appropriate procedure and type of device.
Iliac Arteriovenous Anastomosis Implant Placement
High blood pressure is a leading cause of heart attacks and strokes. When patients do not respond to treatment following being prescribed at least three antihypertensive drug regimens, it is considered uncontrolled hypertension. The ROX Coupler is a novel technology designed to treat patients with uncontrolled hypertension.
A new category III code (0553T) has been added to describe this technology. It includes the entire service: catheterization of the iliac arteries and veins, all procedural imaging and imaging guidance, creation of the AV fistula, angioplasty and/or stent placement in the iliac or femoral artery/vein, and placement of a device to maintain direct flow from the iliac artery to the iliac vein. Ultrasound guidance for puncture of the artery and vein should not be separately reported as the code includes all the imaging guidance procedures.
0553T Percutaneous transcatheter placement of iliac arteriovenous anastomosis implant, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention