Understand and Implement New Cardiology Coding Practices
- By Terry Fletcher
- In Billing
- February 1, 2021
- 4 Comments
Make sure your practice is well versed on the new codes and guidelines outlined in the 2021 CPT® code set.
Advancements spurred by innovation, new technology, and expansion of digital medicine services within the cardiology specialty have increased access to healthcare and, in turn, have resulted in improved health outcomes for patients across the country. The 2021 CPT® code set includes expansion for these new technology services, not only in the Category I section but also in the Category III section of the code book. Here’s what you need to know to ensure proper coding in your cardiology practice.
Continuous Cardiac Monitoring and Detection
Technological advances in the field of continuous cardiac monitoring and detection have prompted the addition of codes 93241–93248, along with associated guideline revisions.
93241 External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation
93242 External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; recording (includes connection and initial recording)
93243 External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; scanning analysis with report
93244 External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; review and interpretation
93245 External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation
93246 External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; recording (includes connection and initial recording)
93247 External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; scanning analysis with report
93248 External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; review and interpretation
These new codes describe the utilization of innovative algorithmic technology that works in concert with a patch that is much easier for patients to wear and provides more accurate and complete data for physician interpretation and analysis.
Your practice should use these codes for dates of service on or after Jan. 1, 2021, in place of Category III codes 0295T, 0296T, 0297T, and 0298T, which were deleted.
CPT® code 93241, for example, is for the Zio Patch®, which the Food and Drug Administration (FDA) approved three years ago. This novel technology is used to monitor for many different types of irregular heart rhythms over more than 48 hours and up to seven days. As of Jan. 1, 2021, you will report this with the Category I code 93241, instead of the 2020 Category III codes 0295T and 0297T.
Shunting for Congenital Cardiac Anomalies
You’ll find five new codes in the Cardiovascular System section of your 2021 CPT® code book, including three new shunting procedure codes for congenital cardiac anomalies:
33741 Transcatheter atrial septostomy (TAS) for congenital cardiac anomalies to create effective atrial flow, including all imaging guidance by the proceduralist, when performed, any method (eg, Rashkind, Sang-Park, balloon, cutting balloon, blade)
33745 TIS creation by stent placement for congenital cardiac anomalies to establish effective intracardiac flow, all imaging guidance by the proceduralist when performed, left and right heart diagnostic cardiac catheterization for congenital cardiac anomalies, and target zone angioplasty, when performed; initial intracardiac shunt
+33746 each additional intracardiac shunt location (List separately in addition to the code for the primary service)
Cardiac Assist
In the Cardiac Assist subsection, you’ll find two new codes, as well as revised guidelines for these devices, also known as “impella” devices.
For the insertion of a ventricular assist device in the right heart, report:
33995 Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; right heart, venous access only
For the removal of a ventricular assist device from the right heart, report:
33997 Removal of percutaneous right heart ventricular assist device, venous cannula, at separate and distinct session from insertion
For insertion of a ventricular assist device, codes 33990 Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; left heart, arterial access only and 33991 Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; left heart, both arterial and venous access, with transseptal puncture are revised to specify that the procedure involves the left heart. Code 33990 is reported for arterial-only access, whereas 33991 is used to report an insertion involving both arterial and venous access via a transseptal puncture.
Also, in this section, 33992 Removal of percutaneous left heart ventricular assist device (VAD), arterial or arterial and venous cannula(s) at separate and distinct session from the insertion and 33993 Repositioning of percutaneous right or left heart VAD, with imaging guidance at separate and distinct session from insertion are revised to specify laterality and device. CPT® also clarified that a “replacement” of a percutaneous VAD is reported using implantation codes (33990, 33991, or 33995), and that the “removal” (i.e., 33992, 33997) is not reported when a device is replaced.
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Hello Ms. Fletcher,
I have some questions regarding the new Holter Monitor codes.
I am looking for more descriptive information regarding the “scanning analysis with report” portion of codes 93241, 93243 and 93245?
What documentation should the coder be looking for to verify this was done?
Are these two codes used for both provider based and non-provider based facilities?
Thank you
From the author:
For CPT code 93241 the provider applies an electrocardiographic, or ECG recorder, to the patient who wears it for more than 48 hours, up to seven days, to help detect abnormal heart rates and rhythms. The Holter is “up to 48 hours” so this is longer. This service includes recording, analyzing, compiling, and interpreting the electrocardiographic findings.
Liken your documentation support to what you would use for Holters and Event monitors or the Zio Patch brand. The 93242-93244 are the carve outs to the global code 93241.
i am new to this specialty. What date of service is billed? the date of hook up or the reading?
For RPM or any device monitoring, it is Best Practices to report the service when it is completed, as you might have to produce a report if asked. So the date that the patient returns the device or the date that the physician documents the final read is the best date of service to use for billing. You may find another payer that will allow billing on the date of hook up, but that would be rare.
Terry