UHC: Notification, Prior Authorization Code Changes

UnitedHealthcare (UHC) recently announced it is making some changes to its Cardiology and Radiology Notification and Prior Authorization Programs. UHC says the procedure code lists for both programs result from annual CPT® and HCPCS Level II code changes for 2011.

Cardiology

Participating physicians are required to notify UHC prior to performing a diagnostic catheter or electrophysiology implant. Certain codes previously used to provide notification to the carrier for cardiac procedures under the Cardiology Notification Program are no longer in use.

Certified Cardiology Coder (CCC) Credential

New diagnostic cardiac catheterization CPT® codes requiring prior notification, effective Jan. 1, 2011 are:

  • 93452  Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed
  • 93453  Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed
  • 93454  Catheter placement in coronary artery(s) including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation
  • 93455  Catheter placement in coronary artery(s) including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography
  • 93456  Catheter placement in coronary artery(s) including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization
  • 93457  Catheter placement in coronary artery(s) including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization
  • 93458  Catheter placement in coronary artery(s) including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed
  • 93459  Catheter placement in coronary artery(s) including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography
  • 93460   Catheter placement in coronary artery(s) including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed
  • 93461  Catheter placement in coronary artery(s) including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass left angiography

Retrospective notification may be submitted within 14 calendar days of the date of service. For procedures performed on or before Dec. 31, 2010, retrospective notification received on or after Jan. 1, 2011 will be routed to the new CPT® codes and paid accordingly.

Visit UnitedHealtcareOnline.com for up-to-date program information (including an updated CPT® crosswalk table).

Radiology

Also effective Jan. 1, 2011, UHC  is making changes to the procedure code list for the Radiology Notification and Prior Authorization program.

The following three new CPT® codes for diagnostic imaging procedures and six new HCPCS Level II codes are being added to the list of procedure codes requiring physician prior authorization:

  • C8931  Magnetic resonance angiography with contrast, spinal canal and contents
  • C8932  Magnetic resonance angiography without contrast, spinal canal and contents
  • C8933  Magnetic resonance angiography without contrast followed by with contrast, spinal canal and contents
  • C8934  Magnetic resonance angiography with contrast, upper extremity
  • C8935  Magnetic resonance angiography without contrast, upper extremity
  • C8936  Magnetic resonance angiography without contrast followed by with contrast, upper extremity
  • 74176  Computed tomography, abdomen and pelvis; without contrast material
  • 74177  Computed tomography, abdomen and pelvis; with contrast material
  • 74178  Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by with contrast material(s) and further sections in one or both body regions

HCPCS Level II codes will be mapped to the appropriate corresponding CPT® code. Claims should be submitted with the CPT® code for which the notification or prior authorization number was received.

The full list of procedure codes requiring notification or prior authorization and an updated CPT® crosswalk table for 2011 is available on www.UnitedHealthcareOnline.com.

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