Cardiology Coding Alert

Code Carefully for Medical Closure Devices, and Increase Chances of Reimbursement

Rumor had it that vascular closure devices would be unbundled from cardiac catheterizations after November, 1998, thus allowing for separate, and higher, reimbursement.

Is it true? Unfortunately, expert sources say, no.

The hearsay gained momentum when the Coding and Nomenclature Committee of the American College Cardiology (ACC) met in November 1998 to discuss the issue.

But ACC sources tell us that, after checking with the cardiac cath committee, the group agreed that vascular access site hemostatis by any technique -- manual or mechanical -- remains an integral part of the cath and does not warrant a separate code.

The committee is, however, open to reviewing additional information and will consider proposals to address this matter further.

The CPT Advisory Committee for the American Medical Association is also currently reviewing a proposal for a specific procedural code by a mechanical device manufacturer, says ACCs advisory committee member James C. Blankenship, MD, FACC.

Does New Technology Help or Hurt

The most uncomfortable parts of the catheterization procedure for patients is the immobility required and the nurses intense direct pressure at the site close the arterial access.

But with a vascular closure device, femoral artery punctures can be quickly and effectively closed without as much post-procedure discomfort.

Such technology could also allow many current inpatient procedures to be performed on an outpatient basis.

Yet Susan Stradley, CPC, CCS-P, points out that while the device may make life easier for the patient, it does not necessarily make reimbursement higher for the physician, says the senior consultant for Medical Group of Elliott Davis and Co., LLP, headquartered in Greenville, SC.

Heres why: The way most payers consider the repair of the femoral artery after a catheterization, is that the physician created the puncture in order to do the procedure, so its up to him or her to repair it as part of that procedure. They dont consider which method is more comfortable for the patient, she explains.

If using the new technology adds significantly more work for the physician, or significantly increases the risk for the patient, Stradley explains. In the case of vascular closure devices, neither is the case, she adds.

Tips for Reimbursement

But there still may be a slight chance of getting reimbursed from some payers, Stradley says.

Make phone calls to your five largest insurance carriers and ask them if they consider the device to be consistently bundled, or if they will consider it on a case-by-case basis, advises Stradley.

Be sure to check with your states Medicare carrier as well, she notes. For example, Blue Cross and Blue Shield of Alabama, which is the carrier for Georgia Medicare, does not reimburse separately for vascular closure devices.

If you get a preliminary go-ahead from your payer, use code 93799 (unlisted cardiovascular service or procedure). However, dont just code 93799 automatically, warns Stradley. Automatically using code 93799 will probably delay your claims because they must be processed by hand. This could cause the time to process the claim to take up to three months, not to mention the appeal, she says.

So by submitting a trial run with each payer, youll get a sense of their response and be able to judge whether its worth the effort.

Beth Thomas, RN, Angio-Seal coordinator with Angio-Seal Information Service in St. Louis, MO, points out that coders will need to provide documentation to support use of the code 93799 by including the following:

1. Operative report or catheterization report.

2. Past and present diagnosing, appropriate health risk factors.

3. Rationale for ordering the procedure/service. For example, a patients mobility is limited for four to six weeks following the procedure because a substantial hematoma forms around the access site.

4. The patients progress, response to and changes in treatment, and any revision of diagnosis.

Even if you dont get reimbursed, using vascular closing devices may still be more cost-effective in the long run, Thomas points out.

You have to also consider the labor to administer the compression closure technique, and the reputation that will spread regarding this more comfortable procedure, she says.

Tip: Dont make the mistake of using codes 35201 and 35226 when billing for a cardiac catheterization. These blood vessel repair codes should only be billed when the repair procedure is the primary one performed, as in a pseudoaneurysm or occlusion of the artery. These codes shouldnt be used in conjunction with any cath procedure for diagnostic or therapeutic intent.