Cardiology Coding Alert

Here's how the 2017 MPFS links cardiology to the new psychiatric CoCM codes.

You've made it through ICD-10 and CPT^® updates for 2017. Now it's time to dig deep and find some energy to give that same careful attention to HCPCS. If you report argatroban or provide care for patients with behavioral health issues following cardiology care, the updated code set has changes you need to know.

Add 2 New Codes for Anticoagulant Argatroban

As of Jan. 1, 2017, two new codes are available for argatroban. The first code is appropriate for patients who require the drug for reasons not related to end stage renal disease (ESRD). The second code is for patients who need the drug for ESRD-related reasons.

Here are the codes:

• J0883, Injection, argatroban, 1 mg (for non-ESRD use)
• J0884, Injection, argatroban, 1 mg (for ESRD on dialysis).

This anticoagulant, which you may see referred to by the name Acova, helps treat and prevent blood clots in patients with low platelet levels (thrombocytopenia) due to heparin. Patients also may receive argatroban during percutaneous coronary procedures if they have, or are at risk for, heparin-induced thrombocytopenia (HIT).

"Argatroban would more commonly be used in the inpatient setting because it's specifically used for heparin-induced thrombocytopenia, which is not very common, and thrombosis," says Ray Cathey, PA, MHS, CMSCS, CHCI, president of Medical Management Dimensions in Stockton, Calif. Physicians may use argatroban while switching patients from heparin to warfarin, Cathey adds. It is given intravenously and has a very short half-life of less than one hour, he says.

In 2016, there was a C code available for this drug, C9121 (Injection, argatroban, per 5 mg). HCPCS 2017 deletes this code.

Remember: Physician coders do not use C codes. CMS initially created C codes for use on Hospital Outpatient Prospective Payment System (OPPS) claims, but a limited number of other providers may use the codes, such as Critical Access Hospitals (CAHs) and Indian Health Service (IHS) hospitals.

Unit tip: If you are a coder who used C9121, then be sure to note that there is a big difference in your unit reporting between the old and new codes:

• Old code C9121, 1 unit per 5 mg
• New codes J0883 and J0884, 1 unit per 1 mg.

See What's New for CoCM Coding

HCPCS 2017 also adds codes for the psychiatric collaborative care model (CoCM). The model involves a provider and behavioral health care manager working with a psychiatric consultant. "This care model has been shown to improve behavioral health outcomes for patients and save money," according to Andy Slavitt, CMS acting administrator, and Patrick Conway, MD, MSc, CMS acting principal deputy administrator and chief medical officer, in a Nov. 2, 2016, post on the CMS blog.

While typical primary care providers will likely perform these services most frequently, the Medicare Physician Fee Schedule (MPFS) 2017 Final Rule also lists cardiology as one of the other possible reporting specialties, offering the example of status-post acute myocardial infarction where co-morbid depression is common. The MPFS is online at www.gpo.gov/fdsys/pkg/FR-2016-11-15/pdf/2016-26668.pdf.

The codes are below. According to the MPFS, you can expect to see similar codes in a future edition of CPT^® (bold added for emphasis):

• G0502, Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: 

          o Outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional; 
          o Initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan; 
          o Review by the psychiatric consultant with modifications of the plan if recommended; 
          o Entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric     consultant; and
          o Provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies. 

• G0503, Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: 

          o Tracking patient follow-up and progress using the registry, with appropriate documentation;
          o Participation in weekly caseload consultation with the psychiatric consultant;
          o Ongoing collaboration with and coordination of the patient's mental health care with the treating physician or other qualified health care professional and any other treating mental health providers;
          o Additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant;
          o Provision of brief interventions using evidence-based techniques such as behavioral activation, » motivational interviewing, and other focused treatment strategies;
          o Monitoring of patient outcomes using validated rating scales; and
          o Relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment

• G0504, Initial or subsequent psychiatric collab­orative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional (List separately in addition to code for primary procedure); (Use G0504 in conjunction with G0502, G0503).

Timing tip: Code G0502 is for the first month and G0503 is for each subsequent month. The MPFS states, "A new episode of care would start after a break in episode of 6 calendar months or more."