Cardiology Coding Alert

Plus: The bundling trend could bring reimbursement woes with these EP and PV changes.

If you like to be the first to know about potential new codes, we've got a site you need to know.

To find summaries of CPT Codes; Editorial Panel meeting actions -- such as accepting code proposals -- check out the documents at www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/cpt-summary-panel-actions.page.

What's in store for cardiology? "Once again, it looks as though the cardiology specialty will be heavily impacted with code changes for 2013. Looking at the proposed changes for new codes and revised codes, we are looking to take another hit on reimbursement. The goal over the past few years, it appears, is to completely streamline component coding for cardiology related procedures," says Terry A. Fletcher, BS, CPC, CCS-P, CCS, CEMC, CCC, CMSCS, CMC, of California-based Terry Fletcher Consulting.

Remember: These changes are tentative. The final CPT® 2013 codes won't be finalized until the fall of 2012.

Prepare to Learn New PCI Codes

Percutaneous coronary intervention (PCI) codes are on the list for possible overhaul, notes Fletcher. And that means you could say so long to some of your most commonly used codes.

CPT® may delete:

• 92980-92981, Transcatheter placement of an intracoronary stent(s) ...
• 92982 and 92984, Percutaneous transluminal coronary balloon angioplasty ...
• 92995-92996, Percutaneous transluminal coronary atherectomy ...

To fill the void, you could see 13 new PCI codes. You can get a sense of how big a change this could be from the panel's reference to accepting "revisions of cross references which restructures the entire section."

Catch Potential Cardiac Cath Note Changes

The possible PCI changes don't end with new codes. The panel also notes an expected "Revision of code instructions to address inappropriate use of diagnostic cardiac catheterization in conjunction with percutaneous coronary interventions at the same session." This change could have a major impact on reimbursement depending on how the instructions guide coding for patients who present for a heart cath and then have an intervention performed, says Fletcher.

Diagnostic cardiac catheterizations may see other instruction revisions, too. For instance, you may see an update to the Surgery/Cardiovascular System, Radiology, and Medicine Section notes to clarify reporting aortography with diagnostic cardiac catheterization. The goal is to bring the instructions in line with changes made to cardiac cath coding in 2011.

RHC: Another area to watch for cardiac caths is a shortened list of primary codes for +93566 (Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective right ventricular or right atrial angiography [List separately in addition to code for primary procedure]) and +93568 (... f or pulmonary angiography [List separately in addition to code for primary procedure]).

The planned revision removes left heart cath and coronary/bypass angiography codes 93452, 93454, 93455, 93458, and 93459 from 2012's listing of 93530-93533 and 93451-93461. The proposed list of primary codes all include right heart catheterization (RHC), which makes sense anatomically for the affected add-on codes: right chamber imaging (+93566) and pulmonary angiography (+93568).

Plan on 1-Stop-Shop Angiography Codes

Peripheral vascular practices will likely have to deal with bundling of cath placement and imaging for cervicocerebral angiography, says Fletcher. "This is in the head and neck area," she explains.

"Currently when a selective carotid angiography is performed, there is a catheter placement and a radiology code reported for the complete procedure," Fletcher says. For example, in 2012 you might report 75676 (Angiography, carotid, cervical, unilateral, radiological supervision and interpretation) and 36216 (Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family).

The proposed 2013 codes "will include any non-selective imaging, any non-selective catheter codes, and combine even more services noted to be routinely performed together," says Fletcher. The panel accepted the following:

• New guidelines and 8 new codes (36xxx) for "bundled non-selective and selective arterial catheter placement and diagnostic imaging of the aortic arch, carotid, and vertebral arteries"
• Deletion of cervicocerebral, carotid, and vertebral/cervical/intracranial angiography codes 75650 and 75660-75685
• New instructions for carotid angiography.

Bundle Up for EP, Too

Electrophysiology (EP) changes look set to bring more bundling. If combining the services brings lower reimbursement, then "EP updates that will not be popular will be the proposed inclusion of EP evaluations with EP ablations," says Fletcher. The changes you may see include:

• Deletion of 93651 (Intracardiac catheter ablation of arrhythmogenic focus; for treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathways, accessory atrioventricular connections or other atrial foci, singly or in combination) and 93652 (Intracardiac catheter ablation of arrhythmogenic focus; for treatment of ventricular tachycardia)
• Five new 9365x codes "to report intracardiac catheter ablation of arrhythmogenic focus with comprehensive electrophysiologic evaluation services"
• Instructions for the new comprehensive EP evaluation codes to include implantable cardioverter-defibrillator reprogramming.

The original request asked for a "code bundling an EP study with AF ablation and add-on codes for additional ablation lesions/lesion sets."

Check for Thrombolysis, Cat. III Changes, Too

Some other changes you may see include:

• Four new 372xx codes that bundle noncoronary transcatheter thrombolysis and radiological supervision and interpretation (and consequently the deletion of thrombolytic therapy cath codes 37201and 37209; deletion of related RS&I code 75900; and revisions to related RS&I codes 75896 and 75898)
• Revision of subsection guidelines for 93668 (Peripheral arterial disease [PAD] rehabilitation, per session)
• Conversion of 0048T (Implantation of a ventricular assist device, extracorporeal, percutaneous transseptal access, single or dual cannulation) and 0050T (Removal of a ventricular assist device, extracorporeal, percutaneous transseptal access, single or dual cannulation) to Cat. I 929xx codes with accompanying instructional revisions
• Revision of 0206T (Algorithmic analysis, remote, of electrocardiographic-derived data with computer probability assessment, including report)
• A new Cat. III code for "non-invasive calculation and analysis of central arterial pressure waveforms with interpretation and report."

Note: For more on possible new codes, see "0256T-0259T Decision Memo Is a Must-Read for TAVR Practices" and "+93463 Solves the Vasoreactivity Question" also in this issue.

And to be sure you're keeping up with all coding changes, review the Cat. III codes effective Jan. 1, 2012, and July 1, 2012, posted at www.ama-assn.org/resources/doc/cpt/cptcat3codes.pdf. Changes include new Cat. III codes for insertion, removal, programming, and interrogation of implantable ischemic monitors or their components.