Cardiology Coding Alert

Although CPT 2004 doesn't bring substantial changes for cardiology coders, you'll have a new code to use when your cardiologist performs aneurysm prosthesis insertions for abdominal aortic aneurysm (AAA). This change could increase your coding accuracy for these procedures.

Use 34805 for Aortic Aneurysm Prosthesis 
 
CPT 2004 elevates an AAA prosthesis code from emerging technology status (Category III) code to an official CPT code. Code 34805 has the same definition as last year's Category III code 0002T: Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using aorto-uniiliac or aorto-unifemoral prosthesis.
 
Many cardiology coders are seeing an increase in endovascular prosthesis billing, says Jim Collins, CHCC, CPC, a cardiology coding consultant and president of Compliant MD Inc. Even if your cardiologist isn't implanting these devices yet, you could see them in your practice very soon because the endovascular approach to aneurysm repair is frequently more advantageous than direct/open repair, he says.
 
The percutaneous prosthesis placement for this procedure is analogous to coronary stent placement for the treatment of coronary artery disease, says Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.
 
During this procedure, the cardiologist, using fluoroscopic guidance, introduces a compressed prosthesis through arteries in the groin to the aneurysm site and expands the prosthesis after it is positioned in the aorta. Many times this will necessitate using a balloon (similar to the one used for angioplasty procedures) and placing stents inside the prosthesis to properly "seat" it.  
 
(Watch future issues of Cardiology Coding Alert for more information on coding AAA prosthesis procedures.)

Don't Look for Starred Procedures
 
You may find that your surgical procedure coding goes more smoothly in 2004. CPT removes the "starred" procedure designation from a number of surgical codes, including several cardio procedure codes.
 
Prior to CPT 2004, a star designation meant that a global package did not apply to the procedure. But many payers, including Medicare, did not recognize the star designation and bundled the pre- and postprocedure services into the main procedure.
 
For instance, CPT 2004 removes stars from 33010 (Pericardiocentesis; initial) and 33011 (... subsequent). In 2003, you could have reported the cardiologist's pericardiocentesis services one day, and then a follow-up E/M service, such as 99214 (Office or other outpatient visit ... established patient ...), on the same day. Medicare and many private insurers, however, would bundle the two services and not pay for the E/M service without a modifier, such as modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). Now, you would report 33010 for the procedure and 99214-25 for the follow-up care.

Learn 7 New Central Venous Access Code Groups 

If your cardiologist places central venous lines, get ready to revamp your billing for these services. Starting Jan. 1, you'll have 27 new catheter and line placement codes to work with, which should help your coding accuracy and reimbursement. 
 
CPT also includes new subsections for line and port placement, revision and removals that will make these codes easier to find.
 
Central venous access devices are basically catheters inserted into the venous central circulation to administer medications and fluids, remove blood and/or monitor the patient's hemodynamic status, Williams says.
 
"We are going to inform all our doctors about the new codes for the central venous procedures so they are aware of the necessary documentation that will be needed to use these codes," says Patricia Gajewski, CPC, with Consultants in Cardiovascular Disease in Erie, Pa.

 In all, the new venous access codes fall into seven subsections: