Cardiology Coding Alert

Cardiac MRI codes 75557-75564 debuted only two years ago, but CPT decided they were already in need of a facelift. Here are the details on a new flow/velocity code, as well as important news about where to locate cardiac CT/CTA codes.

CPT 2010 deletes all of the 2009 cardiac MRI codes that specify flow/velocity quantification (75558, 75560, 75562, 75564, Cardiac magnetic resonance imaging ...).

New option: To replace them, use new code +75565 (Cardiac magnetic resonance imaging for velocity flow mapping [List separately in addition to code for primary procedure]).

Be sure you catch that +75565 is an add-on code,which CPT instructs you to report in addition to the following existing cardiac MRI codes:

• 75557 -- Cardiac magnetic resonance imaging for morphology and function without contrast material

• 75559 -- ... with stress imaging

• 75561 -- Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences

• 75563 -- ... with stress imaging.

Remember: CMS recently announced it will remove the phrase "blood flow measurement," from the Nationally Noncovered Indications at 220.2(C)(2) of the National Coverage Determinations Manual (www.cms.hhs.gov/mcd/index_list.asp). Your local Medicare contractor now has the power to determine cardiac MRI for blood flow coverage. In 2009, the relevant codes are 75558, 75560,75562, and 75564, but that will change to +75565 in 2010.

The 2009 fee schedule does not price the codes, but the 2010 fee schedule indicates +75565 will have 2.54 global relative value units (RVUs).

CPT also will delete the Category III cardiac computed tomography (CT) imaging codes 0144T-+0151T (Computed tomography, heart ...) and replace them with permanent Category I codes, reported Kenneth P. Brin,MD, PhD, FACC, representing the American College of Cardiology at the AMA's CPT and RBRVS 2010 Annual Symposium in Chicago.

The new codes are 75571-75574:

• 75571 -- Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium

Note: Code 75571 is specific to calcium scoring, which many payers deny because the test is not generally recognized, says Jim Collins, CCC, certified cardiology coder and president of CardiologyCoder.com in Saratoga Springs, N.Y. The MPFS assigns 3.33 global RVUs to this code, but remember that the existence of RVUs doesn't mean CMS automatically covers the service.

• 75572 -- Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed)

Note: Electrophysiologists may use 75572 "in advance of atrial fibrillation ablations and left ventricular lead implants. It provides the anatomical information they need to perform these procedures," Collins explains. Providers incorporate these images into the 3D mapping system in the EP lab to use as a roadmap, he adds. This code has 3.8 global RVUs.

• 75573 -- Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3D image postprocessing, assessment ofLV cardiac function, RV structure and function, and evaluation of venous structures, if performed)

Note: The key to properly applying 75573 is understanding that it is specific to congenital patients, Collins says. Code 75573 has 5.1 global RVUs.

• 75574 -- Computed tomography angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed)

Note: Code 75574 is the only cardiac CT angiography code for 2010, as opposed to your 2009 options of 0146T-0149T. You may use 75574 most often because it is the only one focusing on coronary arteries and grafts, Collins predicts. This code has the most RVUs of the cardiac CT codes, with 16.08 global RVUs.

Guidelines: The CPT manual adds a few rules for the new codes. CPT states that cardiac CT and coronary CTA include:

• "axial source images of the pre-contrast, arterial phase sequence, and venous phase sequence (if performed)"

• the study's 2D and 3D reformatted images, includingcine review.

The guidelines also indicate that for cardiac CT and coronary CTA performed with contrast, you should include any quantitative assessment at the same encounter. And be sure to report only one CT heart service per encounter.