Cardiology Coding Alert

Don’t ignore the valve repair codes effective in January but absent from the codebook.

Up and coming cardiology services from subcutaneous implantable cardioverter defibrillator implant to renal sympathetic denervation have their own Category III codes. Be sure you stay on top of these easy to miss coding options.

1. 0319T-0328T: S-ICD Codes Stay in Cat. III

Category III codes 0319T-0328T, which apply to subcutaneous implantable defibrillator (S-ICD) services, are marked as new in CPT® 2014 resources. But you should have been using these codes since their Jan. 1, 2013, implementation. The codes are marked as new because the timing of their introduction kept them out of the 2013 hard copy codebook.

Remember: These Cat. III codes apply to S-ICDs, which means the physician implants both the device and electrode subcutaneously, rather than implanting the electrode intravenously.

2. 0331T-0332T: Go With Option 2 for SPECT

Additional codes marked as new but implemented in 2013 are these codes for myocardial sympathetic innervation imaging:

• 0331T, Myocardial sympathetic innervation imaging, planar qualitative and quantitative assessment
  
• 0332T, … with tomographic SPECT.
  

These codes were implemented July 1, 2013. They apply to nuclear medicine services, also called gamma-scintigraphy. Physicians may order the imaging to help evaluate a congestive heart failure patient, specifically to assess the sympathetic nerves that supply the heart. For the 0331T service, the provider injects a radioactive imagingagent and takes planar images of the patient’s thorax at intervals, such as at 15 minutes and 4 hours after injection. Agent uptake and washout is reviewed based on the different images. If SPECT imaging is performed along with the planar images, then 0332T would be appropriate.

3. 0338T-0339T: 1-Sided or 2 Decides Renal Denervation

The AMA released renal denervation codes 0338T-0339T in July 2013, but their official implementation date is Jan. 1, 2014:

• 0338T, Transcatheter renal sympathetic denervation, percutaneous approach including arterial puncture, selective catheter placement(s) renal artery(ies), fluoroscopy, contrast injection(s), intraprocedural roadmapping and radiological supervision and interpretation, including pressure gradient measurements, flush aortogram and diagnostic renal angiography when performed; unilateral
• 0339T, … bilateral 
  

For these services, the physician makes a small puncture at the vascular access site and maneuvers a catheter through the access vessel to the aorta. He images the renal arteries. He then uses a guiding catheter to access a renal artery and delivers an ablation catheter to that renal artery. He uses radiofrequency energy to perform the ablation. If he performs the service on one side, use 0338T. For a bilateral service, you should report 0339T instead.

Caution: You should not report renal catheterization and angiography codes 36251-36254 with 0338T or 0339T.

4. 0343T-0345T: Match Mitral Repair to Approach

Some of the codes implemented Jan. 1, 2014, didn’t make it into the 2014 manual. These Cat. III codes aren’t slated for official hard-copy publication until the 2015 codebook:

• 0343T, Transcatheter mitral valve repair percutaneous approach including transseptal puncture when performed; initial prosthesis
  
• 0344T, … additional prosthesis(es) during same session (List separately in addition to code for primary procedure) (Use 0343T in conjunction with 0344T)
  
• 0345T, Transcatheter mitral valve repair percutaneous approach via the coronary sinus
  

To help you report these codes correctly, note that 0343T is appropriate for the initial prosthesis placed at that session. According to guidelines with the code, 0343T is appropriate for that prosthesis “even when [the] patient has an existing mitral valve prosthesis in place.”

Also note that you should not report left and right heart cath codes 93451-93453 and 93456-93461 for cath services inherent to 0343T-0345T. Similarly, reporting 93454 with 0345T would be inappropriate.

Remember: Codes 0343T-0345T won’t be in the codebook until 2015, but they are effective Jan. 1, 2014. Consequently, you must report them when they reflect the service performed. To stay up-to-date on current Cat. III codes, review the PDF at www.ama-assn.org/resources/doc/cpt/cptcat3codes.pdf.