Cardiology Coding Alert

Ease into the 25 new ECMO codes with a look at how they’re divided.

Love it or hate it, each year’s new set of CPT® codes never ignores cardiology. From minor wording changes to shifting whole sections from Category III, here are the codes you can expect to start using when CPT® 2015 goes into effect Jan. 1, 2015.

• Implantable defibrillator: CPT® 2015 revises more than a dozen codes that in 2014 referred to a pacing cardioverter-defibrillator or a cardioverter-defibrillator. In 2015, the following codes instead refer to an implantable defibrillator: 33215-33220, 33223-+33225, 33230, 33231, 33240, 33241, 33243-33249, 33262-33264. Similarly, device evaluation codes 93287, 93295, and 93296 delete cardioverter so the codes refer to implantable defibrillators. Codes 93282-93284 and 93289 have a slightly different revision that adds transvenous, as well, replacing “implantable cardioverter-defibrillator” with “transvenous implantable defibrillator.” Electrophysiologic evaluation code 93642 also adds transvenous to specify the type of defibrillator.
• S-ICD: CPT® 2015 moves the codes for subcutaneous implantable cardioverter defibrillators (S-ICDs) from Category III to Category I. The new codes are 33270-33273 for insertion, replacement, and repositioning type services. For evaluation type services, you’ll turn to 93260-93261 and 93644. CPT® 2015 will delete Cat. III S-ICD codes 0319T-0328T.
• Mitral valve repair: If your cardiologist performs percutaneous transcatheter mitral valve repair, in 2015 you’ll use 33418 for the initial prosthesis and +33419 for one or more additional prostheses at the same encounter. With the addition of these codes, CPT® deletes the Cat. III codes 0343T and 0344T.

             o Tip: You’ll still turn to Cat. III for at least one mitral valve repair code: 0345T (Transcatheter mitral valve repair percutaneous approach via the coronary sinus).

• ECMO: You’ll have 25 new codes for extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS). The codes cover initiation (33946-33947), daily management (33948-33949), cannula insertion (33951-33959), cannula repositioning (33962-33964), cannula removal (33965-33966, 33969, 33984-33986), arterial exposure (+33987), left heart vent insertion (33988), and left heart vent removal (33989). To make room for these new codes, CPT® 2015 deletes 33960-33961 (Prolonged extracorporeal circulation …) and 36822 (Insertion of cannula[s] …).
• FEVAR: CPT® 2015 adds another coding option to fenestrated endovascular aortic aneurysm repair (FEVAR). For physician planning of the endograft, you’ll be able to report new code 34839 (Physician planning of a patient-specific fenestrated visceral aortic endograft requiring a minimum of 90 minutes of physician time).
• Carotid stent placement: Codes 37215-37216 will see revisions, adding the underlined language: Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation. 
• Carotid/innominate stent placement: CPT® 2015 adds a new code for antegrade stent placement in the intrathoracic common carotid or innominate artery, 37218 (Transcatheter placement of intravascular stent[s], intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation). 

             o You’ll notice the similarity to the 2014 code added for retrograde services, 37217 (Transcatheter placement of an intravascular stent[s], intrathoracic common carotid artery or innominate artery by retrograde treatment, via open ipsilateral cervical carotid artery exposure, including angioplasty, when performed, and radiological supervision and interpretation). Note that in 2015, CPT® will make  minor revisions to 37217, deleting “an” before intravascular and “via” before open to better match 37217 to 37218. 

             o Codes 0075T and +0076T will no longer apply to intrathoracic carotid services, but in 2015 they will apply to open services, as well as percutaneous services, with this new beginning to the  descriptors: Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision and interpretation, open or percutaneous.

• TEE for guidance: CPT® 2015 adds a new code for transesophageal echocardiography (TEE) used to guide transcatheter procedures on the heart and great vessels. See “9 Steps Help You Use New TEE Code 93355 Correctly From Day 1” in this issue for more details.
• Carotid intima thickness: You’ll have a new code for measuring carotid wall thickness and atheroma, or fatty deposit, evaluation, 93895 (Quantitative carotid intima media thickness and carotid atheroma evaluation, bilateral). 
• Chronic care management: Complex chronic care coordination code 99487 will get an update, becoming complex chronic care management. The new descriptor provides a list of required elements, including 60 minutes of clinical staff time per month. You'll continue to use +99489 for each additional 30 minutes. Note that CPT® 2015 deletes 99488, which you previously used to report the first hour of clinical staff time with a face to face visit. For cases that don't meet the "complex" requirements, you’ll have new code 99490 for other chronic care management services.

Stay tuned: Cardiology Coding Alert will cover the changes in depth in the upcoming issues.