Cardiology Coding Alert

Don’t skimp — Review Cardiovascular, Nervous System, Radiology, and Medicine sections.

Recent issues of Cardiology Coding Alert have revealed proposed changes to cardiology for CPT® 2016. The AMA has released the almost final, preproduction version of the updated code set, so let’s take a look at the Category I changes it includes.

Move to 33477 for Pulmonary Valve Implant

As expected, CPT® 2016 deletes 0262T (Implantation of catheter-delivered prosthetic pulmonary valve, endovascular approach) and replaces it with 33477 (Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed).

The new code number places the service in with other pulmonary valve surgical procedures.

Remember Nonintracranial, Noncoronary for These Thrombectomy/Infusion Codes

Thrombectomy: CPT® 2016 adds “non-intracranial” to the existing descriptors for 37184-+37186, which represent noncoronary (and now explicitly nonintracranial) arterial or arterial bypass graft percutaneous transluminal thrombectomy.

Similarly, CPT® 2016 spells out that 37211 is appropriate for nonintracranial services: Transcatheter therapy, arterial infusion for thrombolysis other than coronary or intracranial …

Remember that as a cardiology coder, you’re more likely to need the codes for coronary vessels, says Christina Neighbors, MA, CPC, CCC, coding quality auditor for Conifer Health Solutions. Those codes include 92975 (Thrombolysis coronary; by intracoronary infusion, including selective coronary angiography) and 92977 (Thrombolysis coronary; by intravenous infusion) and appear to be unchanged for 2016. 

Nonthrombolysis infusion: You’ll find 37202 (Transcatheter therapy, infusion other than for thrombolysis, any type [e.g., spasmolytic, vasoconstrictive]) and 75896 (Transcatheter therapy, infusion other than for thrombolysis, radiological supervision and interpretation) on the deleted list for 2016. 

All of these changes support the addition of new intracranial codes:

• 61645, Percutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis, intracranial, any method, including diagnostic angiography, fluoroscopic guidance, catheter placement, and intraprocedural pharmacological thrombolytic injection(s).
• 61650, Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; initial vascular territory
• +61651, … each additional vascular territory (List separately in addition to code for primary procedure).

Tip: While a cardiologist is unlikely to provide the intracranial services, if you’re also responsible for coding for radiology or vascular physicians, depending on their scope of practice, you may need to use these codes, Neighbors says.

Bundle Up for Accurate Noncoronary IVUS Coding

CPT® 2016 deletes +37250 and +37251 for noncoronary intravascular ultrasound (IVUS) along with associated S&I codes 75945 and +75946.

In place of these separate codes, you’ll have combination codes to use:

• +37252, Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure)
• +37253, … each additional noncoronary vessel (List separately in addition to code for primary procedure).

See 93050 for Central Arterial Pressures

If your practice performs arterial pressure waveform analysis, expect to toss out Cat. III code 0311T (Non-invasive calculation and analysis of central arterial pressure waveforms with interpretation and report).

The code set to replace it is 93050 (Arterial pressure waveform analysis for assessment of central arterial pressures, includes obtaining waveform[s], digitization and application of nonlinear mathematical transformations to determine central arterial pressures and augmentation index, with interpretation and report, upper extremity artery, non-invasive).

Coming up: Future issues of Cardiology Coding Alert will cover the final changes in depth. You also can review these earlier articles on the proposed changes:

• Cardiology Coding Alert, Vol.18, No. 8, “CPT® 2016: Abdominal Aorta Ultrasound Screening May Appear in CPT® in January”
• Cardiology Coding Alert, Vol. 18, No. 7, “CPT® 2016: Prepare for These 7 Possible Cardiology-Related Changes.”

Proposed changes that didn’t make it into the preproduction file include a new abdominal aorta ultrasound screening code and changes to moderate sedation codes.