Cardiology Coding Alert

CPT® 2016:

Deepen Your Understanding of TPVI With Expert Insights

Discover when you can report additional codes with this $1,345 procedure.

We're almost halfway through 2016, and that makes it a good time to check in and find answers to any lingering questions about the year's new codes. Here's a closer look at proper use of the new code for transcatheter pulmonary valve implantation (TPVI).

Clue In to Typical TPVI patient

TPVI is a useful approach to valve implant for patients who have had multiple heart surgeries, such as children with congenital heart defects or adults who had those same types of operations as children, said Robert N. Piana, MD, FACC, a representative to the CPT® advisory committee, presenting at the AMA CPT® and RBRVS 2016 Annual Symposium's cardiovascular session.

The benefit of TPVI's transcatheter approach is that the patient can have the procedure in the cath lab and go home the next day rather than risking surgery in a chest full of fibrosis and scarring from previous surgeries, he said.

Example: A typical patient would be a 26-year-old male born with tetralogy of Fallot, Piana explained. This typical patient previously required a "Blalock-Taussig shunt followed by complete repair using an RV/PA conduit." Over the years he has had three surgical revisions and now "has once again developed conduit stenosis and insufficiency." The patient should feel better after the procedure because the TPVI treats the insufficiency. Note that the patient may require a distinct, separately reportable procedure at the same session, such as an ablation.

TPVI code: In 2016, you should report 33477 (Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed). CPT® added 33477 and deleted your previous option 0262T (Implantation of catheter-delivered prosthetic pulmonary valve, endovascular approach).

3 Tips for Cleaner TPVI Claims

Below are three tips that Piana offered to help with understanding proper use of the new code.

1. Melody valve: You may see the documentation for this procedure refer to a Melody valve, which is from the bovine jugular vein, Piana said.

2. Outflow tract: The code for the procedure includes necessary steps such as mounting the valve on a device and reconstructing the outflow tract.

Putting one or more stents in the outflow tract is a standard part of the procedure, so don't report that placement separately, Piana said.

3. Distinct areas: Although you should not separately report stenting of the valve delivery site, if the patient has a pulmonary artery stenosis at a separate site with separate indications, you may report that separately with a code such as 37236 (Transcatheter placement of an intravascular stent[s] [except lower extremity artery[s] for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary], open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery), Piana said.

Similarly, if the patient requires percutaneous transluminal angioplasty (PTA), you may report it separately, if it's distinct from the TPVI, using a code such as 92997 (Percutaneous transluminal pulmonary artery balloon angioplasty; single vessel), Piana said. But if the PTA is related to the TPVI, you should not tack on a PTA code.

Factor In These Final 33477 Facts

Guidelines: CPT® provides a long list of guidelines with new code 33477. Be sure to read them carefully before you code. CPT® designed 33477 as a comprehensive code that includes necessary work such as percutaneous access; advancing, repositioning, and deploying the device; and radiological guidance. As the previous section explained, there are times when reporting an additional code is correct, but be sure to check the guidelines for instructions before you make your final code choice.

Reimbursement: The reward for proper use of the code is $1,345.17 based on Medicare's national payment rate in 2016. TPVI is a long and complex procedure, Piana said. The procedure has 25 work RVUs, putting it in the same range as transcatheter aortic valve replacement codes. TPVI is on the new technology list to be reviewed in three years, Piana said.

Coverage: There is a catch, though. Not all local MACs cover 33477, so be sure to check your payer's LCDs. You may find 33477 listed in the LCD for non-covered services.

Although Medicare lists 33477 with status A, meaning Active Code, the full definition of that status spells out why coverage is at the MAC's discretion: "These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an 'A' indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy."