Cardiology Coding Alert

CPT® 2018:

Conquer These Anticoagulant, Cat III, and Observation Code Additions

CPT® adds new anticoagulant codes 93792 and 93793.

From anticoagulant additions, to new total replacement heart system choices, to a notable evaluation and management (E/M) observation care language revision, more CPT® changes are coming your way soon. Make sure your cardiology practice is ready.

Bottom line: These changes will become effective on January 1, 2018, but now is the perfect time to start preparing.

New Total Replacement Heart System Codes Replace Cat III Codes

CPT® 2018 will delete several Category III total replacement heart system codes (0051T, 0052T, and 0053T) and replace them with permanent codes.

Additions: Your new total replacement heart system codes are as follows:

  • 33927 (Implantation of a total replacement heart system (artificial heart) with recipient cardiectomy)
  • 33928 (Removal and replacement of total replacement heart system (artificial heart)
  • +33929 (Removal of a total replacement heart system (artificial heart) for heart transplantation (List separately in addition to code for primary procedure).

CPT® 2018 Strikes Out 99363 and 99364, Adds 93792 and 93793

You can currently report anticoagulant codes 99363 (Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of International Normalized Ratio (INR) testing, patient » » » instructions, dosage adjustment (as needed), and ordering of additional tests; initial 90 days of therapy (must include a minimum of 8 INR measurements) and 99364 (... each subsequent 90 days of therapy (must include a minimum of 3 INR measurements) from the E/M section, but these codes will go the way of the dodo next year. In other words, they're on CPT® 2018's delete list.

Additions: CPT® 2018 will add new codes 93792 (Patient/caregiver training for initiation of home international normalized ratio [INR] monitoring under the direction of a physician or other qualified health care professional ...) and 93793 (Anticoagulant management for a patient taking warfarin, must include review and interpretation of a new home, office, or lab international normalized ratio (INR) test result, patient instructions, dosage adjustment (as needed), and scheduling of additional test(s), when performed) to the cardiovascular section.

"This change helps to better understand the type of service that is being provided," according to Suzan Hauptman, MPM, CPC, CEMC, CEDC AAPC fellow, senior principal of ACE Med Group in Pittsburgh. "Checking a patient's lab results around their INR and adjusting the medication may not require a face-to-face service or the attention of the physician; both two components of most all E/M services."

"Assigning this type of service a code in the medicine section allows the service to be more accurately represented," Hauptman adds.

Add These New Cat III Codes to Your Coding Arsenal

CPT® 2018 will bring you some new Category III options. They are as follows:

  • 0482T (Absolute quantitation of myocardial blood flow, positron emission tomography (PET), rest and stress [List separately in addition to code for primary procedure])
  • 0483T and 0484T (Transcatheter mitral valve implantation/replacement (TMVI) with prosthetic valve...)
  • 0497T and 0498T (External patient-activated, physician- or other qualified health care professional-prescribed, electrocardiographic rhythm derived event recorder without 24 hour attended monitoring ...)
  • 0501T through 0504T (Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary computed tomography angiography data using computation fluid dynamics physiologic simulation software analysis of functional data to assess the severity of coronary artery disease...).

Category III codes: Category III codes (also known as "T-codes") are temporary codes for emerging services. Using the Category III code allows for the collection of specific data about use, efficacy, and outcomes.

Rule:  "If a Category III code is available, this code must be reported instead of a Category I unlisted code," CPT® guidelines in the Category III Codes section state.

From a billing standpoint, keep in mind that Category III codes often apply to services that payers consider investigational/experimental. "This means you may not get reimbursed for the procedure," says Jim Pawloski, BS, MSA, CIRCC, R.T. (R)(CV), interventional radiology technologist/coder at William Beaumont Hospital in Royal Oak, Michigan, and coder at Adreima in Phoenix, Arizona.

Catch This Hospital Observation Care Language Change

If you report hospital observation codes 99217 and 99218-99220, don't miss this E/M language change. All of the descriptors will add the phrase "outpatient hospital."

Revisions: Take a look at 99217 (emphasis added):

  • 99217 (Observation care discharge day management [This code is to be utilized to report all services provided to a patient on discharge from outpatient hospital "observation status" if the discharge is on other than the initial date of "observation status." ...)

This change also holds true for initial hospital observation care services 99218 (Initial observation care, per day, for the evaluation and management of a patient ... Usually, the problem[s] requiring admission to outpatient hospital "observation status" are of low severity. Typically, 30 minutes are spent at the bedside and on the patient's hospital floor or unit.) through 99220 (... Usually, the problem(s) requiring admission to outpatient hospital "observation status" are of high severity. Typically, 70 minutes are spent at the bedside and on the patient's hospital floor or unit).

According to Hauptman, this revision further clarifies where these services should be rendered as they related to these code choices. Observing a patient can be accomplished in both an inpatient setting as well as an outpatient setting; it is dependent on the patient's condition. These codes are only to be used when the patient is admitted as an observation patient.