Cardiology Coding Alert

Instead of 75952-75954, you will report code from 34701-34711 range or 0254T.

In 2017, you reported two separate codes for some endovascular procedures, one for the surgery portion (from the 30,000 range) and one for the radiological supervision and interpretation (S&I) (from the 70,000 range). However, that all changes as of January 1, 2018.

New to 2018, CPT^® gives your some all-encompassing codes that include both the surgery and the radiological S&I components.

Check out what else will affect your cardiology practice.

CPT^® 2018 Deletes Endovascular Repair Codes, Gives You 8 New Options

Currently you report the following endovascular repair codes:

• 34800 through 34805 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection ...), and
• +34806 (Transcatheter placement of wireless physiologic sensor in aneurysmal sac during endovascular repair, including radiological supervision and interpretation, instrument calibration, and collection of pressure data (List separately in addition to code for primary procedure).

However, these codes will no longer be valid after January 1, 2018, as CPT^® 2018 will delete them.

Additions: Instead, you should report the following codes in place of 34800-34806:

• 34701 and 34702 (Endovascular repair of infrarenal aorta by deployment of an aorto-aortic tube endograft ...).
• 34703 and 34704 (Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-uni-iliac ...)
• 34705 and 34706 (Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-bi-iliac endograft ...).
• 34707 and 34708 (Endovascular repair of iliac artery by deployment of an ilio-iliac tube endograft ...).

Required components: These new all-encompassing codes will include all of these components: the pre-procedure sizing and device selection; the catheterization; the radiological supervision and interpretation; and the endograft.

Caution: For all the above code pairs, you will report the first code in the pair (34701, 34703, 34705, and 34707) for "other than rupture," according to the code descriptors. For 34702, 34704, 34706, and 34708, you will report for rupture, according to the code descriptors.

Regarding these new all-encompassing codes, Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC's Certified Cardiology Coder steering committee, says, "I found it ideal and less messy to use a single component code when a procedure is provided by one physician and/or facility department."

However, Neighbors adds that when multiple physicians and/or a hybrid lab are involved, there could be challenges involved.

For example: The radiologist provides the radiology portion of the procedure, and the specialist (cardiologist, electrophysiologist or vascular physician) provides the surgery portion of the procedure, which now requires multiple components to capture the complete procedure.

Expert definition: Hybrid ORs have the sophisticated imaging systems for catheter-based procedures, but also meet the required sterile standards, and they have the equipment of a traditional operating room, according to Neighbors.

These hybrid labs allow providers to perform high-risk, minimally invasive procedures giving the options to switch to open surgeries without moving the patient if they pass away or a complication arises, Neighbors says. Hybrid ORs also make it possible to conduct catheter-based and open procedures on a patient at the same time.  

Look to These Codes for Extension Prosthesis Placement

Currently, you can report 34825 and 34826 (Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, or dissection ...). However, CPT^® 2018 will delete these codes.

Additions: For 2018, you will report the following codes in place of 34825 and 34826:

• +34709 (Placement of extension prosthesis(es) distal to the common iliac artery(ies) or proximal to the renal artery(ies) for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, penetrating ulcer...)
• 34710 and +34711 (Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration ...).

Required components: Codes 34709-34711 will include the following components: pre-procedure sizing and device selection; catheterization(s); all associated radiological supervision and interpretation; and treatment zone angioplasty/stenting.

CPT^® 2018 Crosses Out 75952-75954

Deletions: CPT^® 2018 will also delete some radiological codes in the 70,000 range:

• 75952 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection, radiological supervision and interpretation)
• 75953 (Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal aortic or iliac artery aneurysm, pseudoaneurysm, or dissection, ...)
• 75954 (Endovascular repair of iliac artery aneurysm, pseudoaneurysm, arteriovenous malformation, or trauma, using ilio-iliac tube endoprosthesis... ).

In the place of 75952-75954, you will report a code from the 34701 through 34711 range or category III code 0254T (Endovascular repair of iliac artery bifurcation ... using bifurcated endograft from the common iliac artery into both the external and internal iliac artery ...). Remember, Category III CPT^® codes are temporary codes that describe emerging technology, services and procedures. The primary purpose of these codes is to allow for data collection, which in turn provides information for evaluating the effectiveness of new technologies and the formation of public and private policy.

Mark Down These Delivery to the Endograft, Endo Prosthesis Additions

Additions: CPT^® 2018 will also add the following codes for delivery to the endograft and delivery of endovascular prosthesis:

• 34712 (Transcatheter delivery of enhanced fixation device(s) to the endograft (eg, anchor, screw, tack) and all associated radiological supervision and interpretation)
• +34713 (Percutaneous access and closure of femoral artery for delivery of endograft through a large sheath (12 French or larger), including ultrasound guidance, when performed, unilateral (List separately in addition to code for primary procedure)
• +34714 (Open femoral artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by groin incision, unilateral (List separately in addition to code for primary procedure)
• +34715 (Open axillary/subclavian artery exposure for delivery of endovascular prosthesis by infracla­vicular or supraclavicular incision, unilateral (List separately in addition to code for primary procedure)
• +34716 (Open axillary/subclavian artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass ...).

Along with the delivery of endovascular prosthesis additions, you will also see some revisions to your current code options.

Revisions: For CPT^® 2018, +34812 (Open femoral artery exposure for delivery of endovascular prosthesis...), +34820 (Open iliac artery exposure for delivery of endovascular prosthesis or iliac occlusion during endovascular therapy...), +34833, and +34834 have all become add-on codes. This means you will need to list them in addition to the appropriate code for the primary procedure.

Codes +34833 and +34834 will also see additional changes to their code descriptors (emphasis added):

• +34833 (Open iliac artery exposure with creation of conduit for delivery of aortic or iliac endovascular prosthesis or for establishment of cardiopulmonary bypass, by abdominal or retroperitoneal incision, unilateral [List separately in addition to code for primary procedure])
• +34834 (Open brachial artery exposure to assist in the deployment of aortic or iliac endovascular prosthesis by arm incision, unilateral for delivery of endovascular prosthesis, unilateral ...).