Cardiology Coding Alert

Hint: CPT^® 2022 will delete congenital heart cath codes 93530- 93533.

When CPT^® 2022 becomes effective on Jan. 1, 2022, you’ll see many new codes, deletions, and revisions. Cardiology practices should especially be aware of the new atrial appendage (LAA) exclusion codes, as well as the new coarctation of aorta repair codes, the new and deleted congenital heart catheter codes, and electrophysiologic (EP) study revisions.

Here’s what you need to know to keep your claims squeaky clean next year.

Hone in on New LAA Codes

You will receive several new LAA exclusion codes in 2022. They are as follows:

• 33267 (Exclusion of left atrial appendage, open, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip))
• +33268 (Exclusion of left atrial appendage, open, performed at the time of other sternotomy or thoracotomy procedure(s), any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip) (List separately in addition to code for primary procedure))
• 33269 (Exclusion of left atrial appendage, thoracoscopic, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip))

Don’t miss: Codes 33267-33269 describe LAA exclusion, which your cardiologist can perform by methods such as excision, isolation via stapling, oversewing, ligation, plication, or clip, per the CPT^® 2022 guidelines. Your cardiologist will perform LAA to treat atrial fibrillation and alleviate postoperative thromboembolic complications.

Discover New Coarctation of Aorta Repair Choices

In 2022, you will also see some new codes you can report for transcatheter interventions for revascularization or repair of the coarctation of the aorta. They are as follows:

• 33894 (Endovascular stent repair of coarctation of the ascending, transverse, or descending thoracic or abdominal aorta, involving stent placement; across major side branches) and 33895 (… not crossing major side branches). Note: You should report codes 33894 and 33895 when your cardiologist uses stent placement to treat the patient’s coarctation, according to the CPT^® guidelines. When it comes to the main difference between these two codes, your cardiologist will place the stent across one or more major side branches of the aorta in a 33894 procedure, but not with a 33895 procedure.
• 33897 (Percutaneous transluminal angioplasty of native or recurrent coarctation of the aorta). Note: You should report 33897 when your cardiologist dilates the coarctation via balloon angioplasty without stent placement.

Coarctation of aorta defined: The coarctation of the aorta is a birth defect where part of the patient’s aorta is narrower than normal, according to the Centers for Disease Control and Prevention (CDC).

Don’t miss: Codes 33894-33897 include many services so you cannot report these separately, per the CPT^® guidelines. Some of these included services are:

• Fluoroscopic guidance of the intervention
• Diagnostic congenital left heart catheterization
• All catheter and wire introductions and manipulation
• Angiography of the target lesion

See New, Deleted Congenital Heart Defects Cath Codes

CPT^® 2022 will delete some congenital heart cath codes including 93530 (Right heart catheterization, for congenital cardiac anomalies)-93533 (Combined right heart catheterization and transseptal left heart catheterization through existing septal opening, with or without retrograde left heart catheterization, for congenital cardiac anomalies).

In the place of these deleted codes, CPT^® will offer the following new congenital heart cath codes:

• 93593 (Right heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone; normal native connections) and 93594 (… abnormal native connections)
• 93595 (Left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone, normal or abnormal native connections)
• 93596 (Right and left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone(s); normal native connections) and 93597 (…abnormal native connections)
• +93598 (Cardiac output measurement(s), thermodilution or other indicator dilution method, performed during cardiac catheterization for the evaluation of congenital heart defects (List separately in addition to code for primary procedure))

Don’t miss: As you can see, good medical documentation is key to knowing which of the above codes is appropriate to report. For example, you must know if the native connections are normal or abnormal. You also must know if your cardiologist performed right, left, or right and left catheterization.

Observe Revised EP Study Codes

You will also see revisions to three EP study codes in 2022 — 93653, 93654, and 93656.

For example, 93653 will change to (Emphasis added): (Comprehensive electrophysiologic evaluation including with insertion and repositioning of multiple electrode catheters, with induction or attempted induction of an arrhythmia with right atrial pacing and recording and catheter ablation of arrhythmogenic focus, including intracardiac electrophysiologic 3-dimensional mapping, right ventricular pacing and recording (when necessary), left atrial pacing and recording from coronary sinus or left atrium, and His bundle recording, when performed (when necessary) with intracardiac catheter ablation of arrhythmogenic focus; with treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathway, accessory atrioventricular connection, cavo-tricuspid isthmus or other single atrial focus or source of atrial re-entry)

As you can see, code 93653 will now include left atrial pacing and recording from coronary sinus or left atrium. Also, instead of reading “when necessary,” the descriptor will now read “when performed.”

Code 93653 now also includes the 3D mapping, any prophylactic ablations of accessory pathways of the original source arrhythmia, and any prophylactic ablation of the cavo-tricuspid isthmus related to the original source arrhythmia, says Robin Peterson, CPC, CPMA, Manager of Professional Coding Services, Pinnacle Integrated Coding Solutions, LLC. For code 93653, that means that previously separately billed codes +93621 (Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left atrial pacing and recording from coronary sinus or left atrium (List separately in addition to code for primary procedure)) and +93613 (Intracardiac electrophysiologic 3-dimensional mapping (List separately in addition to code for primary procedure)) are now “bundled” into code 93653.

Code 93654 underwent changes to include left atrial pacing and recording from coronary sinus or left atrium when performed in addition to removal of the verbiage “including 3D mapping” because this is now a part of the parent code descriptor, and “when necessary” was revised to “when performed,” Peterson said.

Finally, code 93656 will see some changes. The descriptor will be as follows (Emphasis added): 93656 (Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation, including intracardiac electrophysiologic 3-dimensional mapping, intracardiac echocardiography including imaging supervision and interpretation, induction or attempted induction of an arrhythmia including left or right atrial pacing/recording when necessary, right ventricular pacing/recording when necessary, and His bundle recording, when necessary performed with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation).

As you can see, part of the descriptor will move from the end to the beginning: “intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation.” Also, code 93656 will now include “intracardiac electrophysiologic 3-dimensional mapping, intracardiac echocardiography including imaging supervision and interpretation.”

“Once again, we see an exciting new year of changes. Look for the method of approach in the provider’s documentation to assign the LAA codes, the new congenital cardiac catheterization codes include imaging guidance, and you’ll want to watch the provider’s documentation for the type of native connections, whether normal or abnormal,” Peterson says. “Look to see if the endovascular stent is placed across one or more side branches of the aorta to properly assign the new endovascular stent repair of coarctation of the aorta codes.”