Cardiology Coding Alert

There’s something for everyone — congenital, nuclear, TAVR, TCM, FEVAR, and more.

It may be summer, but you can already start whipping your CPT^® update muscles into shape. Here’s an early look at the cardiology coding changes likely to go into effect Jan. 1, 2014.

Caution: The potential revisions below are listed as “accepted” in the October 2012 and January-February 2013 CPT^® Editorial Panel meeting summaries. But the actual codes, descriptors, and guidelines won’t be finalized until closer to the time of CPT^® 2014’s official publication.

Expect Percutaneous Patent Ductus Arteriosus Code

The Editorial Panel accepted the addition of a new 9358X code to report patent ductus arteriosus closure by a percutaneous approach. The October 2012 meeting summary states you can expect to see new and revised parenthetical instructions to help with proper use of the new code. To see the complete October 2012 meeting summary, head to www.ama-assn.org/resources/doc/cpt/oct-2012-cpt-panel-action-memo.pdf.

The procedure: The ductus arteriosus is a blood vessel needed before birth to move blood around the fetus’s lungs. Once the baby is born, the ductus arteriosus isn’t needed and typically closes within a few days. The term patent means open, indicating that the patient’s ductus arteriosus didn’t close. The result is abnormal blood flow between the pulmonary artery and aorta. The physician can use an obstructing device (coil) to close the opening.

Look to 9358X for New Septal Ablation Code

Another percutaneous procedure expected to have a new code is catheter-based septal reduction therapy involving alcohol ablation. The procedure may be used in patients with hypertrophic obstructive cardiomyopathy. The physician inserts alcohol into the heart to induce a myocardial infarction with the aim of shrinking the enlarged septal bulge.

This code should also be a 9358X code. New cross-references and parentheticals are planned, as well, the October 2012 summary states.

Go to Cat. III for Gamma Scintigraphy

You also should keep an eye out for two new Category III myocardial innervation imaging codes, the October 2012 summary shows. This is a nuclear medicine service, also called gamma-scintigraphy. The imaging allows assessment of the sympathetic nerves that supply the heart. For instance, the physician could order scintigraphy to help evaluate a congestive heart failure patient.

Recall that if CPT^® offers a Cat. III code specific to a procedure, you must use that code and not an unlisted Cat. I procedure code.

Toss Out 37204, 37210 for New Embolization Choices

The January-February 2013 CPT^® Editorial Panel Meeting “Summary of Panel Actions” holds its own collection of newsworthy changes (www.ama-assn.org/resources/doc/cpt/summary-jan-feb-2013-panel-meeting.pdf).

One of the accepted changes is to do away with embolization codes 37204 and 37210:

• 37204, Transcatheter occlusion or embolization (e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method, non-central nervous system, non-head or neck
• 37210, Uterine fibroid embolization (UFE, embolization of the uterine arteries to treat uterine fibroids, leiomyomata), percutaneous approach inclusive of vascular access, vessel selection, embolization, and all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the procedure.

In their place, expect four new codes bundling in embolization and occlusion services in the 37XXX range. To help ensure proper reporting, CPT^® plans to add a subsection with new guidelines.

See if Deletion’s in Store for Stent Codes 37205-+37208

The January-February 2013 meeting summary has news for those coders who report stent services, too.

The Editorial Panel accepted the deletion of codes 37205-+37208 and 75960:

• 37205-+37206, Transcatheter placement of an intravascular stent(s) (except coronary, carotid, vertebral, iliac, and lower extremity arteries), percutaneous …
• 37207-+37208, Transcatheter placement of an intravascular stent(s) (except coronary, carotid, vertebral, iliac and lower extremity arteries), open …
• 75960, Transcatheter introduction of intravascular stent(s) (except coronary, carotid, vertebral, iliac, and lower extremity artery), percutaneous and/or open, radiological supervision and interpretation, each vessel.

Four new codes in the 37XXX range will replace the deleted codes and will include placement of intravascular stent(s) as well as radiological supervision and interpretation (S&I).

Bundling S&I with the intravascular stent codes seems to be in keeping with the recent AMA trend of creating such combination codes for cardiology, notes Marchelle Cagle, CPC, CPC-I, CMOM,  of Alabama-based Cagle Medical Consulting. Such codes can be more straightforward to use and understand, but they often result in decreased reimbursement, Cagle notes. So you’ll want to compare 2013 and 2014 fees, when available, to assess any impact.

Mark Possible Retrograde Cervical Option

You also can anticipate seeing a new 37XXX code for transcatheter stent placement via an open cervical carotid artery access. The code will be specific to retrograde treatment of a lesion. Remember that retrograde means against the direction of blood flow. The January-February 2013 summary shows this request has been accepted.

Plan for More Complete 3336X TAVR Range

The Cat. III code for open thoracic transcatheter aortic valve replacement (TAVR) should be joining its fellow TAVR codes in Cat. I next year.

CPT^® added TAVR codes 33361-33365 and +33367-+33369 in 2013, but it relegated open thoracic TAVR to 0318T (Implantation of catheter-delivered prosthetic aortic heart valve, open thoracic approach, [e.g., transapical, other than transaortic]). The Editorial Panel accepted a 2014 move to 3336X for 0318T at the January-February 2013 meeting.

TCM Guidelines Will Match CMS

CPT^® 2014 promises to work some of the kinks out of new-in-2013 transitional care management (TCM) codes 99495 and 99496.

The Editorial Panel accepted guideline revisions that will indicate TCM services can apply to new patients. The 2013 guidelines limit the codes to established patients, but payers such as Medicare already allow the use of the codes for new patients, too. You’ll also get clarifications about reporting discharge services and other E/M services in addition to TCM.

4 Old FEVAR Codes May Expand to 8 New Options

Finally, the Panel accepted a transition to Cat. I for certain abdominal aortic aneurysm (AAA) Cat. III codes.

According to the January-February meeting summary, codes 0078T-+0081T will be deleted. These codes describe endovascular repair (and related S&I) of AAA, pseuodoaneurysm, or dissection of the abdominal aorta involving visceral branches and using a prosthesis.

The move to Cat. I will result in eight new 348XX codes. The codes will include endovascular repair and S&I. You’ll also have new guidelines and instructions to help you properly code these services, which are known as fenestrated endovascular repair (FEVAR).

The move from Cat. III to Cat. I is a positive one, notes Cagle. The move suggests the Cat. III AAA/FEVAR codes were used enough to show the services deserved Cat. I codes. Cat. I codes “are more easily processed and recognized by the insurance payers for payment,” she says. Plus, Cat. I codes typically have higher reimbursement than Cat. III codes, Cagle says. Codes 0078T-+0081T are carrier priced for Medicare.

Make the Most of Online CPT® 2014 News

You may access all available Panel Action Summaries from www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/cpt-summary-panel-actions.page.

The files related to the items above are “2013 Jan-Feb, CPT^® Editorial Summary of Panel Actions” and “2012-Oct, CPT^® Editorial Summary of Panel Actions.”

There may be more changes to come. Actions from the May meeting will be posted this summer, including the verdict on revising electrophysiology codes 93600-93623 and 93653-93662 (www.ama-assn.org/resources/doc/cpt/may-2013-public-panel-agenda.pdf).