You're 12 bullets away from a better understanding of CPT® 2013.
In what's becoming an annual tradition, cardiology procedure coding has a large number of modifications planned for the New Year. Cardiology Coding Alert will focus on the following changes in the coming months, including updates after the codes are finalized later in the fall.
LV pacing:
+33225 will see a minor revision, removing pocket revision from the descriptor.
Fluid removal from chest:
Pneumocentesis and thoracentesis codes 32420-32422 will be deleted. New codes for pleural aspiration (32554, 32555) and pleural drainage (32556, 32557) will take their place. Tube thoracostomy code 32551 will be revised to specify that it's an open procedure. These changes should help clarify proper coding, says
Lori Hendrix, CPC, CPC-I, CPC-H, CIRCC, PCS, FCS, senior project coordinator, compliance department, for Wellstar in Georgia. A common area for confusion is "aspiration versus the drainage tube, and the new codes explain it better."
TAVR/TAVI:
Transcatheter aortic valve replacement will move from Cat. III to Cat. I. Codes 33361-33365 differ based on approach (percutaneous femoral, open femoral, open axillary, open iliac, transaortic). Add-on codes +33367-+33369 allow separate reporting of cardiopulmonary bypass: percutaneous peripheral, open peripheral, or central.
VAD:
Expect four new percutaneous ventricular assist device codes for insertion (33990, arterial access; 33991, arterial and venous access/transseptal puncture), removal (33992), and repositioning (33993).
Catheter introduction:
Moderate sedation is now included in catheter introduction codes for the vena cava (36010) and extremity arteries (36140).
Cervical, cerebral, and carotid angiography:
Anticipate eight new codes (36221-+36228) that each represent both catheter placement and radiological services for cervical, cerebral, and carotid angiography. For example, one of the new codes is 36225 (
Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed). Because the new codes include angiography, 75650-75685 will be deleted.
Transcatheter foreign body retrieval:
New code 37197 will include both transcatheter retrieval and imaging. Consequently, CPT® will delete transcatheter retrieval code 37203 and its related S&I code 75961.
Transcatheter therapy infusion:
Soon-to-be-deleted thrombolysis codes 37201 (therapy) and 37209 (catheter exchange) will be replaced with several more specific codes that include the therapy and related S&I. New code 37211 will be for an initial arterial infusion day, 37212 will be for an initial venous infusion day, 37212 will apply to "continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed," and 37214 will offer a way to report ending the thrombolysis service, including removing the catheter and closing the vessel. As part of the overhaul, 75896 and 75898 will no longer apply to thrombolysis and 75900 (catheter exchange) will be deleted.
Coronary revascularization:
Coronary stent and angioplasty codes 92980-92984 will be deleted along with coronary atherectomy code 92995-92996. In their place, you'll have the 13 new 929xx codes described in "92982 Swaps Places With 92920 on January 1" on page 81.
Mechanical thrombectomy:
Code +92973 will specify "coronary thrombectomy mechanical," ending confusion about whether the code is appropriate to use for aspiration devices (it's not!).
EP studies:
The New Year will bring three new codes that include both comprehensive EP study and ablation. The codes vary based on whether the physician treats supraventricular tachycardia (93653), ventricular tachycardia (93654, includes 3D mapping and LV pacing/recording), or atrial fibrillation (93656). There also will be a new add-on code for ablation of a discrete mechanism of arrhythmia (+93655) and another for additional ablation to treat atrial fibrillation (+93657).
Other qualified professional:
A variety of codes will see revisions to reference "other qualified professional" in addition to "physician." Some of the affected codes include E/M services; monitoring codes 93224, 93227-93229, 93268, 93272; device eval codes 93279-93298; and stress echo code 93351. Several other codes remove the term "physician." For instance, stress test codes 93015-93016 will soon refer to "supervision" rather than "physician supervision." As always, review payer policy and state scope of practice to determine which provider types may provide and bill for specific services. See "CPT® 2013 Gives a Nod to NPP E/M Services" below for more on the E/M change.
