Cardiology Coding Alert

Hint: You’ll receive new codes 33858 and 33859 for ascending aorta grafts.

When CPT^® 2020 becomes effective on Jan. 1, 2020, you’ll see 248 new codes, 71 deletions, and 75 revisions. Cardiology practices should especially be aware of the new and deleted pericardiocentesis codes and the brand-new myocardial imaging codes.

Keep your cardiology claims in tip-top shape by staying on top of these code additions, revisions, and deletions.

Take a Look at New and Deleted Pericardiocentesis Codes

Additions: CPT^® 2020 will add the following new pericardial drainage codes:

• 33017 (Pericardial drainage with insertion of indwelling catheter, percutaneous, including fluoroscopy and/or ultrasound guidance, when performed; 6 years and older without congenital cardiac anomaly)
• 33018 (…  birth through 5 years of age or any age with congenital cardiac anomaly)
• 33019 (Pericardial drainage with insertion of indwelling catheter, percutaneous, including CT guidance).

In 2020, you will also see a shiny, new code for pericardiocentesis, which is 33016 (Pericardiocentesis, including imaging guidance, when performed).

Deletions: CPT^® 2020 will also bring you several deletions to the pericardiocentesis and tube pericardiostomy codes.

Current codes 33010 and 33011 will be deleted. Instead, you should report new codes 33016-33019.

Current pericardiostomy code 33015 will also be deleted. You should report new codes 33017-33019 instead.

And, you will say goodbye to current ultrasonic guidance for pericardiocentesis code 76930 in 2020. You should instead report new codes 33016-33018.

I’m so excited that pericardiocentesis combination code(s) were created, says 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. Now, let’s hope the RVUs increased, as well, to support physician and patient risk. This procedure has higher risk than a complete LHC, and the current reimbursement does not take the ‘physician and patient risk’ into consideration.

Add New Aorta Graft Choices to Your Coding Arsenal

Additions: CPT^® 2020 will add the following aorta graft codes:

• 33858 (Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed; for aortic dissection)
• 33859 (…  for aortic disease other than dissection (eg, aneurysm)).

You will also see one new code for a transverse aortic arch graft, so get ready to use 33871 (Transverse aortic arch graft, with cardiopulmonary bypass, with profound hypothermia, total circulatory arrest and isolated cerebral perfusion with reimplantation of arch vessel(s) (eg, island pedicle or individual arch vessel reimplantation).

Deletions: CPT^® 2020 will delete current ascending aorta graft code 33860. You should instead turn to new codes 33858 and 33859 to report this condition.

CPT^® 2020 will also delete current transverse arch graft code 33870. You should instead report new code 33871.

Count on Brand-New Myocardial Imaging Codes, Revisions

Additions: CPT^® 2020 will also give you five new codes for myocardial imaging, starting with 78429 (Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), single study; with concurrently acquired computed tomography transmission scan)) and going up to 78433 (Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (eg, myocardial viability); with concurrently acquired computed tomography transmission scan).

Revisions: When it comes to myocardial imaging, you will also see several revisions to current codes 78459, 78491, and 78492. For example, check out the revisions concerning 78491 (Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); single study, at rest or stress (exercise or pharmacologic)). (Emphasis added).

As you can see, these revisions will merely add more information to the code descriptors. For example, it will be clearer that you should report 78491 for a myocardial imaging, PET, perfusion study. And this procedure will include ventricular wall motions and or ejection fractions, if the cardiologist performs it. Also, this code includes both exercise or pharmacologic studies.

Prep for New Self-Measured Blood Pressure, Ambulatory Blood Pressure Monitoring Codes

Additions: CPT^® 2020 will add two new self-measured blood pressure codes that will actually appear in the evaluation and management (E/M) section of the CPT^® manual. They are as follows:

• 99473 (Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration)
• 99474 (… separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health care professional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient).

Revisions: In addition to the new self-measured blood pressure codes, you will also see several revisions to current ambulatory blood pressure monitoring codes 93784-93790.

For example, check out the revisions you should expect for 93784 (Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, report-generating software, automated, worn continuously for 24 hours or longer; including recording, scanning analysis, interpretation and report). (Emphasis added).

As you can see this revision will add the distinction that 93784 uses report-generating software, the monitor is automated, and the patient should wear it continuously.

Exploration Services Get New Codes, Revisions

Additions: You will see two new exploration codes in 2020. They are as follows:

• 35702 (Exploration not followed by surgical repair, artery; upper extremity (eg, axillary, brachial, radial, ulnar))
• 35703 (Exploration not followed by surgical repair, artery; lower extremity (eg, common femoral, deep femoral, superficial femoral, popliteal, tibial, peroneal)).

Revision: You will also see a revision to code 35701 (Exploration (not followed by surgical repair,), with or without lysis of artery; neck (eg, carotid artery, subclavian). (Emphasis added).

As you can see, this revision removes the language with or without lysis of from the code descriptor, and it adds the distinction that you should report this code for the neck. This revision will also delete the word artery and add subclavian as an example.

Deletions: Also, CPT^® will delete exploration with or without lysis of the artery codes 35721, 35741, and 35761.

Check Out 3 New Miscellaneous Cardiology Codes

In your cardiology practice, you should also be aware of new code 78434 (Absolute quantitation of myocardial blood flow (AQMBF), positron emission tomography (PET), rest and pharmacologic stress (List separately in addition to code for primary procedure)).

You will also see two new duplex scan codes in 2020. They are as follows:

• 93985 (Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete bilateral study)
• 93986 (…  complete unilateral study).

Don’t Miss Miscellaneous Deletion and Revision

Finally, don’t miss one final deletion and one final revision.

Deletion: CPT^® 2020 will delete current remote interrogation device evaluation code 93299. You should report remote interrogation device evaluation codes 93297 and 93298 instead for this procedure.

Revision: You will see some changes to the descriptor for 33275 (Transcatheter removal of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography), when performed). (Emphasis added).

As you can see, the descriptor for 33275 will get a lot of new information added to it. For example, the descriptor will now specify that it includes imaging guidance when the cardiologist performs it.