Cardiology Coding Alert

CPT 2000 lists a number of important changes for cardiologists, including new codes for event recording, a number of changes in the pacemaker/defibrillator section, and a significant change in the wording of critical care codes that will allow cardiologists to bill these services more often.

In CPT 1999, codes 99291-99292 were to be used for the critical care, evaluation and management of the unstable critically ill or unstable critically injured patient, requiring the constant attendance of the physician. (Code 99291 is for the first hour, defined as between 30-74 minutes, and 99292 is used for every subsequent 30-minute period.) Cardiologists may have understood this to mean that caring for a critically ill or injured patient did not in itself fully meet the criteria of the code. The patient also had to be unstable, meaning that he or she had to have a life-threatening, immediate problem that required stabilization.

In CPT 2000, the situation has been greatly clarified. The revised terminology now reads, critically ill or critically injured patient. Thus, there is now no requirement that the patient be unstable in all instances. This means that if the cardiologist has a patient listed as critical in the ICU or critical care unit and is directly involved with that patient (by performing, for example, ventilator management, interpretation of cardiac output measurement, blood gases, ECGs, temporary pacemakers, etc.), he or she now can code critical care time of total duration on a given date more than 30 minutes.

Note: If the critical care takes less then 30 minutes, it should be billed as 99233 (subsequent hospital care).

These clarifications indicate that the codes have been softened, says Susan Callaway-Stradley, CPC, CCS-P, an independent reimbursement and coding consultant in North Augusta, SC.

Yet, valuable as this change is, cardiologists should note that the critical care guidelines, which are found just before the two codes in the E/M section, instruct that the critical illness or injury must acutely impair one or more vital organ systems such that the patients survival is jeopardized. In other words, services for a patient who is not critically ill but has been placed in a critical care unit should be reported using other E/M codes for hospital visits. Thus, the mere fact that the patient physically resides in the ICU or CCU does not in itself qualify the case for critical care codes. It is the patients condition that must be critical

New Codes for Patient-Activated Loop Recorders

Previously, unlisted codes had to be used for the implantation and removal of patient-activated loop recorders. But CPT 2000 has added two new codes33282 (implant of patient-activated event recorder) and 33284 (removal of patient-activated event recorder)for these procedures, Callaway-Stradley says, adding [...]