Cardiology Coding Alert

National requirements for FDA-approval and local requirements for code use could affect your claim.

CMS released a proposed decision memo presenting a plan to limit coverage for left atrial appendage closure (LAAC) therapy using an implanted device to services in clinical studies meeting specified conditions.

Examples of the specified conditions include using a device FDA-approved for patients with non-valvular atrial fibrillation and meeting certain training and experience requirements for interventional cardiologists and electrophysiologists involved.

Resource: To check out the details, head to www.cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?NCAId=281.

Coding tip: CPT^® includes LAAC Category III code 0281T (Percutaneous transcatheter closure of the left atrial appendage with implant, including fluoroscopy, transseptal puncture, catheter placement[s], left atrial angiography, left atrial appendage angiography, radiological supervision and interpretation).

But you should check payer policy on use of this code. For example, in LCD L35956, National Government Services has a rule that “0281T should be used for the Watchman device. CPT^® code 33999 [Unlisted procedure, cardiac surgery] should be used for other devices (e.g., Atricure or Lariat).” Note that the current policy states LAAC “is considered not reasonable or necessary for the prevention of stroke.”