Cardiology Coding Alert

The two new peri-procedural codes and the CPT line notes with them are as follows:

• For a pacemaker: 93286 -- Peri-procedural device evaluation and programming of device system parameters before or after a surgery, procedure, or test with physician analysis, review and report; single, dual, or multiple lead pacemaker system

(Report 93286 once before and once after surgery, procedure, or test, when device evaluation and programming is performed before and after surgery, procedure, or test)

(Do not report 93286 in conjunction with 93279-93281, 93288)

• For an ICD: 93287 -- ... single, dual, or multiple lead implantable cardioverter-defibrillator system

(Report 93287 once before and once after surgery, procedure, or test, when device evaluation and programming is performed before and after surgery, procedure, or test)

(Do not report 93287 in conjunction with 93282-93284, 93289).

"The peri-procedural programming is very different from regular device work,"says Sandi Fuller, CPC, MCS-P, HIS supervisor and compliance officer for Cardiovascular Associates of East Texas.

The prefix "peri-" means "around." So a peri-procedural device evaluation happens around -- that is, before and after -- a procedure.

CPT defines peri-procedural device evaluation and programming for pacemakers and ICDs as an evaluation to "adjust the device to settings appropriate for the patient prior to a surgery, procedure, or test" that involves interrogating the device system to evaluate:

• lead(s)

• sensor(s)

• battery.

The provider also should review "stored information, including patient and system measurements," CPT states.

The provider will program the settings so they're appropriate for whatever procedure or test prompted the evaluation and programming.

After the procedure or test, the provider will perform another evaluation and programming to settings appropriate for the patient.

National payment for the professional component of 93286 and 93287 is in the $15-$22 range, which is lower than more extensive programming codes such as 93279 and 93282 (Programming device evaluation ...), which pay closer to $36 and $47 respectively.

You should report the pre- and post-services separately, CPT guidelines state. So if your cardiologist performs both the pre- and post-evaluation and programming, you'll report the appropriate code (93286 for pacemaker or 93287 for ICD) once for each service.

Be sure to follow your payer's preference for reporting the service twice on the same claim, such as appending modifier 59 (Distinct procedural service) to the second code.

In some cases, you may have one provider performing the service before the procedure and another providing the service after the procedure, noted Bruce Wilkoff, MD,FACC, co-presenter of the "ACC/MedAxiom Webinar on New 2009 CPT Codes for Cardiac Device Monitoring"(http://qualityfirst.acc.org/advocacy/Pages/CDMonitoringWebinar.aspx). Wilkoff is director of cardiac pacing and tachyarrhythmia devices for the Cleveland Clinic.

Each code representing a single service also simplifies coding in these cases. Each cardiologist will report the appropriate code once.

Watch out: Other individuals may perform the service, so be sure your documentation supports coding for the cardiologist before you submit a claim. For example, device representatives may perform the service and should not charge for it, Fuller says. In this situation,you should not submit a claim for payment.