Radiology Coding Alert

Learn which codes are specific to CHD conditions.

Providers use cardiac intraoperative ultrasound (IOUS) to diagnose several heart-related conditions while in the middle of a heart surgery. Effective Jan. 1, 2024, the CPT^® code set added four new cardiac IOUS codes.

Read on to learn about these IOUS codes and how to report the procedures.

Correctly Assign CHD Cardiac IOUS Codes

The 2024 CPT^® code set added three codes for intraoperative epicardial cardiac ultrasound procedures:

• 76987 (Intraoperative epicardial cardiac ultrasound (ie, echocardiography) for congenital heart disease, diagnostic; including placement and manipulation of transducer, image acquisition, interpretation and report)
• 76988 (… placement, manipulation of transducer, and image acquisition only)
• 76989 (… interpretation and report only)

“The intraoperative epicardial cardiac ultrasound services are specific for when these procedures are performed on a patient with a congenital heart disease,” said Raemarie Jimenez, CPC, CDEO, CIC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC, chief product officer at AAPC in the “2024 CPT^® Coding Updates” AAPC webinar. “These are codes that would be included or performed in addition to other services that we see being performed in order to perform the actual surgery itself,” she explained.

You’ll assign 76988 when the provider places and moves the ultrasound transducer to capture images only. If the provider just interprets the images and writes a report, then you’ll assign 76989. On the other hand, if the provider places and manipulates the transducer, captures images, and performs the interpretation and report, then you’ll assign 76987. Code 76987 is a comprehensive code that includes all components of the service.

“In this type of service, sometimes you’ll have different entities or different providers performing the different aspects of the procedure and that’s why you’ll have a comprehensive code and then codes that break it up into its components,” Jimenez said.

For example, if one facility performs the image acquisition and a provider at another facility does the interpretation and report, each entity will have to report the services separately. That separate reporting is accomplished with the individual component codes 76988 and 76989.

Understand Thoracic Aorta Ultrasound

The CPT^® code set added another cardiac IOUS code in 2024. Code 76984 (Ultrasound, intraoperative thoracic aorta (eg, epiaortic), diagnostic) is a diagnostic ultrasound procedure performed during surgery to view the thoracic aorta.

The thoracic aorta reaches from the aortic arch down to the diaphragm. Several arteries and branches exit off the thoracic aorta, including the bronchial, esophageal, pericardiac, and mediastinal branches and superior phrenic artery. A physician uses IOUS on the thoracic aorta to assess the structure for different conditions, such as plaque buildup in the blood vessel.

According to the American College of Radiology (ACR), 76984 and 76987-76989 “are used to evaluate cardiovascular structures, provide intraoperative guidance, and provide real-time perioperative surgical decision-making information that may affect the intraoperative strategy (e.g., changing cannulation strategies, altering bypass targets, and identifying additional defects)” (www.acr.org/-/media/ACR/Files/Advocacy/CPT-2024-Anticipated-Code-Changes.pdf).

Examine This Cardiac IOUS Scenario

Now that you understand the different cardiac IOUS codes, review the following scenario to put your knowledge into practice.

Scenario: A cardiac surgeon performs open-heart surgery on a 5-year-old patient diagnosed with asymptomatic atrial septal defect. The surgery aims to repair the heart defect to improve the patient’s quality of life. During the surgery, a radiologist performs an intraoperative epicardial cardiac ultrasound, evaluates the images, and writes their report. The diagnosis allows the cardiac surgeon to assess the heart, the repair, and make any adjustments while the patient is still in the operating room.

In this scenario, the cardiac surgeon will assign 33641 (Repair atrial septal defect, secundum, with cardiopulmonary bypass, with or without patch) to report the open-heart surgery, while you’ll assign 76987 to report the intraoperative epicardial cardiac ultrasound performed by the radiologist.

Condition definition: Atrial septal defect is a congenital heart defect that affects the heart’s upper chambers, also known as the atria. The condition consists of a hole in the septum (wall) of the atria. If the hole doesn’t close on its own, a doctor may require surgery to repair the hole. If the hole is not closed, blood flow through the lungs increases over time, which can cause damage to the lungs’ blood vessels.