Wiki Coronary Shockwave Lithotripsy - CPT code?

vidraj

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Hello everyone,

Need opinion with CPT code for the interventional procedure below.



Procedure note:
The right radial artery was accessed via Seldinger technique, 6-French sheath was introduced. A 6-French EBU 3.75 guide was used to cannulate left main. Diagnostic angiography reveals patent left main at the ostium, body and the bifurcation.
Left anterior descending artery had a mid long 80% calcific lesion in a type 2 vessel with a quick taper off of the LAD beyond the apical diagonal.
BMW wire was advanced through the lesion with ease and parked into the apical LAD. The lesion was directly subjected to an intravascular lithotripsy using a shockwave device, 2.5 x 12 balloon at 2 atmospheres with 10 cycles of shock wave done twice in sequence through the length of the lesion without complications. Lesion opened up very smoothly. Lesion was then subjected to a direct stenting using a 2.75 x 26 Onyx drug-eluting stent and deployed at 22 atmospheres with good distal apposition. The stent was then post dilated with a 3.0 NC balloon in the mid and distal parts with adequate stent apposition to the arterial walls. There was haziness in the proximal part of the stent at the bend of the artery and hence another 3.5 x 8 Onyx drug-eluting stent was deployed in overlapping manner at 16 atmospheres and post-dilated at 14 atmospheres in the overlapping segment with excellent angiographic results without complications. The patient tolerated the procedure well.
325 mg of aspirin and 300 mg of additional Plavix was given on the day of the procedure post angioplasty. ACT was monitored throughout the case as needed. Heparin was given for anticoagulation.
Procedure was completed without complications.
CONCLUSIONS: Successful shock wave lithotripsy and angioplasty with stent deployment in the mid LAD using a 2.75 stent as well as a 3.5 stent in overlapping manner with excellent angiographic results without complications.



I couldn't find a specific CPT CODE for Coronary Shockwave Lithotripsy.

- Can we consider this as Atherectomy and code it as 92933 - LD ?
Or
- is this considered part of angioplasty and code as 92928 - LD Only?

TIA
Vid.
 
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Hello - if you are coding professional charges for the cardiologist, there is no separate code for the coronary shockwave lithotripsy. The lithotripsy is not the same as an atherectomy so it shouldn't be coded as such. You would code the most extensive intervention in the vessel as normal (in this case the stent placement).
If you are coding for an outpatient hospital, you can use C1761 for the lithotripsy. There were some issues I think when CMS was determining which codes in the C960x series could be reported with C1761, but last I heard many consultants and professional societies were appealing to CMS to review their guidance for outpatient hospital reporting.

I hope that helps!

Kim
www.codingmastery.com
 
Please see MLN #- MM12316 - effective July 2021.

See page 4 of 8 - It states that C1761 is not to be coded, but to use 92928 for the professional services for lithotripsy.
 
What HCPCS code is everyone using when a coronary IVL is done? Should C1725 be used instead of C1761? Is anyone else running into device edits when the physcian goes off label with the IVL catheter?
 
I am new to coding the shockwave coronary IVL and was wondering if anyone has gotten this paid yet? I do know from my research that when billing for my provider I would use the category cat III code 0715T in conjunction with the primary procedure code, but since there is no Medicare fee schedule for this code yet I am having issues with getting my corporate office to even add this code for billing in our system. I did also see where someone asked what the hospital code for this was and again from my research the hospital code to use is C1761. Thanks for any assistance in billing with this code.
 
What HCPCS code is everyone using when a coronary IVL is done? Should C1725 be used instead of C1761? Is anyone else running into device edits when the physcian goes off label with the IVL catheter?
I was wondering if you have found any guidance for this? I am coding for an op surgery center and the physician is doing the transluminal lithotripsy but not placing a stent. We are also getting a lot of these back. Thank yo for your help!
 
I was wondering if you have found any guidance for this? I am coding for an op surgery center and the physician is doing the transluminal lithotripsy but not placing a stent. We are also getting a lot of these back. Thank yo for your help!
The shockwave lithotripsy is an add on code to be billed with either an angioplasty, atherectomy and/or stent. If your provider did not do a stent was an angioplasty performed? And you would more than likely need to submit records with the claim. This is a new code that has no Medicare fee schedule attached to it.
 
Follow these guidelines for what to crosswalk 0715T to in Box 19 and there is an approval letter you can mail in along with your report... https://shockwavemedical.com/reimbursement/coronary/ AND ALSO https://shockwavemedical.com/wp-con...sician-Reimbursment-Guide-SPL66945-Rev.-A.pdf
We've done this many times and are reimbursed.
Nicole I would love to chat with you on this. My provider is doing quite a few of these and I am struggling to get them paid. I am sending appeal letters, copies of the SWL documentation that you have listed and still no payment. Medicare has paid on one so far and denied another. Cigna HS is horrible and wont pay at all.
 
as far as i know; the whole procedure converged to remove the solid plaque then stented. Intravascular lithotripsy is not listed CPT code book, it is very rare. either you can bill 92928+93799. Or you can bill 92933 if payer can accept.
 
as far as i know; the whole procedure converged to remove the solid plaque then stented. Intravascular lithotripsy is not listed CPT code book, it is very rare. either you can bill 92928+93799. Or you can bill 92933 if payer can accept.
Coronary Shockwave lithotripsy is coded with cpt code 0715T and is listed in the CPT book under the Cat III codes. it is an add on code and billed with one of the angioplasty/stent codes.
 
I would like to know more on this response. Yes, there is no specific CPT code for Intravascular Lithotripsy, and it leads to an unlisted code. When our cardiologist performs this procedure in a facility, we cannot bill the HCPCS code for him. Have you had any success by submitting 92933 in such scenarios?
.as far as i know; the whole procedure converged to remove the solid plaque then stented. Intravascular lithotripsy is not listed CPT code book, it is very rare. you can bill 92928+93799. Or you can bill 92933 if payer can accept.
 
I would like to know more on this response. Yes, there is no specific CPT code for Intravascular Lithotripsy, and it leads to an unlisted code. When our cardiologist performs this procedure in a facility, we cannot bill the HCPCS code for him. Have you had any success by submitting 92933 in such scenarios?
Coronary shockwave lithotripsy SWL is billed using cpt code 0715T for the physician billing. This is listed in the cpt code book under the Cat III section. This code, which is an add-on code, is billed in conjunction with any of the angioplasty, stent, or atherectomy codes. Cpt code 92933 is not used for SWL but if the physician performed SWL then did angioplasty/stent with atherectomy then you can bill both 92933 with 0715T for the SWL. If you will look up in this thread on date 08/31/23 Nicole has posted a link to all the info needed on SWL and billing.
 
How many Mue can you bill for 0715T?
This code was deleted effective 01/01/24 and was replaced with 92972. It doesn't appear that the new code is not on the 2024 NCCI MUE tables, linked here, for practitioners and facilities yet. The MUE for 0715T for 4th quarter 2023 was 3 for practitioner. I can't imagine that the units has changed much but currently there isn't an officially established MUE units max for the new code for 2024.
 
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