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In today's podcast, Natalie Tornese, our Senior Solutions Manager will discuss about the cardiovascular coding updates for the year 2019.

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Hello Everyone and Welcome to our podcast series.

This is Natalie Tornese, Senior Solutions Manager at Outsource Strategies International.

Wanted to talk a little bit about Cardiovascular Coding and some of the changes that are taking place for 2019. Cardiovascular coding is complicated as the procedures are intricate and difficult to understand. There are several significant changes coming into play in 2019.

The changes can be better understood by looking at the codes for coronary procedures in 2018.

I will include a transcript along with this podcast with the CPT codes for diagnostic procedures and imaging

  • The guidelines for 2019 go into detail about the changes in regard to the insertion of catheters.
  • The insertion of a catheter into the right ventricle will not be included in the insertion, replacement or removal of a leadless pacemaker system.
  • Right heart catheterization codes should not be reported with the insertion or removal codes unless the right heart catheterization treats a condition that is "distinct from the leadless pacemaker procedure."
  • There is a new CPT code 33274 which is a Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular. That should be reported when a system is removed and replaced during the same session.

I will include a detailed transcript for Category III codes as well to use when billing for implant, replacement, interrogation and programming of the new leadless pacemakers as well as more of the changes for 2019. Leadless pacemakers are a tiny self contained unit that are directly implanted into the right ventricle.

  • The 2019 CPT manual provides the changes to the codes for leadless pacemakers, which are as follows:
    • Category III codes 0387T-0391T have been deleted and replaced with permanent codes 33274 and 33275. There are also several revisions to central venous access. Two new peripherally inserted central venous catheter (PICC) codes will be created that bundle the placement of a PICC and all associated radiological supervision and interpretation.
    • The descriptors for current PICC insertion codes will be updated to state that the service does not include image guidance and according to the CPT manual, one of these codes should be reported when a PICC line is placed with magnetic guidance.
    • The procedure guidelines for central venous access will be updated to include the saphenous vein as an example of an entry site for a PICC and will clarify the instructions for reporting image guidance used for centrally inserted central venous catheters. Providers can report code 77001 for fluoroscopic central venous catheter accessor code 76937 for ultrasound guidance for vascular access "when imaging guidance is used for centrally inserted central venous catheters, for gaining access to the venous entry site and/or for manipulating the catheter into final central position."
    • Image guidance will be added to PICC replacement using code 36584 and the two new insertion codes that include image guidance are 36572 and 36573. 
    • Chest X-ray codes (71045-71048) or other imaging services to document the final catheter tip position are now going to be bundled into 36584 and 36572-36573. If the provider uses imaging but does not confirm the tip's location, modifier 52, which is reduced service modifier should be appended with the code
    • The manual instructs using avenipuncture code (36400-36410) to report a midline catheter.
 

I hope this helps, but always remember that proper documentation as well a thorough knowledge of pay regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for listening!