Cardiologists like other physicians need to be aware of the periodic changes and modifications introduced in the medical coding scenario to steer clear of coding errors and receive the due reimbursement. Many procedural codes may get deleted or modified. All medical providers will be impacted. Let us look at the significant coding changes that will have a bearing on cardiologists in 2013.
As part of the 2013 Medicare Physician Fee Schedule Final Rule, the Centers for Medicare and Medicaid Services (CMS) bundled several codes for payment. The work related to the placement of a stent in an arterial branch has been bundled into the base code for the placement of a stent in an artery. With effect from Jan 1, 2013 in major code changes specific to cardiology, six codes have been deleted and 13 new codes introduced.
Changes in cardiovascular coding include an emphasis on percutaneous coronary intervention (PCI), pacemaker and ablation codes. The new codes can differentiate between simple and complex stenting scenarios. With these codes, for the first time since 1994, fees were reduced for the simple stent and reimbursement is offered at higher levels for complex stent placement.
PCI Coding Changes
Six codes that are no longer used are: 92980, 92981, 92982, 92984, 92995, and 92996. Codes 92920-92944 and one revised code +92973 are to be used to report PCI (percutaneous coronary intervention) procedures.
The new codes will be used to classify services as follows:
- Angioplasty, atherectomy, and/or stent placement
- Single major coronary artery or branch vs. each additional branch
- Native artery vs. coronary artery bypass graft (CABG)
- Chronic total occlusion (CTO)
- Service performed during acute myocardial infarction (AMI)
Of the 13 new codes for PCI, the first eight codes are for reporting revascularization for each major coronary artery and branch treated. The remaining five codes are for reporting the same services provided to specific patient populations such as those with chronic total coronary artery occlusion, active STEMI (ST-elevated myocardial infarction), and those who have had CABG ( coronary artery bypass grafts).
PCI codes include services such as accessing and selectively catheterizing the vessel, traversing the lesion, radiological supervision and interpretation specific to the intervention, closure of the arteriotomy carried out through the access sheath, imaging performed to record the completion of the intervention as well as the intervention performed.
Pacemaker and Ablation Code Changes
Regarding pacemaker evaluations, codes 93279 – 93298 were created to include the language “review and report by a physician or other qualified healthcare professional.” The CPT codes 93279 – 93292 refer to the diagnostic cardiovascular services subject to the MPPR (Multiple Procedure Payment Reduction) table.
For ablation, CPT codes 93651 and 93652 have been removed and replaced with five new codes 93653 through 93657. This is with a view to bundling ablations together with a complete electrophysiologic evaluation and introducing a new bundled code to report atrial fibrillation.
Codes to Report TAVR & PVAD
For TAVR (transcatheter aortic valve replacement), eight new codes including CPT codes 33361- 33365, and revised codes +33367, +33368 and +33369 and guidelines were developed. 0318T is the Category III code created for TAVR with a transapical approach. According to CMS’ NCD (National Coverage Determination) for TAVR, a cardiothoracic surgeon as well as an interventional cardiologist must perform the procedure. Each physician has to bill with modifier -62 to indicate that co-surgery payment apples. Medicare reimburses each surgeon 62.5% of the fee schedule amount.
The new PVAD codes 33990-33993 and guidelines were developed for the insertion, repositioning, and removal of a percutaneous ventricular assist device (PVAD) percutaneously.
Reporting Cervicocerebral Angiography
Selective and non-selective arterial catheter placement and diagnostic imaging of the aortic arch, vertebral arteries and carotid are to be reported with eight new CPT codes 36221 – 36228.
- 36221 – 36226: accessing the vessel, placement of catheter(s), contrast injection(s), fluoroscopy, radiological supervision and interpretation, and closure of the arteriotomy by pressure, or application of an arterial closure device
- +36227 is to be used in conjunction with 36222, 36223, or 36224; +36228 is to be used in conjunction with 36224 or 36226. 36228 cannot be reported more than twice per side
Other developments include:
- New parentheticals for aortography for the CPT codes 75600-75605, 75635–75658, and 75746-75791
- Foreign body removal and transcatheter thrombolytic infusion are to be described by 5 new CPT codes 37197 and 37211 – 37214
- New Category III codes – 0219T and 0292T for intravascular optical coherence tomography (OCT); 0293T and 0294T for left atrial hemodynamic monitoring; 0295T – 0298T for external electrocardiographic recording, and 0302T – 0307T for intracardiac ischemia monitoring