Billing and coding cardiologic procedures can be extremely complex. In 2017, cardiology practices and the medical coding companies that serve them have to deal with Medicare program updates as well as several CPT code changes from angioplasty to coronary IVUS. Here are the significant updates affecting cardiology practice reimbursement this year.
- Moderate Sedation: Cardiologists need to take note of the changed rules for reporting moderate sedation and the new codes (99151-99157) that have been introduced.
99151, Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age99152, … initial 15 minutes of intraservice time, patient age 5 years or older
+99153, … each additional 15 minutes intraservice time (List separately in addition to code for primary service).
Note: Code 99151 should be used for the first 15 minutes of moderate sedation services for a patient younger than five. For patients age five or older, use 99152 for the first 15 minutes. Code +99153 applies to each additional 15 minutes regardless of the patient’s age.
Cardiology CPT codes affected by this change include:
33206-33223 (pacemaker procedures)
33233-33235 (removal of pacemaker generator and lead(s))
33240-33264 (defibrillator procedures)
33244 (removal of defibrillator electrodes by transvenous extraction)
33249 (insert or replace defibrillator system)
33282, 33284 (patient activated event recorder, implantation and removal)
- New Cardiovascular CPT Codes
33340, Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation
33340 describes transcatheter placement of an implant to close the left atrial appendage. This procedure may be recommended as an alternative to long-term oral anticoagulants to deter emboli formation and prevent stroke.Note: When using 33340, do not bill separately for the radiological supervision and interpretation. Also a diagnostic heart catheterization should not be reported separately with this procedure unless distinctly documented as per CPT guidelines.
- Revised Valvuloplasty Coding:
Two new codes have replaced deleted valvuloplasty codes 33400, 33401, and 33403:33390, Valvuloplasty, aortic valve, open, with cardiopulmonary bypass; simple (i.e., a simple procedure such as valvotomy, debridement, debulking, and/or simple commissural resuspension)
33391, Complex procedure (for e.g., leaflet extension, leaflet resection, leaflet reconstruction, or annuloplasty)
Note: A corrections document to CPT 2017 changes revised the description of the procedure for codes 33390 and 33391 to clarify that the patient was heparinized (treated with heparin).
- New Code for Partial Exchange Transfusion
36456, Partial exchange transfusion, blood, plasma or crystalloid necessitating the skill of a physician or other qualified health care professional, newbornThis code was added to report blood transfusion in a newborn that requires the service of a physician or other qualified healthcare professional.
Note: Per CPT® guidelines: Do not report 36456 in conjunction with 36430 (Transfusion, blood or blood components), 36440 (Push transfusion, blood, 2 years or younger), or 36450 (Exchange transfusion, blood; newborn).
- Transluminal Balloon Angioplasty:
CPT 2017 introduced four new codes to report transluminal balloon angioplasty that include all necessary imaging and radiological S&I. These new codes replace eight transluminal balloon angioplasty codes, plus the related radiological S&I codes.37246 Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery
+37247 Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure)
This new add-on code describes transluminal balloon angioplasty in each additional artery beyond an initial artery — except for those arteries in the lower extremities for occlusive disease, intracranial arteries, coronary arteries, or pulmonary arteries. +37247 should be reported in addition to 37246 (initial artery).
37248 Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein
+37249 Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure)
Note: CPT guidelines instruct: codes 37246 (artery) and 37248 (vein) should be reported for the primary vessel treated, as appropriate. Codes 37247 (artery) and 37249 (vein) are add-on codes that should be reported for each additional vessel treated.
Keeping track of the updates, revisions and deletions to CPT coding changes is necessary for accurate reporting of cardiology procedures for clean medical billing processes. Cardiology practices can ensure they get the reimbursement they deserve with efficient support from an experienced cardiology medical billing and coding company.