CPT Code Details

Transcription

1 CPT Code Details Code Descriptor Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; each additional vessel (List separately in addition to code for primary procedure) Notes: (Use in conjunction with 93571) (Intravascular distal coronary blood flow velocity measurements include all Doppler transducer manipulations and repositioning within the specific vessel being examined, during coronary angiography or therapeutic intervention [eg, angioplasty]) (For unlisted cardiac catheterization procedure, use 93799) Lay Term In this procedure, the provider passes a catheter into a coronary vessel or bypasses graft and injects a medication that increases blood flow. He then measures the blood s velocity and pressure using the Doppler method to determine the extent of a blockage in each additional vessel. Modifier Explanation In this procedure, the provider passes a catheter into a coronary vessel or bypasses graft and injects a medication that increases blood flow. He then measures the blood s velocity and pressure using the Doppler method to determine the extent of a blockage in each additional vessel. After the provider performs a percutaneous procedure on a coronary vessel, he attaches a Doppler ultrasound transducer to a guide wire and advances it through the existing catheter. He measures the blood flow and then administers a stress agent. He takes another measurement and then compares the two measurements. Tips This code represents the procedure performed on an additional vessel. It must be reported with the primary code, 93571, Intravascular Doppler velocity and or pressure derived coronary flow reserve measurement, coronary vessel or graft, during coronary angiography including pharmacologically induced stress, initial vessel; list separately in addition to code for primary procedure.

2 CPT Guidelines Range Specific Guideline All injection codes include radiological supervision, interpretation, and report. Cardiac catheterization codes ( ), other than those for congenital heart disease, include contrast injection(s) for imaging typically performed during these procedures (see Cardiac Catheterization above). Do not report in conjunction with When injection procedures for right ventricular, right atrial, aortic, or pulmonary angiography are performed in conjunction with cardiac catheterization, these services are reported separately ( ). When right ventricular or right atrial angiography is performed at the time of heart catheterization, use with the appropriate catheterization code (93451, 93453, 93456, 93457, 93460, or 93461). Use when supravalvular ascending aortography is performed at the time of heart catheterization. Use with the appropriate right heart catheterization code when pulmonary angiography is performed. Separately reported injection procedures do not include introduction of catheters but do include repositioning of catheters when necessary and use of automatic power injectors, when performed. When contrast injection(s) are performed in conjunction with cardiac catheterization for congenital cardiac anomalies ( ), see Injection procedure codes include imaging supervision, interpretation, and report. Injection procedures represent separate identifiable services and may be coded in conjunction with one another when appropriate. The technical details of angiography, supervision of imaging and processing, interpretation, and report are included. Section Specific Guideline Codes describe percutaneous revascularization services performed for occlusive disease of the coronary vessels (major coronary arteries, coronary artery branches, or coronary artery bypass grafts). These percutaneous coronary intervention (PCI) codes are built on progressive hierarchies with more intensive services inclusive of lesser intensive services. These PCI codes all include the work of accessing and selectively catheterizing the vessel, traversing the lesion, radiological supervision and interpretation directly related to the intervention(s) performed, closure of the arteriotomy when performed through the access sheath, and imaging performed to document completion of the intervention in addition to the intervention(s) performed. These codes include angioplasty (eg, balloon, cutting balloon, wired balloons, cryoplasty), atherectomy (eg, directional, rotational, laser), and stenting (eg, balloon expandable, self-expanding, bare metal, drug eluting, covered). Each code in this family includes balloon angioplasty, when performed. Diagnostic coronary angiography may be reported separately under specific circumstances. Diagnostic coronary angiography codes ( ) and injection procedure codes ( ) should not be used with percutaneous coronary revascularization services ( ) to report: 1. Contrast injections, angiography, roadmapping, and/or fluoroscopic guidance for the coronary intervention, 2. Vessel measurement for the coronary intervention, or 3. Post-coronary angioplasty/stent/atherectomy angiography, as this work is captured in the percutaneous coronary revascularization services codes ( ).

3 Diagnostic angiography performed at the time of a coronary interventional procedure may be separately reportable if: 1. No prior catheter-based coronary angiography study is available, and a full diagnostic study is performed, and a decision to intervene is based on the diagnostic angiography, or 2. A prior study is available, but as documented in the medical record: a. The patient's condition with respect to the clinical indication has changed since the prior study, or b. There is inadequate visualization of the anatomy and/or pathology, or c. There is a clinical change during the procedure that requires new evaluation outside the target area of intervention. Diagnostic coronary angiography performed at a separate session from an interventional procedure is separately reportable. Major coronary arteries: The major coronary arteries are the left main, left anterior descending, left circumflex, right, and ramus intermedius arteries. All PCI procedures performed in all segments (proximal, mid, distal) of a single major coronary artery through the native coronary circulation are reported with one code. When one segment of a major coronary artery is treated through the native circulation and treatment of another segment of the same artery requires access through a coronary artery bypass graft, the intervention through the bypass graft is reported separately. Coronary artery branches: Up to two coronary artery branches of the left anterior descending (diagonals), left circumflex (marginals), and right (posterior descending, posterolaterals) coronary arteries are recognized. The left main and ramus intermedius coronary arteries do not have recognized branches for reporting purposes. All PCI(s) performed in any segment (proximal, mid, distal) of a coronary artery branch is reported with one code. PCI is reported for up to two branches of a major coronary artery. Additional PCI in a third branch of the same major coronary artery is not separately reportable. Coronary artery bypass grafts: Each coronary artery bypass graft represents a coronary vessel. A sequential bypass graft with more than one distal anastomosis represents only one graft. A branching bypass graft (eg, Y graft) represents a coronary vessel for the main graft, and each branch off the main graft constitutes an additional coronary vessel. PCI performed on major coronary arteries or coronary artery branches by access through a bypass graft is reported using the bypass graft PCI codes. All bypass graft PCI codes include the use of coronary artery embolic protection devices when performed. Only one base code from this family may be reported for revascularization of a major coronary artery and its recognized branches. Only one base code should be reported for revascularization of a coronary artery bypass graft, its subtended coronary artery, and recognized branches of the subtended coronary artery. If one segment of a major coronary artery and its recognized branches is treated through the native circulation, and treatment of another segment of the same vessel requires access through a coronary artery bypass graft, an additional base code is reported to describe the intervention performed through the bypass graft. The PCI base codes are 92920, 92924, 92928, 92933, 92937, 92941, and The PCI base code that includes the most intensive service provided for the target vessel should be reported. The hierarchy of these services is built on an intensity of service ranked from highest to lowest as = = > > = > PCI performed during the same session in additional recognized branches of the target vessel should be reported using the applicable add-on code(s). The add-on codes are 92921, 92925, 92928, 92934, 92938, and and follow the same principle in regard to reporting the most intensive service provided. The intensity of service is ranked from highest to lowest as = > > > >

4 PCI performed during the same session in additional major coronary or in additional coronary artery bypass grafts should be reported using the applicable additional base code(s). PCI performed during the same session in additional coronary artery branches should be reported using the applicable additional add-on code(s). If a single lesion extends from one target vessel (major coronary artery, coronary artery bypass graft, or coronary artery branch) into another target vessel, but can be revascularized with a single intervention bridging the two vessels, this PCI should be reported with a single code despite treating more than one vessel. For example, if a left main coronary lesion extends into the proximal left circumflex coronary artery and a single stent is placed to treat the entire lesion, this PCI should be reported as a single vessel stent (92928). In this example, a code for additional vessel treatment (92929) would not be additionally reported. When bifurcation lesions are treated, PCI is reported for both vessels treated. For example, when a bifurcation lesion involving the left anterior descending artery and the first diagonal artery is treated by stenting both vessels, and are both reported. Target vessel PCI for acute myocardial infarction is inclusive of all balloon angioplasty, atherectomy, stenting, manual aspiration thrombectomy, distal protection, and intracoronary rheolytic agent administration performed. Mechanical thrombectomy is reported separately. Chronic total occlusion of a coronary vessel is present when there is no antegrade flow through the true lumen, accompanied by suggestive angiographic and clinical criteria (eg, antegrade "bridging" collaterals present, calcification at the occlusion site, no current presentation with ST elevation or Q wave acute myocardial infarction attributable to the occluded target lesion). Current presentation with ST elevation or Q wave acute myocardial infarction attributable to the occluded target lesion, subtotal occlusion, and occlusion with dye staining at the site consistent with fresh thrombus are not considered chronic total occlusion. Codes (percutaneous transluminal coronary thrombectomy, mechanical), (coronary brachytherapy), and (intravascular ultrasound/optical coherence tomography), and and (intravascular Doppler velocity and/or pressure [fractional flow reserve (FFR) or coronary flow reserve (CFR)]) are add-on codes for reporting procedures performed in addition to coronary and bypass graft diagnostic and interventional services, unless included in the base code. Non-mechanical, aspiration thrombectomy is not reported with 92973, and is included in the PCI code for acute myocardial infarction (92941), when performed. (To report transcatheter placement of radiation delivery device for coronary intravascular brachytherapy, use 92974) (For intravascular radioelement application, see 77770, 77771, 77772) (For nonsurgical septal reduction therapy [eg, alcohol ablation], use 93799) ICD-9 Vol 1 Crossref , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 411.0, 411.1, , , 413.0, 413.1, 413.9, , , , , , , , , , , , 414.2, 414.3, 414.4, 414.8, 414.9, , Fee Schedule

5 Medicare Fees National Adjusted 26 TC 53 Facility Non Facility RVU - Nonfacility National Adjusted 26 TC 53 Work RVU: PE RVU: Malpractice RVU: Total RVU: RVU - Facility National Adjusted 26 TC 53 Work RVU: PE RVU: Malpractice RVU: Total RVU: Global & Other Info Global Split Preoperative %: 0 Intraoperative %: 0 Postoperative %: 0 Total RVU: 0 Global Period (days): ZZZ Radiology Diagnostic Tests : 99 Code Status : C PC/TC Indicator : 1 Endoscopic Base Code : None Medically Unlikely Edit (MUE) : None Modifier Guidelines Modifier Rules(Click on rules for Details)

6 MULT PROC 51 No multiple procedure payment adjustment BILAT SURG 50 No 150% bilateral payment boost ASST SURG 80 Assistant payment allowed when supported CO-SURG 62 Co-surgeons not permitted TEAM SURG 66 Team surgeons not permitted MINIMUM ASST SURG 81 Assistant payment allowed when supported. ASST SURG (QUALIFIED RESI. NA) 82 Assistant payment allowed when supported. PHYSICIAN SUPERVISION *PS Concept does not apply. MUE Medically Unlikely Edits Source: 2017 Medically Unlikely Edits (MUE) Publisher: CMS Date: April 01, 2017 Services MUE MAI MUE Rationale Practitioner Services 2 3 Clinical: Data DME Suplier Services NA NA NA Facility Outpatient Services 2 3 Clinical: Data