February 2013 Jean C. Russell, MS, RHIT jrussell@epochhealth.com Richard Cooley, BA, CCS rcooley@epochhealth.com 518-430-1144
2 Agenda Cardiology special considerations 2013 Cardiology Codes Deleted Codes New Codes Changed Codes Documentation Requirements Modifiers
3 Charging Considerations There are a number of changes in this area for 2013, most are coded procedures However, sometimes certain cardiology procedures are hard-coded/charged rather than soft coded by HIM Revenue code 48x, cardiology, cannot always be linked to a soft-coded procedure from HIM Results in charging being performed by technicians and staff that are not trained in coding Suggest review new technologies and software upgrades that will allow these codes to be coded
4 Modified Description 33225 - Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator (eg, for [replacing word including ] upgrade to dual chamber system [removed words and pocket revision ]) (List separately in addition to code for primary procedure)
5 Percutaneous Coronary Interventions CPT code changes include 13 new codes (92920 92944), one revised code (+92973) and six deleted codes (92980 92984 and 92995 92996) CPT has added extensive new introductory language to assist physicians and coders on the new PCI codes
6 Deleted Codes Stent, Dilation and Atherectomy Codes
7 New Codes
8 Intracoronary Stent Placement There were two codes for placing a non drug eluting stent (92980 and 92981), replaced with new CPT codes Medicare had two other codes (G0290 and G0291) for placement of a drug eluting stent, replaced with new temporary codes (C960x) Required Stents have not changed (CMS procedure to required device edits) C1874 Stent, coated/cov w/del sys C1875 Stent, coated/cov w/o del sy C1874 Stent, coated/cov w/del sys C1876 Stent, non-coa/non-cov w/del C1877 Stent, non-coat/cov w/o del C1875 Stent, coated/cov w/o del sy
9 Percutaneous Coronary Interventions PCI codes build on a progressive hierarchy, the codes now 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 Source: http://www.cardiosource.org/advocacy/physician-payment/coding- Changes-for-2013.aspx
10 Coronary Stents
11 Cardiology Modifiers Two new HCPCS (level II) modifiers for coronary arteries: - LM Left main coronary artery - RI Ramus intermedius coronary artery In addition to the three original modifiers for coronary arteries: - LC Left circumflex - LD Left anterior descending - RC Right Coronary Source: Medtronic
12 Intracardiac Catheter Ablation Codes Deleted Codes New Codes
13 Intracardiac Catheter Ablation Codes Five new codes and extensive CPT guidelines were developed for bundling ablations together with a comprehensive EP evaluation Plus a new bundled code for atrial fibrillation CPT codes 93651 and 93652 were removed and replaced with new CPT codes 93653 through 93657 96355 and 96357 are add-on codes
14 EP and Ablation Composite Cardiac EP Evaluation and Ablation (APC 8000) CPT codes 93653, 93654, and 93656 have SI Q3 They are added to a new Group C under the Composite APC s CPT codes 93655 and 93657 will be packaged with SI N The Deleted CPT codes 93651 and 93652 are removed from Group B of the composite
15 EP and Ablation Codes The three new primary ablation codes combine elements of the EP study with the ablation procedure: 1. EPS plus SVT (supraventricular) ablation (93653) 2. EPS plus VT (ventricular tachycardia) ablation (93654) 3. EPS plus PVI (Pulmonary Vein Isolation for A-fib) (93656) The add-on codes allow for reporting additional lesion treatment 1. Ablation of an additional discrete mechanism, or SVT or VT remaining after the primary procedure (93655) 2. Additional ablation (linear or focal) to treat AF remaining after PVI (93657), may be reported with 93656 Code 93650 for AV (atrioventricular node) ablation was not changed
16 EP and Ablation Codes 93653 - Comprehensive (i) EP eval including insertion and repositioning of multiple electrode catheters with (ii) induction or attempted induction of an arrhythmia with (iii) right atrial pacing and recording, (iv) right ventricular pacing and recording, (v) His recording with intracardiac catheter ablation of arrhythmogenic focus; with treatment of (vi) SVT (supraventricular tachycardia) by ablation of fast or slow atrioventricular pathway, accessory atrioventricular connection, cavo-tricuspid isthmus or other single atrial focus or source of atrial re-entry
17 EP and Ablation Codes 93654 - ; with treatment of ventricular tachycardia or focus of ventricular ectopy including intracardiac electrophysiologic 3D mapping, when performed, and left ventricular pacing and recording, when performed
18 EP and Ablation Codes 93656 - Comprehensive (i) EP eval including (ii) transseptal catheterizations, insertion and repositioning of multiple electrode catheters with (iii) induction or attempted induction of an arrhythmia (iv) with atrial recording and pacing, when possible, (v) right ventricular pacing and recording, (vi) His bundle recording with intracardiac catheter ablation of arrhythmogenic focus, with treatment of atrial fibrillation by ablation by (vii) pulmonary vein isolation
19 Cervicocerebral Angiography New codes Describe non-selective and selective arterial catheter placement and diagnostic imaging of the aortic arch, carotid and vertebral arteries Eight new codes were created (36221 36228) New Codes
20 Cervicocerebral Angiography Codes 36221-36226 include the work of: 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.
21 Thrombolytic Infusion Deleted Codes New Codes Five new codes for foreign body removal and transcatheter thrombolytic infusion
22 Thrombolytic Infusion Note associated CPT changes for 75896 (cannot be reported with these new procedures) Other S&I codes, 75900 and 75961 have been deleted
23 Cardiac Catheterization New parentheticals for aortography for CPT codes 75600-75605, 75635 75658, and 75746-75791. E.g., For supravalvular aortography performed at the time of cardiac catheterization, use 93567, which includes imaging supervision, interpretation, and report Also, new introductory wording in the Cardiac Cath Section of the CPT book (page 511, CPT 2013 Professional Edition) And new wording in the ECHO Section of the CPT book (page 510, CPT 2013 Professional Edition)
24 Category III Codes Two new Category III Codes for intravascular optical coherence tomography (OCT) (0219T and 0292T) Two new Category III Codes for left atrial hemodynamic monitoring (0293T and 0294T) Ten new Category III Codes for external electrocardiographic recording (0295T - 0298T) and Intracardiac ischemia monitoring (0302T -0307T)
25 Questions and Discussion
26 Richard Cooley Contact Us Phone: 518-430-1144 Email: RCooley@EpochHealth.Com Jean Russell Phone: 518-369-4986 Email: JRussell@EpochHealth.Com
27 http://www.epochhealth.com/
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