Cardiology Coding Alert

The 2002 Physician Fee Schedule, published in the Federal Register on Nov. 1, notes that the relative value unit (RVU) conversion rate has been cut from 38.2581 to 36.1992. Although this cut will seriously impact reimbursement for most physicians, cardiologists may find that they come out ahead when changes in CPT Codes 2002 that cover brachytherapy, AngioJet, electrophysiology studies and other cardiology-specific matters are considered.
 
Coding and billing staff for all specialties, meanwhile, will be pleased to find that CMS has removed "transitional" payment columns from the Fee Schedule , bringing the number of payment columns down to six, mainly to avoid the confusion that two sets of fees and 10 payment columns caused. 
Brachytherapy and AngioJet
CPT 2002 introduces 92974 (transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy [list separately in addition to code for primary procedure]) as an add-on code to the following:

92980 transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel

92982 percutaneous transluminal coronary balloon angioplasty; single vessel

93508 catheter placement in coronary artery(s), arterial coronary conduit(s), and/or venous coronary bypass graft(s) for coronary angiography without concomitant left heart catheterization.
Note: A radiation oncologist is typically present when the cardiologist performs brachytherapy. CPT 2002 links 92974 with 77781-77784 (remote afterloading high intensity brachytherapy) "for intravascular radioelement application."
 
The fee schedule sets the value of 92974 at 5.44 RVUs. If the cardiologist uses brachytherapy to treat the restenosis of a previously stented vessel and places a second stent, for example, the operative session is valued 21.84 (for the stent) + 5.44 (for the brachytherapy) = 27.28 RVUs.
 
Although 92974 is listed in CPT 2002 and the fee schedule, Medicare carriers still may not cover the procedure. The fee schedule lists brachytherapy as a status A (active) code, which CMS defines as follows: "These codes are paid separately under the Physician Fee Schedule , if covered. There will be RVUs for codes with this status. The presence of an 'A' indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy." Ask your Part B carrier (and third-party payers) whether they consider brachytherapy a covered service.
 
Note: Code 92974 assumes ZZZ global days, which means it assumes the number of global days of the primary procedure.
 
Code 92973 (percutaneous transluminal coronary thrombectomy [list separately in addition to code for primary procedure]) developed out of the increased use of the AngioJet Rheolytic Thrombectomy System (Possis) to remove coronary blood clots. Although 92973 is also a new add-on code classified as status A with ZZZ global days, it differs from 92974 [...]