Cardiology Coding Alert

New information stresses a 'mechanical' requirement for the thrombectomy code.

If you've been using coronary thrombectomy code + CPT 92973 to report a variety of methods, take heed. Thrombectomy by aspiration catheter is included in the intervention, according to the American Medical Association (AMA) and American College of Cardiology (ACC).

Take a Closer Look at +92973

The code under discussion is +92973 (Percutaneous transluminal coronary thrombectomy [List separately in addition to code for primary procedure]).

For years, many resources have based their coding recommendations on the plain face of the definition of +92973. If you read the descriptor, you'll see that it "does not specify anything other than 'Percutaneous transluminal coronary thrombectomy,'" says Theresa Dix, CCS-P, CCP, CPMA, CCC, certified medical coder and auditor with East Tennessee Heart Consultants, MPS Cardiology.

As a result, a common recommendation has been that you may assign +92973 for a variety of methods used to remove thrombus, including both fragmentation and aspiration catheters.

Some of the devices used in these services included AngioJet, Pronto, Fetch, Xpress-Way, QuickCat, and Export devices, says Christina Neighbors, MA, CPC, CCC, ACS-CA, charge capture reconciliation specialist and coder at St. Joseph Heart & Vascular Center in Tacoma, Wash.

Consider the Aspiration Catheter Question

The issue: The 2011 CPT® Reference Guide for Cardiovascular Coding (co-published by the AMA and ACC) states that +92973 is appropriate only when the physician uses a mechanical device that fragments the thrombus and removes the clots, reports Neighbors.

For example, the AngioJet meets this requirement. The physician activates the catheter by depressing a foot pedal. He manually withdraws the catheter slowly across the lesion. The device breaks the clot into tiny fragments allowing it to then remove thrombus from the body, says Neighbors. "The key here is the thrombectomy must utilize a system that includes a drive unit, pump, and foot pedal that mechanically fragments and removes clots," she notes.

The ACC/AMA publication's focus on the mechanical method made proper use of +92973 "a source of confusion for many cardiology coders," says Dix. What about thrombectomy by aspiration catheters?

What's new: A number of firms sought clarification from the AMA about proper coding for +92973. The firms have recently reported individually that the AMA's response has been to support the information in the ACC/AMA publication: +92973 is not appropriate for thrombectomy by aspiration catheter.

The reported AMA responses also indicate that non-mechanical coronary thrombectomy is included in any other intervention performed (such as coronary angioplasty or stent placement). Under that interpretation, "thrombectomies performed with aspiration devices such as Pronto and Fetch are included in the intervention and not separately reportable," explains Dix. So you would "need to see proof that the physician fragmented (broke up) the thrombus versus aspirated (suctioned)" it to report +92973, she says.

Confusion remains: Many coders say they want to see clearer guidance in the CPT® manual for +92973 and published guidance from CMS to settle the issue since it could involve changing practice policy on coding these services. Some industry experts have suggested that until CMS issues written guidance, practices should code the service consistently across the board. In other words, the recommendation is that in the absence of written guidance, you shouldn't code differently for different payers.

Head Back to 2002 for More Information

A look at CPT® Assistant (March 2002) adds more information for you to consider. CPT® Assistant states that +92973 "should be used to report the performance of coronary artery thrombectomy specifically by catheter-based angiojet."

The same CPT® Assistant issue includes a clinical vignette for +92973 and explains why the AMA created the code. The purpose of the new code was to describe a "procedure using a unique method of fragmenting and removing clots from the coronary artery" lumen. The portion of the vignette specific to the thrombectomy includes advancing the thrombectomy catheter distal to the lesion, activating the catheter using a foot pedal, and then manually withdrawing the catheter to remove the thrombus (repeating as needed).

Bonus: Additional Tips Aid +92973 Accuracy

When your documentation does support reporting +92973, remember that you should not report it as a stand-alone code. It is an add-on code and must accompany either 92980 (Transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel) or 92982 (Percutaneous transluminal coronary balloon angioplasty; single vessel).

Think of the thrombectomy as clearing blood clots that have formed on the area of obstruction that the physician wants to treat. For example, the physician wouldn't want to place a stent with the blood clot in place; the clot would be stuck between the artery wall and the stent. So he must remove the thrombus first.

Finally, if the cardiologist treats more than one site in the same coronary vessel, you should report +92973 only once. In other words, report +92973 per vessel, according to CPT® Assistant (March 2004).