Cardiology Coding Alert

Also, 78990's deletion means you'll be reporting A9500 a lot more
 
If your cardiologist places a carotid stent, starting Jan. 1 you can use CPT 37215 and CPT 37216, which include selective carotid access, diagnostic imaging, and supervision and interpretation (S&I).

In addition to the carotid stent codes, CPT Codes 2005 contains other changes that will impact cardiology coders, so make sure you check out the following advice from our experts on myocardial perfusion study changes, wearable external defibrillator codes, and endovascular repair codes.

Get ready now: Keep in mind that for 2005, you will not be allowed the usual 90-day "grace period" to transition to the new codes. Beginning on Jan. 1, you must use CPT 2005 exclusively for Medicare payers, according to CMS transmittal 95 (February 2004). You Can No Longer Report S&I for Carotid Stent Procedures CPT has released two new Category I codes that replace Category III carotid stent codes 0005T-0007T, as the September 2004 Cardiology Coding Alert reported. When the cardiologist places an intravascular stent, you will have to choose between 37215 (Transcatheter placement of intravascular stent[s], cervical carotid artery, percutaneous; with distal embolic protection) and 37216 (Transcatheter placement of intravascular stent[s], cervical carotid artery, percutaneous; without distal embolic protection).

Important: Unlike other peripheral vascular unbundled procedures, CPT includes selective carotid access, diagnostic imaging as well as supervision and interpretation into the new carotid stent codes. What that means is you shouldn't bill for the catheter placement or preprocedure imaging or S&I for the procedure - unless the cardiologist performs the diagnostic procedure on a date prior to the therapeutic service, says Roseanne Wholey, president of Roseanne R. Wholey and Associates, a medical reimbursement consulting firm in Oakmont, Pa.

"If a diagnostic cath is performed without therapeutic intervention, you may bill for carotid access, imaging and S&I," Wholey says. "But if a diagnostic procedure is followed by the use of an approved carotid stent, then you would only report the appropriate surgical carotid stent code 37215 or 37216." 

These new codes join the codes for transcatheter stent placement in a noncoronary vessel (37205-37208).

The new codes specifically describe stent placement to treat carotid artery stenosis, which the cardiologist may perform "in patients replacing an open carotid endarterectomy [35301]," says Gary W. Barone, MD, associate professor of surgery at the University of Arkansas for Medical Sciences in Little Rock.

Differentiate with and without distal embolic protection: To distinguish between 37215 and 37216, you must know whether the cardiologist used a distal embolic protection device with the stent placement. Report [...]