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 37215 only if the cardiologist specifically notes that he used such a device, and you can provide supporting documentation for the insurer.

Distal embolic protection devices are sold under the brand names Pride, Captive and others. The cardiologist places the device to trap particle debris (also called plaque or thrombi) in the artery.

New Code Additions Revise 37205/37206

The addition of 37215/37216 means you should not use 37205/37206 for stent placements in carotid vessels. To further accentuate this point, CPT has revised the descriptors for 37205/37206, along with their companion radiologic supervision and interpretation code:

37205 - Transcatheter placement of an intravascular stent(s) (except coronary, carotid, and
vertebral vessel), percutaneous; initial vessel

+37206 - ... each additional vessel (list separately in addition to code for primary procedure)

75960 - Transcatheter introduction of intravascular stent(s) (except coronary, carotid, and vertebral
vessel), percutaneous and/or open, radiological supervision and interpretation, each vessel.

Don't forget: Back in July, the American Medical Association Web site listed the new 2005 Category III codes describing carotid stent procedures, which start their temporary tenure Jan. 1:

0075T - Transcatheter placement of extracranial vertebral or intrathoracic carotid artery stent(s),
including radiologic supervision and interpretation, percutaneous; initial vessel

0076T - ... each additional vessel (list separately in addition to code for primary procedure).

When your cardiologist places a carotid artery stent, the patient undergoes a minimally invasive alternative to carotid endarterectomy. This is great news for patients considered at risk for adverse outcomes during an endarterectomy surgery.

Scratch 78990, Use A9500-A9502 Instead

You can forget about using 78990 (Provision of diagnostic radiopharmaceutical[s]) during myocardial perfusion studies, because CPT had deleted this code from your possible choices.

Instead, you should look to the codes for Cardiolite (A9500, Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m sestamibi, per dose) and Myoview (A9502, Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m tetrofosmin, per unit dose).

"All government payers have used A9500 for some time," says Kathy Zinger, BA, CMM, RMC, office manager of Parkside Cardiology in Colorado Springs, Colo. "Therefore I think it will be a benefit to eliminate 78990 and to have everyone on the same page with regard to coding radiopharmaceutical agents."

Also, when you assign myocardial perfusion imaging codes 78464-78465, notice the clarifying information included in parentheses after either single study or multiple studies:

78464 - Myocardial perfusion imaging; tomographic (SPECT), single study (including attenuation correction when performed), at rest or stress (exercise and/or pharmacologic), with or without quantification

78465 - Myocardial perfusion imaging; tomographic (SPECT), multiple studies (including attenuation correction when performed), at rest and/or stress (exercise and/or pharmacologic) and redistribution and/or rest injection, with or without quantification.

The phrase "attenuation correction" refers to a more defined method of imaging.