Cardiology Coding Alert

Bonus:  Discover how to handle fluoroscopy codes

CPT 2006 adds a whole new section for "Endovascular Repair of Descending Thoracic Aorta," which means you'll be throwing out Category III codes 0033T-0040T in favor of 33880-33891. But make sure you know what services these codes do--and do not--include.

Learn the New Codes

You'll apply these codes when your cardiologist repairs the descending thoracic aorta using an endovascular graft.

"Clinically, this is similar to the procedures doctors have been performing for years to treat abdominal aortic aneurysm (AAA). The key difference is that the anatomic area being treated is in the thoracic aorta--the portion of aorta between the abdominal aorta and the aortic arch," says Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition in Matthews, N.C.  

The new codes include device introduction, manipulation, positioning and deployment.

For example, you'll be able to bill for the endovascular thoracic aorta repair with coverage of left subclavian artery origin (33880, Endovascular repair of descending thoracic aorta [e.g., aneurysm, pseudo-aneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption]; involving coverage of left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension[s], if required, to level of celiac artery origin) or without (33881, ...not involving coverage of left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension[s], if required, to level of celiac artery origin).

Heads up: Unlike the traditional AAA repair codes, these endovascular thoracic repair codes include any distal extensions deployed at the time of the procedure.

Second, if your cardiologist deems proximal extensions necessary at the time of the initial graft deployment, you should separately report them with new codes 33883 (Placement of proximal extension prosthesis for endovascular repair of descending thoracic aorta [e.g., aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption]; initial extension) and +33884 (...each additional proximal extension [list separately in addition to code for primary procedure]). 

Note this difference: "These codes are unlike the existing AAA extension graft codes (34825-34826) in that you should separately code each graft your cardiologist deploys rather than 'each vessel,' as is the case with the AAA codes," Collins says. Similarly, you should separately report distal extension prostheses deployed after the initial procedure with 33886 (Placement of distal extension prosthesis[s] delayed after endovascular repair of descending thoracic aorta).  

This section also includes surgical transposition of the subclavian to the carotid artery with endovascular repair of the descending thoracic (33889, Open subclavian to carotid artery transposition performed in conjunction with endovascular repair of descending thoracic aorta, by neck incision, unilateral) and a bypass graft with an endovascular repair of the descending thoracic (33891, Bypass graft, with other than vein, transcervical retropharyngeal carotid-carotid, performed in conjunction with endovascular repair of descending thoracic aorta, by neck incision).

What Codes to Cross Out

Along with the new "Endovascular Repair of Descending Thoracic Aorta" section in your CPT come stipulations regarding how you should report these new codes. Many coders welcome the regulations. "It'll be really useful to have so much guidance on which procedures are bundled with thoracic aorta repair," says Kristin Simpson, a consultant in Yorba Linda, Calif.

Services not separately reportable: You should avoid reporting the following services with 33880-33891:

• any additional codes for any work your cardiologist does to introduce position or manipulate the device

• balloon angioplasty or stent deployment either before or after endograft deployment in the targeted treatment area, Collins says.

Keep in mind: For a distal extension prosthesis, you can use 33886 (Placement of distal extension prosthesis[s] delayed after endovascular repair of descending thoracic aorta), but you can't bill 33880 or 33881 along with the applicable graft placement code. Therefore, your cardiologist must perform the 33886 procedure after the initial operation

Also, CPT says that you cannot report 33889 (Open subclavian to carotid artery transposition performed in conjunction with endovascular repair of descending thoracic aorta, by neck incision, unilateral) with 35694 (Transposition and/or reimplantation; subclavian to carotid artery). Code 35694 stands on its own, while you'll find that 33889 is similar to an add-on code because the definition says you can only report this code at the time of another specific procedure, Collins says.

Similarly, you cannot report 33891 (Bypass graft, with other than vein, transcervical retropharyngeal carotid-carotid, performed in conjunction with endovascular repair of descending thoracic aorta, by neck incision) with 35509 (Bypass graft, with vein; carotid-carotid) or 35601 (Bypass graft, with other than vein; carotid).
 
Special case: When you're reporting 33889 or 33891, you can separately code the transposition of the subclavian artery to carotid (33889). This goes for carotid-carotid bypass as well.

What You Can Code in Addition

You can report 33880-33891 along with the following codes:
 
• Any open arterial exposure and closure of the arteriotomy sites (such as 34812, 34820, 34833,  34834)

• Introduction of guidewires and catheters (such as 36140, 36200)

• Extensive repair or replacement of an artery (such as 35226, 35286)

• Other interventional procedures (such as innominate, carotid, subclavian, visceral, or iliac artery transluminal angioplasty or stenting, arterial embolization, intravascular ultrasound). This is the case for interventions performed outside of the target graft treatment zone.

Keep in mind: If your cardiologist places a "proximal extension" prosthesis for the endovascular repair, you'll be able to bill 33883, plus 33884 for each additional proximal extension.

Accurate reporting: Don't be afraid to bill separately for fluoroscopic guidance with 33880-33891 using codes 75956-75959. As with the existing endovascular AAA repair codes, you can report both the procedure and the radiological supervision and interpretation services necessary to place the graft and confirm its successful deployment.