Cardiology Coding Alert

You'll cheer for new anticoagulant codes--here's why

CPT 2007 brings many major changes to cardiology coding, and you're responsible for learning how to use this slew of new codes by Jan. 1. As with last year, you've got no grace period.

"No matter how hard you prepare, it always feels like a rip-tide effect -- the old codes being yanked out from underneath you, while trying to keep up with the new codes for the new year," says Karen Salowitz, RN, CPC, billing coordinator at Heart and Vascular Center of Arizona in Phoenix.

Avoid feeling this way by learning the following cardiology changes now.

Pacemaker Insertion Gets Overhaul

When you prepare to report pacemaker insertions with epicardial electrode(s), you've got to strike out two old codes and look to two new ones to represent the service your cardiologist provided.

In the past: When your cardiologist inserted a pacemaker with epicardial electrode(s), you would report either 33200 (Insertion of permanent pacemaker with epicardial electrode[s]; by thoracotomy) or 33201 (... by xiphoid approach).

As of Jan. 1: CPT 2007 introduces 33202 (Insertion of epicardial electrode[s]; open incision [e.g., thoracotomy, median sternotomy, subxiphoid approach]) and 33203 (... endoscopic approach [e.g., thoracoscopy, pericardioscopy]) for insertion of an epicardial electrode(s). Notice how one code covers open incision and the other covers endoscopic approach.

Important: You can use 33202 and 33203 for either pacemakers or defibrillators. The new parenthetical note under 33240 says, "Use 33240, as appropriate, in addition to the epicardial lead placement codes to report the insertion of the generator when done by the same physician during the same session." You should use these new codes for the electrode placement, not the generator.

"The fact that cardiologists can perform this endoscopically is great news for patients," says Inga Burton, CPC, certified coding specialist at Pima Heart Physicians in Tucson, Ariz. "This minimally invasive approach can offer a safe and effective option for patients whose vascular anatomy prevents a percutaneous approach to cardiac resynchronization therapy."

New codes 33202-33203 are also great news for coders. "Because the incision and endoscopic approaches are distinct, and CPT codes are supposed to describe exactly what the cardiologist performs, this is a positive change for 2007," says Rhena Burge, billing analyst for North Oaks Medical Center in Hammond, La.

Don't miss: In addition, CPT 2007 deletes 33245 (Insertion of epicardial single or dual chamber pacing cardioverter-defibrillator) and 33246 (... with insertion of pulse generator).

CPT Clarification Solves Your CTA Questions

Chest computed tomographic angiography (CTA) code 71275 (Computed tomographic angiography, chest [noncoronary], without contrast material[s], followed by contrast material[s] and further sections, including image postprocessing) now clarifies that it only applies to noncoronary chest CTAs. In other words, you should use this specifically for the CT of the chest.
 
Think of it this way: If your cardiologist images the coronary arteries, you should use the Category III codes 0146T-0149T. Anything else, you should use 71275.

If you forget, CPT explains this in a note under 71275 directing you to look at 0146T-0149T if your cardiologist performs a coronary artery CTA including calcification score and/or cardiac morphology. "At least now we can't question whether to use 71275 or the Category III codes," says Sarah Tupper, CMC, coder at Central New York Cardiology PC in Utica.

"Using Category III codes means that CPT will be tracking its use, and hopefully we'll have a (Category I) coronary CTA code shortly -- especially when it sounds as if a multitude of practices are using this technology," Salowitz says.

Ante Up Your New Anticoagulant Codes

For patients taking warfarin (Coumadin), you have two new codes that represent anticoagulant management, and again, you need to be ready to use them by Jan. 1.

The codes include physician review and interpretation of the International Normalized Ratio (INR) testing, plus patient instructions, dosage adjustment and ordering of additional tests.

Code 99363 (Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of International Normalized Ratio [INR] testing, patient instructions, dosage adjustment [as needed], and ordering of additional tests; initial 90 days of therapy [must include a minimum of 8 INR measurements]) covers the first 90 days, including at least eight INR measurements, and 99364 (... each subsequent 90 days of therapy [must include a minimum of 3 INR measure-ments]) covers each additional 90 days, including at least three INR measurements.

These two new codes "will be a welcome addition for practices with protime or coumadin clinics," says Sheldrian Leflore, CPC, revenue management educator with The Coding Group, a division of IRM in Carlsbad, Calif.  

Catch this: In the past, you haven't had a code to describe anticoagulant management, and some coders have caused controversy by using 99211 (Office or other outpatient visit ...) for this service, Leflore says. Some Medicare carriers identified this practice as inappropriate billing and a high-risk area for all who routinely bill in this fashion.

Don't Miss These Other Additions

You've got a few other changes that you should know before the start of 2007.

CPT 2007 deletes the existing one-size-fits-all maze procedure code 33253 (Operative incisions and reconstruction of atria for treatment of atrial fibrillation or atrial flutter [e.g., maze procedure]) and replaces it with five new codes, 33254-33256 and 33265-33266. These new codes allow you to specify whether the maze procedure was limited, extensive, or extensive with cardiopulmonary bypass. You can also bill for a limited or extensive endoscopic maze procedure.

"My physician most often performs the modified Maze with cardiopulmonary bypass," says Lisa Alexander, a coder with ProHealth in Pekin, Ill. With the existing code, she had to append a modifier to explain that the physician didn't perform the standard Maze procedure.

You've got two new codes for repair of isolated partial anomalous pulmonary venous return, also known as scimitar syndrome (33724, Repair of isolated partial anomalous pulmonary venous return [e.g., scimitar syndrome]), and pulmonary venous stenosis repair (33726, Repair of pulmonary venous stenosis).

You shouldn't find this any big surprise, but the new descriptors for inpatient consultation codes 99251-99255 delete the word "initial" to account for the fact that last year's CPT update deleted the follow-up inpatient consultation codes.