Cardiology Coding Alert

It's official: The American Medical Association (AMA) has released the list of CPT 2008 codes, and it's up to you to learn these five cardiology-specific areas of change. Beat the holiday rush by deciphering the new cardio codes before Jan. 1 hits.

CPT 2008 deletes cardiac magnetic resonance imaging (MRI) codes 75552-75556 and replaces them with eight new codes. "This will affect us the most," says Yvette Hofmeister, CPC, a cardio coding analyst at OSU Internal Medicine in Columbus, Ohio.

Old way: Codes 75552-75556 divided cardiac MRI into three groups including MRI for morphology, function (with or without morphology), and velocity flow mapping.

New way: The new codes cover cardiac MRI for both morphology and function:

• 75557 -- Cardiac magnetic resonance imaging for morphology and function without contrast material

• 75558 -- ... with flow/velocity quantification

• 75559 -- ... with stress imaging

• 75560 -- ... with flow/velocity quantification and stress

• 75561 -- Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences

• 75562 -- ... with flow/velocity quantification

• 75563 -- ... with stress imaging

• 75564 -- ... with flow/velocity quantification and stress.

Notice: The first four codes cover cardiac MRI without contrast material, and the second batch of four includes cardiac MRI "without contrast material(s), followed by contrast material(s) and further sequences." Each group of four further divides into plain cardiac MRI, cardiac MRI with flow/velocity quantification, cardiac MRI with stress imaging, and cardiac MRI with both flow/velocity quantification and stress imaging.

What this means to you: You'll have to pay more attention to how your doctor documents cardiac MRI in 2008 to make sure you're coding for further sequences, stress imaging and other additional services, when applicable.

When your cardiologist performs a procedure that involves a vascular access device, a venous access device, or a wireless physiologic sensor, you'll need to refer to four new codes.

Declotting by thrombolytic agent: You can report declotting by a thrombolytic agent, or implanted vascular access device or catheter, using new code 36593 (Declotting by thrombolytic agent of implanted vascular access device or catheter).

Blood specimen: When your doctor collects a blood specimen, you'll have two new codes. For collection from a completely implantable venous access device (VAD), use 36591 (Collection of blood specimen from a completely implantable venous access device). Code 36592 (Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified) covers collection from an established central or peripheral venous catheter, which is "not otherwise specified."

Wireless physiologic sensor: When your physician places a wireless physiologic sensor in the aneurismal sac during an endovascular repair, you'll have a new code to report this procedure: +34806, Transcatheter placement of wireless physiologic sensor in aneurysmal sac during endovascular repair, including radiological supervision and interpretation, instrument calibration, and collection of pressure data. Code 34806 includes radiological supervision and interpretation, instrument calibration, and collection of pressure data.

"The only test that a cardiologist would generally perform in an office is a basic metabolic panel (BMP)," says Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte. And CPT 2008 brings you a new code to reflect this test.

You'll use 80047 (Basic metabolic panel [Calcium, ionized]). According to the CPT definition, this panel must include the following:

• Calcium, ionized (82330)

• Carbon dioxide (82374)

• Chloride (82435)

• Creatinine (82565)

• Glucose (82947)

• Potassium (84132)

• Sodium (84295)

• Urea nitrogen (BUN) (84520).

When your cardiologist performs the modified maze procedure at the same session as another surgery in 2007, you may have to write it off because existing codes 33254-33256 are only for stand-alone procedures.

But 2008 brings better options. In January, you'll have three new add-on codes (33257-33259) for when your surgeon performs the modified maze along with a primary procedure. They are:

In short: The three new codes break down into limited, extensive without cardiopulmonary bypass, and extensive with cardiopulmonary bypass.

5. Gear Your Claims Up With Cutting-Edge Graft Code

A cutting-edge aortic valve graft procedure, known as the Tirone David Procedure or the Yacoub Procedure, gets its own code: 33864, Ascending aorta graft, with cardiopulmonary bypass with valve suspension, with coronary reconstruction and valve-sparing aortic annulus remodeling (e.g., David Procedure, Yacoub Procedure). This involves an ascending aorta graft with a cardiopulmonary bypass for valve suspension. It also includes coronary reconstruction and "valve-sparing aortic annulus remodeling."

Because the aortic valve is such a complex structure, no valve prosthesis can duplicate its function. So surgeons have developed procedures that either spare the aortic valve or replace it with "very similar autologous tissue," according to an August 2006 article in the German journal Herz ("Reconstructive surgery of the aortic valve: the Ross, David and Yacoub Procedures").