Cardiology Coding Alert

Claim checkpoint: Catheter exchanges and follow-up studies are bundled into the new codes.

Thrombolysis coders trained to find 75898 reporting opportunities will need to form new habits for 2013. As part of the non-coronary thrombolysis code update, related services all fall under 37211-37214. Here are the details.

2012: Review Thrombolysis and Radiology Options

Infusion: In 2012, your code choices included the following codes for infusion and radiological supervision and interpretation (S&I):

·         37201, Transcatheter therapy, infusion for thrombolysis other than coronary

·         75896, Transcatheter therapy, infusion, any method (e.g., thrombolysis other than coronary), radiological supervision and interpretation.

Follow-up: For follow-up angiography through an existing catheter to check the patient’s progress, the appropriate 2012 code was:

·         75898, Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion.

Exchange: If the physician exchanged the catheter, you used the following codes for 2012 services:

·         37209, Exchange of a previously placed intravascular catheter during thrombolytic therapy

·         75900, Exchange of a previously placed intravascular catheter during thrombolytic therapy with contrast monitoring, radiological supervision and interpretation.

2013: Base Code Choice on Vessel and Day

CPT® 2013 deletes 37201 and 37209, and replaces them with new options that include S&I. Because the new infusion codes include S&I, 75900 has been deleted for 2013. Codes 75896 and 75898 have not been deleted, but they have been revised to specify they apply to transcatheter therapy infusion “other than for thrombolysis,” says Julie Graham, BA, CPC, coder and compliance specialist for Concentra in Texas.

You’ll also notice that the new codes apply to an entire day of treatment. Use a “midnight to midnight time period,” stated Sean P. Roddy, MD, FACS, of the Society for Vascular Surgery and member of the AMA CPT® Advisory Committee, in the “Vascular Surgery and Interventional Radiology” presentation at the AMA’s CPT® and RBRVS 2013 Annual Symposium.

Initial day: New 2013 codes 37211 and 37212 vary based on whether the infusion is arterial or venous. To properly apply these codes, you also need to remember that the codes include related services (such as S&I, follow-up angiography, and catheter repositioning or exchange), and that 37211 and 37212 are specific to the initial treatment day. You should report each code only once for the date of service:

·         37211, Transcatheter therapy, arterial infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, initial treatment day

·         37212, Transcatheter therapy, venous infusion for thrombolysis, any method, including. radiological supervision and interpretation, initial treatment day.

Subsequent day: In 2013, you have two options to choose from for treatment subsequent to the initial day of treatment. Both 37213 and 37214 include S&I, thrombolytic therapy, follow-up angiography, and catheter repositioning or exchange. The difference between the two codes is that 37214 additionally includes completing the thrombolysis service by removing the catheter and closing the vessel involved. The codes are defined as follows and are intended to be reported only once per day:

·         37213, Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed 

·         37214, Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed; cessation of thrombolysis including removal of catheter and vessel closure by any method.

Set Aside Symbol Confusion

When you review the codes in your CPT® text, you’ll see two symbols next to each of the new codes.

The first symbol is #. This symbol means “resequenced code” and indicates that a code is out of numerical order. CPT® 2013 places 37211-37214 after 37200 and before 37202. By placing the codes out of numerical order, CPT® is able to add new codes near similar transcatheter service codes without having to renumber entire sections.

The other symbol is ʘ. This symbol indicates moderate sedation services performed by the same provider are included in the service and should not be charged separately.

S&I: Steer Clear of Separate Imaging Codes

As mentioned above, codes 75896 and 75898 have been revised in 2013 because they are no longer appropriate for thrombolysis S&I. The new code definitions are:

·         75896, Transcatheter therapy, infusion other than for thrombolysis, radiological supervision and interpretation

·         75898, Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis.

Crucial: Take special care to remember that follow-up angiography code 75898 is no longer appropriate for thrombolysis services. “Coders will need to beware of trying to bill 75898 for the follow-up done same day as this is now included with 37211,” says Graham. Same-day follow-up angiography is also included in 37212, according to CPT® guidelines.

“You can, however, bill 37213 on a subsequent day,” she adds. Or report 37214 for a subsequent day that includes completion of thrombolysis. Recall that the subsequent day codes include follow-up angiography and all other services related to the thrombolysis performed on that day.