Cardiology Coding Alert

A handy list of primary codes ensures your myocardial imaging add-on code has a proper match.

One fun (or frustrating) fact of Category III codes is that implemented codes aren’t always in the most current printed CPT^® manual. Because the codes often apply to emerging technology, the schedule for quick adoption of these hot-topic codes may not line up with the annual printing schedule for CPT^® updates.

Here’s a look at cardiology Category III codes going into effect January 1, with notes on which you will — and which you won’t — see in the printed manual.

Check it out: See “Capture CCM System Services With ‘Early Release’ Codes 0408T-0418T” in Cardiology Coding Alert, vol. 18, no. 11, for information on more Category III codes with a Jan. 1, 2016, implementation date that won’t appear in the AMA printed manual.

Watch Units and Primary Options for Myocardial Imaging

Be sure your echocardiography team knows about new myocardial strain imaging code +0399T (Myocardial strain imaging [quantitative assessment of myocardial mechanics using image-based analysis of local myocardial dynamics] [List separately in addition to code for primary procedure]).

Myocardial strain imaging is “appropriately used by providers who are treating CHF patients undergoing cardiac resynchronization pacing,” explains Ray Cathey, PA, MHS, CMSCS, CHCI, president of Medical Management Dimensions in Stockton, Calif. You also may see it as “a supplemental test in stress echocardiography in patients who have angina with suspected coronary artery stenosis as an early predictor of coronary artery ischemia and left ventricular failure. It is also valuable in treating patients with cardiomyopathies.”

Because +0399T is an add-on code, you must report it in addition to an appropriate primary code. According to guidelines with the code, appropriate primary code options include the following:

• Transthoracic echocardiography (TTE) codes 93303-93308
• Transesophageal echo (TEE) codes 93312, 93314, 93315, and 93317
• Stress echo codes 93350 and 93351
• Intervention guidance TEE code 93355.

Unit rule: You should report new code +0399T only once per session.

Expert tip: “As with any newly introduced technology, I would suggest that the billing/coding staff talk with the equipment manufacturer representative about diagnoses needed and to obtain a copy of the FDA certificate, which all devices require before they can be used in the clinical setting,” Cathey says. “I’d suggest dropping these claims to paper and sending a copy of the FDA certificate with the claim. This could assist in letting the payer know that the test is not ‘investigational.’” Establishing that the test is not investigational is an important step in supporting payment for the test.

Release and implementation: The AMA released this code July 1, 2015, with an implementation date of Jan. 1, 2016. You can expect to see this code in the CPT^® 2016 print manual.

Look at New Lab Code 0423T for sPLA2

You also may be interested in learning about 0423T (Secretory type II phopholipidase A2 [sPLA2-IIA]). Labs will use this code for AccuCardia™, a test system that uses sPLA2-IIA for assessing cardiovascular event risk levels.

If you keep tabs on cardiology-related lab codes to assist your cardiologist with orders, take note that 0423T is not the correct code for Lp-PLA2, which helps with assessment of coronary artery disease and stroke risk. Labs report that test using 83698 (Lipoprotein-associated phospholipase A2 [Lp-PLA2]).

Release and implementation: The AMA released 0423T July 1, 2015, with an implementation date of Jan. 1, 2016. Expect the code to appear in the AMA’s CPT^® 2017 printed manual.

Put Your Best Foot Forward for Cat. III Claims

When a Category III code is available for a service, CPT^® guidelines require you to report the Category III code rather than an unlisted procedure code from Category I. But “there are a number of issues with billing the Category III codes,” Cathey warns. 

Providers frequently don’t know the codes exist, Cathey notes. Billing and coding staff also may not understand that they may report the Category III codes, or the staff may confuse Category III with Category II codes, Cathey says. So be sure to include relevant Category III updates when you communicate with providers and the rest of the team about coding changes.

The reality that both government and commercial payers often don’t cover Category III codes can be discouraging, making coders and billers “reluctant to take the trouble to use the codes and go through the hoops required to get them paid,” Cathey says. And because these codes are often “carrier priced” and are frequently new, many practices report that “they have no basis for comparison in setting prices and the payers aren’t willing to suggest a possible reimbursement amount.” You can use the time before the new year starts to try to convince payers to cover and reimburse the services you perform, providing comparisons to codes and fees for similar services.

Good news: Reporting the Category III code helps show that providers use the service in current practice, which is one element that helps support moving the service to a more permanent and (potentially more easily paid) Category I code.