Cardiology Coding Alert

Hint: Never append modifier 63 to code 33741.

In the article “Sort Through These Congenital Transcatheter, Ventricular Assist Device, and ECG Recording Codes Before Jan. 1. Hits” in Cardiology Coding Alert Vol. 23, No. 10, you learned all about the new shunting procedure codes you will gain in 2021. Along with these new codes, CPT^® has also added numerous guidelines and rules for you to follow.

Read on to keep your shunting claims in tip-top shape.

Discover Rules for 3 New Shunting Procedure Codes

You will receive the following three new codes for reporting shunting procedures for congenital cardiac anomalies in 2021:

• 33741 (Transcatheter atrial septostomy (TAS) for congenital cardiac anomalies to create effective atrial flow, including all imaging guidance by the proceduralist, when performed, any method (eg, Rashkind, Sang-Park, balloon, cutting balloon, blade)).
• 33745 (Transcatheter intracardiac shunt (TIS) creation by stent placement for congenital cardiac anomalies to establish effective intracardiac flow, including all imaging guidance by the proceduralist, when performed, left and right heart diagnostic cardiac cather­ization for congenital cardiac anomalies, and target zone angioplasty, when performed (eg, atrial septum, Fontan fenestration, right ventricular outflow tract, Mustard/Senning/ Warden baffles); initial intracardiac shunt) and +33746 (… each additional intracardiac shunt location (List separately in addition to code for primary procedure)).

Make sure to heed these rules when reporting codes 33741, 33745, and +33746, per the CPT^® guidelines.

Rule 1: Never append modifier 63 (Procedure performed on infants less than 4 kg) to code 33741.

Rule 2: You should report code 33741 when your cardiologist percutaneously creates improved atrial blood flow, such as with the balloon/blade method, for infants </=4 kg who have congenital heart disease.

Rule 3: You should report code 33745 when your cardiologist performs intracardiac shunt creation by stent placement to establish improved intracardiac blood flow. Examples of this include an atrial septum, Fontan fenestration, right ventricular outflow tract, or Mustard/Senning/Warden baffles. “Multiple stents placed in a single location may only be reported with a single code,” according to CPT^®.

Rule 4: You should report add-on code +33746 when your cardiologist treats additional, different intracardiac locations in the same session. You should always report code +33746 in conjunction with primary code 33745. Code +33746 describes “each additional intracardiac shunt creation by stent placement at a separate location during the same session as the primary intervention (33745),” according to CPT^®.

Rule 5: Never report codes 33745 and +33746 with codes 93530 (Right heart catheterization, for congenital cardiac anomalies)-93533 (Combined right heart catheterization and transseptal left heart catheterization through existing septal opening, with or without retrograde left heart catheterization, for congenital cardiac anomalies).

Don’t miss: “You can report diagnostic congenital heart catheterization (codes 93530-93533) with code 33741 if a full diagnostic study is performed and the documentation meets the CPT^® requirements to bill a separate diagnostic study,” says Robin Peterson, CPC, CPMA, Manager of Professional Coding, Pinnacle Integrated Coding Solutions, LLC. “The documentation per CPT^® should reflect there was no prior study available or a prior study was available but there was inadequate visualization of the anatomy, the patient’s clinical condition changed since the prior study regarding the clinical indication, or there was a clinical change during the procedure that requires a more thorough evaluation.”

You may also report same session diagnostic cardiac angiography (codes +93563 and +93565-+93568) with code 33741 if it is used to evaluate anatomy separate and distinct from the shunt creation, Peterson adds. However, make sure to append modifier 59 (Distinct procedural service) to the cardiac catheterization and angiography codes in these circumstances.

Understand Included Services

When you report codes 33741, 33745, and +33746, you must know which services are already included in these codes so you understand if you can separately report other codes with them.

For example, when your cardiologist performs it, both codes 33741 and 33745 include ultrasound guidance for vascular access and fluoroscopic guidance for the intervention.

Code 33741 includes the cardiologist’s work of performing the percutaneous access, placing the access sheath(s), advancing the transcatheter delivery system, and creating an effective intracardiac atrial blood flow.