Cardiology Coding Alert

Remember: Check the documentation for length of recording time when reporting ECG codes.

When CPT^® 2021 becomes effective on Jan. 1, 2021, you’ll see numerous new codes, deletions, and revisions. Cardiology practices should especially be aware of the new congenital transcatheter codes, as well as the new ventricular assist device codes and revisions.

Keep your cardiology claims in tip-top shape by staying on top of the following code additions, revisions, and deletions you will see next year.

Discover New Congenital Transcatheter Codes

In 2021, you will gain the following new codes for reporting the creation of effective intracardiac blood flow in congenital heart defects:

• 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))

Don’t miss: Code 33741 involves a transcatheter atrial septostomy (TAS) for congenital cardiac anomalies, while codes 33745 and add-on code +33746 involve transcatheter intracardiac shunt (TIS) creation by stent placement.

TAS defined: A transcatheter atrial septostomy is generally performed as a palliative procedure for transposition of the great arteries (TGA), says Robin Peterson, CPC, CPMA, Manager of Professional Coding, Pinnacle Integrated Coding Solutions, LLC. Almost all babies with TGA will need to undergo atrial septostomy, which enlarges an existing foramen ovale and allows the oxygen rich blood and the oxygen poor blood to circulate through the heart and body until they can undergo an arterial switch.

TIS defined: The transcatheter intracardiac shunt purposely diverts the “normal” blood flow pathway and is done before a more definitive surgery can be performed such as an arterial switch, Peterson explains. Most frequently this is performed to increase pulmonary blood flow.

“When reviewing documentation for 33745, remember the code will include all imaging guidance, all hemodynamics obtained from both left and right diagnostic congenital heart catheterization, and angioplasty within the target vessel, which is any segment of vessel that is treated,” Peterson says. “Angioplasty outside of the treatment zone during the same procedure may be billable with a modifier, if appropriate.”

Mark Down 2 New Ventricular Assist Device Codes and Numerous Revisions

You will also see two new reporting choices for ventricular assist devices in 2021.

For the insertion of a percutaneous right heart ventricular assist device, you should report new code 33995 (Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; right heart, venous access only).

As you can see from the code descriptor for 33995, this code includes radiological supervision and interpretation. Also, you must check the medical documentation carefully because code 33995 does specify that it is to be used for “venous access only.”

On the other hand, if you need to report the removal of a percutaneous right heart ventricular assist device, you should report new code 33997 (Removal of percutaneous right heart ventricular assist device, venous cannula, at separate and distinct session from insertion).

According to the code descriptor for 33997, you should report this code when your cardiologist performs the percutaneous right heart ventricular assist device removal in a separate and distinct session from the insertion of the ventricular assist device.

“The key to proper code selection for a ventricular assist device in 2021 will be to decipher whether the access was arterial, arterial and venous, or venous,” Peterson says. “If the documentation is not clear, you’ll want to query the provider.”

Revisions: You will also see the following revised ventricular assist device codes in 2021. (Emphasis added):

• 33990 (Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; left heart, arterial access only)
• 33991 (Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; left heart, both arterial and venous access, with transseptal puncture)
• 33992 (Removal of percutaneous left heart ventricular assist device, arterial or arterial and venous cannula(s), at separate and distinct session from insertion)
• 33993 (Repositioning of percutaneous right or left heart ventricular assist device with imaging guidance at separate and distinct session from insertion)

Don’t miss: The descriptors for 33990-33992 now include “left heart.” In addition, code 33992 also added the words “arterial or arterial and venous cannula(s)” to its descriptor. Finally, code 33993 added “right or left heart” to its code descriptor.

Dial Into Numerous New Electrocardiographic Recording Codes

You will also see the following new external electrocardiographic (ECG) recording codes in 2021:

• 93241 (External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation)
• 93242 (… recording (includes connection and initial recording)
• 93243 (… scanning analysis with report)
• 93244 (… review and interpretation)

You will report codes 93241-93244 for recording more than 48 hours and up to seven days. Code 93241 is the global code you should report if your cardiologist reports all of the parts of the service including the recording, scanning analysis with report, and the review and interpretation.

On the other hand, if your cardiologist performs just a component of the electrocardiographic service, you should report the appropriate component code. For example, if your cardiologist performs just the review and interpretation of an external ECG recording service for 50 hours for seven days a week, you would report code 93244.

Codes 93245-93248: You will also gain the following new ECG recording codes to report more than seven and up to fifteen days:

• 93245 (External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation)
• 93246 (… recording (includes connection and initial recording))
• 93247 (… scanning analysis with report)
• 93248 (… review and interpretation)

You should report code 93245 for the global service if your cardiologist performs all of the parts of this service. On the other hand, you should report component codes 93246-93248 if your cardiologist reports just one part of the service.

Don’t miss: You must always check the medical documentation to see how long the cardiologist performed the ECG recording because the main difference between codes 93241-93244 and codes 93245-93248 is the length of recording time.

Finally, Don’t Miss These Deleted Codes

In 2021, you will say good-bye to the following two cardiology-specific CPT^® codes:

• 92992 (Atrial septectomy or septostomy; transvenous method, balloon (eg, Rashkind type) (includes cardiac catheterization))
• 92993 (… blade method (Park septostomy) (includes cardiac catheterization)).