Cardiology Coding Alert

Hint: Remember to check venography documentation carefully for correct code choice.

When CPT^® 2024 becomes effective on Jan. 1, 2024, you’ll see several new codes, deletions, and revisions. Cardiology practices should especially be aware of the new congenital heart disease and defect codes and the revised evaluation and management (E/M) codes.

Here’s what you need to know to keep your claims on track next year.

Take a Look at New Coronary FFR Codes

In 2024, you will see several new cardiology-related radiology codes.

For example, you will gain new code 75580 (Noninvasive estimate of coronary fractional flow reserve (FFR) derived from augmentative software analysis of the data set from a coronary computed tomography angiography, with interpretation and report by a physician or other qualified health care professional) for a noninvasive estimate of coronary fractional flow reserve (FFR).

You will also see several new ultrasound options, including intraoperative thoracic aorta code 76984 (Ultrasound, intraoperative thoracic aorta (eg, epiaortic), diagnostic).

In addition, you will be able to report the following new intraoperative epicardial cardiac ultrasound options:

• 76987 (Intraoperative epicardial cardiac ultrasound (ie, echocardiography) for congenital heart disease, diagnostic; including placement and manipulation of transducer, image acquisition, interpretation and report)
• 76988 (… placement, manipulation of transducer, and image acquisition only)
• 76989 (… interpretation and report only)

Don’t miss: Current intraoperative ultrasonic guidance code 76998 (Ultrasonic guidance, intraoperative)

will not be deleted in 2024. It seems like CPT^® has merely added more specific cardiology options with the addition of 76984 and 76987-76989.

Pinpoint New Venography Codes

Next year, you will also get some new add-on venography codes for congenital heart defects. They are as follows:

• +93584 (Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; anomalous or persistent superior vena cava when it exists as a second contralateral superior vena cava, with native drainage to heart (List separately in addition to code for primary procedure))
• +93585 (… azygos/hemiazygos venous system (List separately in addition to code for primary procedure))
• +93586 (… coronary sinus (List separately in addition to code for primary procedure))
• +93587 (… venovenous collaterals originating at or above the heart (eg, from innominate vein) (List separately in addition to code for primary procedure))
• +93588 (… venovenous collaterals originating below the heart (eg, from the inferior vena cava) (List separately in addition to code for primary procedure))

Venography defined: A venogram is a test that uses x-rays to create moving pictures of blood flow in your veins. Your cardiologist can use venography to diagnose deep vein thrombosis when ultrasound images aren’t sufficient to provide the needed information.

“As codes +93585-+93588 are for congenital heart defects, they would only be reported with a congenital heart catheterization code,” says Robin Peterson, CPC, CPMA, manager of professional coding and compliance services, Pinnacle Enterprise Risk Consulting Services, LLC in Centennial, Colorado.

Don’t Miss These Revised E/M Codes

Some E/M codes will also be revised in 2024. Those affected include new patient codes 99202-99205, established patient codes 99212-99215, initial nursing facility care code 99306, and subsequent nursing facility care code 99308.

Codes 99202-99205 and 99212-99215 will all see similar revisions to their code descriptors.

For example, 99202 will be changed to: (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15-29 minutes of total time is spent on the date of the encounter minutes must be met or exceeded.) Emphasis added.

Code 99212 will be revised to: (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10-19 minutes of total time is spent on the date of the encounter minutes must be met or exceeded.) Emphasis added.

“The Centers for Medicare and Medicaid Services (CMS) sought clarifications on the reporting of evaluation and management (E/M) services, which prompted revisions to the CPT^® 2024 code set, specifically revisions to remove time ranges from office or other outpatient visit codes,” Peterson said. “It’s important to stay informed about these changes to ensure accurate coding and billing.”

Codes 99306 and 99308 will each receive minor revisions to their descriptors regarding the amount of time that must be met or exceeded. For example, 99306 will be revised to: (Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/ or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 45 50 minutes must be met or exceeded.)

Identify New Caregiver Training Codes

Next year will also bring some new codes you can report for caregiver training.

These are your options:

• 97550 (Caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (eg, activities of daily living [ADLs], instru­mental ADLs [iADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face; initial 30 minutes) and +97551 (… each additional 15 minutes (List separately in addition to code for primary service)
• 97552 (Group caregiver training in strategies and techniques to facilitate the patient’s functional performance in the home or community (eg, activities of daily living [ADLs], instrumental ADLs [iADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face with multiple sets of caregivers).