Cardiology Coding Alert

Cardiology practice coders accustomed to reporting 92980 and 92981 for the insertion of all stent types could be using two new HCPCS codes G0290 and G0291 after April 1 when interventional cardiologists insert drug-eluting stents. Specifically, drug-eluting stents (DES) are designed to release immunosuppressive agents such as Sirolimus that inhibit smooth muscle cell proliferation, which is the leading cause of restenosis within stented coronary arteries, says Susan M. Hull, RHIA, CCS, practice manager for coding products and services with the American Health Information Management Association (AHIMA) in Chicago. The stent delivers or elutes"" the active drug over a period of 30 to 45 days through a polymer coating that remains on the stent after all the drug has been released she says.DES Set to Transform Interventional ProceduresCoders should expect to see an increase in DES use in interventional procedures and subsequent changes in operative reports that could impact reimbursement in the near future.

Indeed in the next two years the use of drug-eluting stents could reduce bypass surgery by almost 50 percent cause significant reductions in the need for medical therapy and increase the frequency of interventional procedures for coronary artery disease says Joseph D. Babb MD FACC FSCAI professor of medicine at East Carolina University School of Medicine in Greenville N.C. and moderator of a debate on drug-eluting stents sponsored by the Society for Cardiac Angiography and Interventions (SCAI).Drug-eluting stents cost as much as three times more than conventional stents. However there should be no significant financial impact on physician practices because these procedures are performed in hospital settings Hull says.

Even so physicians will want to use the new stents and will press hospitals to invest in the most costly devices Hull predicts.

Moreover the reduced rate of restenosis should in turn reduce reoperation rates and may lead physicians to use DES in smaller and smaller coronary vessels that were previously not amenable to revascularization by stenting Hull says. In effect coders could see more of these procedures and will need to master the complexities of small coronary vessels for correct DES coding. Use G0290 and G0291 for DES PlacementIndeed coders are used to reporting 92980 (Transcatheter placement of an intracoronary stent[s] percutaneous with or without other therapeutic intervention any method; single vessel) when the physician places a standard (bare-metal) intracoronary stent and adding 92981 for stent insertion of any type in each additional vessel.

But stent coding will change on April 1 the implementation date for two HCPCS level II codes for drug-eluting stent insertion Hull says.For all stent placement procedures including DES insertion prior to April 1 report 92980 and 92981 as appropriate says Sheldrian Wayne CPC a cardiology coding specialist with Coding Strategies Inc. of Powder [...]