Cardiology Coding Alert

Hint: New code C7531 includes transluminal angioplasty.

The Centers for Medicare & Medicaid Services (CMS) recently released the January 2023 updates to the HCPCS Level II file. You’ll see several cardiology-specific changes, including new codes for catheter placement in the coronary artery for coronary angiography, brand-new revascularization options, and some new pacemaker codes.

Editor’s note: The effective date for these codes is January 1, 2023, unless otherwise specified.

Take a look to make sure you know how to report these new codes.

Mark Down 16 Cath Placement Codes

In 2023, you will see numerous new options for catheter placement in the coronary artery for coronary angiography. Some of these new codes include the following:

• C7516 (Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report )
• C7521 (… with right heart catheterization with endoluminal imaging of initial coronary vessel or graft …)
• C7525 (… imaging supervision and interpretation, with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with endoluminal imaging of initial coronary vessel or graft …)
• C7527 (… imaging supervision and interpretation, with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, with endoluminal imaging of initial coronary vessel or graft …)
• C7552 (… imaging supervision and interpre­tation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress, initial vessel)

“For C7516-C7527, the codes include the possibility of utilizing coronary optical coherence tomography (OCT),” says Arlene Baril, MHA, RHIA, CHC, Director, Pinnacle Enterprise Risk Consulting Services, LLC. “OCT is an intravascular modality that uses near-infrared light to provide high-definition, cross-sectional, and three-dimensional images of the vessel microstructure during percutaneous coronary intervention (PCI).”

Baril goes on to say, “Code C7552 is used with a right heart artery graft angiography fractional flow reserve (FFR). This is less invasive than traditional FFR and doesn’t require a pressure wire, thus increasing the clinical benefits of FFR without factors that limit the invasive technique.”

Coronary angiography defined: Cardiologists perform coronary angiograms by using contrast material and X-rays to see how blood flows through the arteries in the patient’s heart.

Focus on 3 New Revascularization Options

CMS will also add the following three new revascularization codes next year:

• C7531 (Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(ies), unilateral, with transluminal angioplasty with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation)
• C7534 (… with atherectomy, includes angioplasty within the same vessel, when performed with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation)
• C7535 (… with transluminal stent placement(s), includes angioplasty within the same vessel, when performed, with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation)

Don’t miss: As you can see, C7531 includes a transluminal angioplasty, while C7534 includes an atherectomy. On the other hand, C7535 includes a transluminal stent placement. In order to report the appropriate code, check the documentation carefully.

Pinpoint Brand-New Pacemaker Codes

If you report pacemaker procedures in your practice, make sure you are aware of the following new insertion, replacement, and removal options.

• C7537 (Insertion of new or replacement of permanent pacemaker with atrial transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable debribrillator or pacemake pulse generator (eg, for upgrade to dual chamber system))
• C7538 (… with ventricular transvenous electrode(s), with insertion of pacing electrode, cardiac venous system …)
• C7539 (… with atrial and ventricular transvenous electrode(s), with insertion of pacing electrode, cardiac venous system …)
• C7540 (Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator, dual lead system, with insertion of pacing electrode, cardiac venous system …)

“These codes are used solely in cardiac resynchronization therapy procedures (CRT),” according to Baril.

Don’t miss: The only difference between codes C7537, C7538, and C7539 is the type of transvenous electrodes. For example, report C7537 for atrial transvenous electrodes. Report C7538 for ventricular transvenous electrodes, and report C7539 for both atrial and ventricular transvenous electrodes.

Highlight New Injection Codes

In 2023, you will also see some new drug codes you can report in your cardiology practice. They include:

• J0283 (Injection, amiodarone hydrochloride (nexterone), 30 mg). Cardiologists commonly use amiodarone hydrochloride to treat symptoms of ventricular arrhythmias.
• J0891 (Injection, argatroban (accord), not therapeutically equivalent to j0883, 1 mg (for non-esrd use)) and J0898 (Injection, argatroban (auromedics), not therapeutically equivalent to j0883, 1 mg (for non-esrd use)). Cardiol­ogists use argatroban to prevent blood clots in adults who have thrombocytopenia caused by using Heparin.
• J1643 (Injection, heparin sodium (pfizer), not therapeu­tically equivalent to j1644, per 1000 units). Cardiologists use heparin sodium to treat blood clots.

Remember G Codes for Patient Prolonged Service

Based on disagreement about when to start counting prolonged service, the Medicare Physician Fee Schedule (MPFS) CY2023 final rule introduced three new codes you’ll use for Medicare patients for reporting prolonged services instead of using CPT^® prolonged service codes +99417 and +99418:

• G0316 (Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services). (do not report g0316 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418, 99415, 99416). (do not report g0316 for any time unit less than 15 minutes)
• G0317 (Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99306, 99310 for nursing facility evaluation and management services). (do not report g0317 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418). (do not report g0317 for any time unit less than 15 minutes)
• G0318 (Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99345, 99350 for home or residence evaluation and management services). (do not report g0318 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99417). (do not report g0318 for any time unit less than 15 minutes)