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Cardiology Coding Alert

Locate In-Person Device Eval Requirements At a Glance

Published on Sat Feb 28, 2009

Tip:Verify where ILR information came from before reporting 93291.

If you're tired of getting paper cuts from flipping between 93288-93292 and the CPT section guidelines, just keep this article close at hand. We've paired these newfor-2009 codes with their matching guidelines in one convenient spot.

CPT distinguishes the codes from 93288-93292 (Interrogation device evaluation [in person] with physician analysis, review and report, includes connection, recording and disconnection per patient encounter ...) by the kind of device involved. So you can quickly pinpoint the codes for the services you provide most often. For example, you may see pacemakers (93288) and ICDs (93289) most often, like Jennifer Crowell, CCC, CEMC, with Spokane Cardiology in Washington.

But there are also a couple of key concepts that apply to all the codes in this range:

• In-person: These are "in-person" services. CPT guidelines specify this means a "face-to-face" evaluation, which distinguishes these codes from remote interrogation codes 93294-93299. The in-person codes include retrieving and evaluating stored and measured information to determine the device's current programming. The exact components evaluated depend on the specific device, as discussed in the sections below.

• Per procedure: CPT guidelines also instruct you to report these codes per procedure. Again, this is in opposition to remote codes, which you report once every 30 or 90 days, depending on the service.

93288 Is for Pacemaker, Regardless of Leads

"One of the biggest changes with the new device codes is the difference in coding between interrogation and programming," says Sarah Tupper, CMC, coder for Central New York Cardiology in Utica.

For example: CPT 2008 included the following codes related to pacemaker interrogation and reprogramming:

• 93731 -- Electronic analysis of dual-chamber pacemaker system ... without reprogramming

• 93732 -- ... with reprogramming

• 93734 -- Electronic analysis of single-chamber system ... without reprogramming

• 93735 -- ... with reprogramming.

CPT 2009 deleted those codes, and in-person "pacemaker device interrogations now only have one code regardless of the number of leads: 93288 [... single, dual, or multiple lead pacemaker system]," Tupper says. (Note: For information on 2009 programming codes, see Cardiology Coding Alert, Vol. 12, No. 4.)

Components: CPT guidelines indicate that 2009

pacemaker interrogation code 93288 requires evaluation of the following:

• programmed parameters

• lead(s)

• battery

• capture and sensing function

• heart rhythm.

Coding caution: You should not report pacemaker interrogation code 93288 with the following, according to CPT guidelines:

• pacemaker programming codes 93279-93281

• peri-procedural device evaluation and programming code 93286

• remote interrogation codes 93294 and 93296.

93289: ICD Follows Pacemaker's 'Lead'

Like pacemaker coding, CPT 2009 replaces 2008 coding options with a single code for in-person defibrillator interrogation, 93289 (... single, dual, or multiple lead implantable cardioverter-defibrillator system, including analysis of heart rhythm derived data elements), says Tupper.

Components: Before you report 93289, be sure you see evaluation of these elements documented:

• programmed parameters

• lead(s)

• battery

• capture and sensing function

• presence or absence of therapy for ventricular

tachyarrythmias

• underlying heart rhythm.

Coding caution: CPT instructs you not to report 93289 with:

• programming codes 93282-93284

• peri-procedural device evaluation and programming code 93287

• remote interrogation codes 93295 and 93296.

Watch for: An additional note with 93289 states, "For monitoring physiologic cardiovascular data elements derived from an ICD, use 93290." Find out what this means below.

Add ICM Code 93290 toYour Payable List

Another new code this year is 93290 (... implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors), says Tupper.

93289 + 93290: You can bill 93290 in addition to ICD interrogation (93289) when your practitioner pulls and reviews both ICD and ICM data, Tupper says. "This would be any non-rhythm-related cardiac conditions, such as congestive heart failure, which is a big indication for primary prevention ICD implants these days. Medicare reimburses around $30 [global] on the average, so this is good news. We have always reviewed this data, but it was included in the device check," she says.

CPT reminds you of this coding option with the note, "For heart rhythm derived data elements, use 93289."

Components: To report ICM code 93290, CPT says to check for evaluation of:

• programmed parameters

• analysis of a minimum of one "recorded physiologic cardiovascular data element from either internal or  external sensors."

Coding caution: CPT prohibits you from reporting 93290 along with remote interrogation codes 93297 and 93299.

Separate ILR/93291 From Other In-Person Evals

For an in-person implantable loop recorder interrogation, you should report 93291 (... implantable loop recorder system, including heart rhythm derived data analysis).

But watch out. CPT guidelines state if the provider derives ILR data from an ICD or pacemaker, you should not report the ILR code. Use the ICD or pacemaker code instead.

Components: CPT requires evaluation of these elements for 93291:

• programmed parameters

• heart rate and rhythm "during recorded episodes from both patient initiated and device algorithm detected events, when present."

Coding caution: You shouldn't report 93291 with: • 33282 (Implantation of patient-activated cardiac event recorder)

• in-person evaluation codes 93288-93290

• remote interrogation codes 93298 and 93299.

Wearable Device Sneaks in With 93292

The final code in the in-person eval family is 93292 (... wearable defibrillator system). Unlike the devices in 93288-93291, this code refers to a wearable device. A wearable cardioverter defibrillator does the same work as an ICD, but it isn't invasive. The patient wears a sort of vest or holster with sensors to measure heartbeat and a small defibrillator to shock the heart when the sensors detect a dangerously irregular heartbeat.

Physicians choose a wearable device when an ICD isn't practical or desired. For instance, CPT Changes 2009: An Insider's View offers the example of a patient who has a wearable device because infection and intracardiac vegetations led to removal of her ICD for three months.

Components: The "Cardiovascular Device" section guidelines don't offer required components specific to a wearable cardioverter-defibrillator. But according to the example in CPT Changes 2009, the requirements are similar to an ICD. Elements reviewed may include, but are not limited to, the following:

• presenting electrograms

• stored episodes

• alerts

• battery

• leads

• capture and sensing function

• heart rhythm.

Coding caution: You shouldn't report 93292 and 93745 (Initial set-up and programming by a physician of wearable cardioverter-defibrillator ...) on the same date for the same patient

SupportYour Claim With Proper V Code

Be sure you apply an appropriate ICD-9 code to your claim, as well. Possible codes include V45.01 (Other postprocedural service; cardiac device in situ; cardiac pacemaker) and V45.02 (... automatic implantable cardiac defibrillator), says Crowell.

Code V53.x (Fitting and adjustment of other device) is another possibility for routine device interrogations, while acute sign and symptom codes are more likely for interrogations performed in response to patient complaints or device alerts. As always, check your payer policies for covered codes -- including which you may use as primary -- and also watch your denials to analyze whether the codes you report are covered.

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