Cardiology Coding Alert

New HCPCS Code for External Counterpulsation

Medicare has revised its coverage policy on external counterpulsation (ECP) for severe angina. The policy, which took effect July 1, 1999, called the procedure enhanced external counterpulsation (EECP) and instructed physicians to use CPT code 93799 (unlisted cardiovascular service or procedure).

Now, according to Medicare Transmittal R122, for services furnished on or after January 1, 2000 use HCPCS code G0166 (external counterpulsation, per treatment session) until a CPT code is established. In addition, the service again will be referred to with the acronym ECP.

Transmittal R122, which was issued on Feb. 1, 2000, and became effective April 1, revises section 35-74 of Medicares Coverage Issue Manual (CIM). This section of the CIM describes external counterpulsation as a service that should be provided to patients who have been diagnosed with disabling angina (Class III or Class IV, Canadian Cardiovascular Society Classification or equivalent classification) and, in the opinion of a cardiologist or cardiothoracic surgeon, are not readily amenable to surgical intervention, such as percutaneous transluminal coronary angioplasty (PTCA) or cardiac bypass because: (1) their condition is inoperable, or at high risk of operative complications or postoperative failure; (2) their coronary anatomy is not readily amenable to such procedures; or (3) they have co-morbid states that create excessive risk.

A full course of therapy usually consists of 35 one-hour treatments, which may be offered once or twice daily, usually five days per week.

Although ECP and similar devices have Food and Drug Administration (FDA) permission to be used in treating many conditions, including stable or unstable angina pectoris, acute myocardial infarction and cardiogenic shock, Medicare coverage is limited to its use in patients with stable angina pectoris since only that use has developed sufficient evidence to demonstrate its medical effectiveness, according to the CIM guidelines, which also state that:

1. Other uses of this device and similar devices remain non-covered.
2. Non-coverage of hydraulic versions of these types of devices remains in force.
3. ECP must be done under direct supervision of a physician.

CCI Update Bundles S&I to Atherectomy

Supervision and interpretation (S&I) code 93556 (imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; pulmonary angiography, aortography, and/or selective coronary angiography including venous bypass grafts and arterial conduits [whether native or used in bypass]) and atherectomy code 92995 (percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty; single vessel) have been added as a code pair in the latest version of the national Correct Coding Initiative (CCI). The revision corrects an anomaly whereby related S&I code 93555 (imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; ventricular and/or atrial angiography) was bundled to 92995, but 93556 was not.

The new edit has a 1 indicator, which means it can be modified (typically, with modifier -59 [separate procedures] or modifiers -RC [right coronary artery], -LD [left anterior descending coronary artery] and -LC [left circumflex coronary artery]) if the procedures are reported for separate or significantly identifiable reasons (for example, if a diagnostic catheter is performed during the same session, modifier -59 would be placed on the 93556 to indicate it is part of the cath, not the atherectomy).

When this occurs, the cardiologists notes should describe the medical necessity for performing both procedures on the same day during the same session. A cardiac cath that finds an obstruction that requires an atherectomy, for example, is medically justified and separately billable.