Cardiology Coding Alert

Watch for this conflict between CPT® and CMS guidelines.

CPT® 2013 overhauled your coding options for percutaneous coronary intervention (PCI), but CMS isn’t convinced it needs to pay separately for all of the new add-on codes.

The codes: Starting Jan. 1, 2013, new codes are in place for PCI, which includes services such as angioplasty, atherectomy, and stent placement. The codes are designed to have a base code for the most intensive service on a single major coronary artery or branch and then an add-on code for PCI performed in up to two additional branches of the target vessel. For example, note these codes for angioplasty only:

• 92920, Percutaneous transluminal coronary angioplasty; single major coronary artery or branch
• +92921, … each additional branch of a major coronary artery (List separately in addition to code for primary procedure).

MPFS: The 2013 Medicare Physician Fee Schedule (MPFS; final rule with comment period), published Nov. 16, 2012, indicates that the add-on codes will not be paid separately: "On an interim final basis for CY 2013, add-on CPT® codes 92921 [angioplasty], 92925 [atherectomy], 92929 [stent], 92934 [atherectomy and stent], 92938 [PCI of or through graft], and 92944 [PCI of chronic total occlusion] will have a PFS procedure status indicator of B (Bundled code. Payments for covered services are always bundled into payment for other services, which are not specified. If RVUs are shown, they are not used for Medicare payment. If these services are covered, payment for them is subsumed by the payment for the services to which they are bundled) and will not be separately payable."

The reason given for bundling payment is to prevent physicians from increasing the number of stents simply to increase reimbursement: "We believe that unbundling the placement of branch-level stents in a fee-for-service system may encourage increased placement of stents. To eliminate that incentive, on an interim final basis for CY 2013, we are rebundling the work associated with the placement of a stent in an arterial branch into the base code for the placement of a stent in an artery."

Many experts are recommending that you continue to report the bundled add-on codes in case the decision for payment is reversed and to help in tracking how often additional branch PCI is performed. Inform physicians of the importance of detailed documentation to support the extra work that goes into the additional PCI.

Review the MPFS discussion of the new PCI codes beginning on PDF page 173 of the Nov. 16, 2012, Federal Register: www.gpo.gov/fdsys/pkg/FR-2012-11-16/pdf/2012-26900.pdf.