Cardiology Coding Alert

Quiz:

Can You Remember 2023’s Coding Updates? Take this Year-in-Review Quiz

Published on Wed Dec 27, 2023

Answer these questions to start next year on the right foot.

As 2023 ends, it is the perfect time to brush up on the 2024 coding changes so you can avoid claim denial next year. Put your coding skills to the test with these questions to ensure you are ready to hit the ground running after you ring in 2024.

Pinpoint New Add-On Codes

Question 1: Will we gain any new venography codes for next year?

Answer 1: Yes. In 2024, you will get some new add-on venography codes for congenital heart defects. They are as follows:

+93584 (Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; anomalous or persistent superior vena cava when it exists as a second contralateral superior vena cava, with native drainage to heart (List separately in addition to code for primary procedure))
+93585 (… azygos/hemiazygos venous system (List separately in addition to code for primary procedure))
+93586 (… coronary sinus (List separately in addition to code for primary procedure))
+93587 (… venovenous collaterals originating at or above the heart (eg, from innominate vein) (List separately in addition to code for primary procedure))
+93588 (… venovenous collaterals originating below the heart (eg, from the inferior vena cava) (List separately in addition to code for primary procedure))

Venography defined: A venogram is a test that uses X-rays to create moving pictures of blood flow in your veins. Your cardiologist can use venography to diagnose deep vein thrombosis when ultrasound images aren’t sufficient to provide the needed information.

“Catheter placement in a normal superior vena cava (SVC) or normal inferior vena cava (IVC) is considered part of a standard congenital heart catheterization. An anomalous or persistent superior vena cava is a second SVC on the opposite side of the chest from the first SVC,” says Robin Peterson, CPC, CPMA, manager of professional

coding and compliance services, Pinnacle Enterprise Risk Consulting Services, LLC in Centennial, Colorado. “In a scenario where the patient has bilateral SVCs, you would code the first venography performed with 75827 (Venography, caval, superior, with serialography, radiological supervision and interpretation) and report the catheter placement and venography of the persistent SVC with 93584 (Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; anomalous or persistent superior vena cava when it exists as a second contralateral superior vena cava, with native drainage to heart). Use these new venography codes only in conjunction with a congenital heart catheterization code when performed. Parentheticals instruct to only report 93584, 93585, 93586, 93587, or 93588 once per session.”

Refresh Your Coronary FFR Coding Knowledge

Question 2: Providers use coronary fractional flow reserve (FFR) to estimate the blood flow in the patient’s heart arteries. Healthcare providers can appraise the coronary FFR with artificial intelligence (AI) starting Jan. 1, 2024. What code(s) will you assign to report this procedure in 2024?

Answer 2: You’ll assign 75580 (Noninvasive estimate of coronary fractional flow reserve (FFR) derived from augmentative software analysis of the data set from a coronary computed tomography angiography, with interpretation and report by a physician or other qualified health care professional) to report the procedure of estimating the patient’s coronary fractional flow reserve (FFR) with the help of artificial intelligence (AI).

Code 75580 is assigned for instances where the physician evaluates the blood circulation in the patient’s heart arteries. This evaluation is based on the data obtained from coronary computed tomography angiography (CCTA) and analyzed by advanced software. This software employs AI to scrutinize the CCTA data and generate results. The physician or a qualified healthcare professional (QHP) then interprets these results to draft their report.

According to the Appendix S: Artificial Intelligence Taxonomy for Medical Services and Procedures in the CPT^® code set, Augmentative AI is used when physicians or QHPs use machines to perform certain work and then the “machine analyzes and/ or quantifies data to yield clinically meaningful output.” This process still requires a physician or QHP to interpret the results and compile a report.

Important: A parenthetical note listed under the code instructs you to use 75580 only once per CCTA examination.

Same-day procedure: If 75580 occurs on the same day as the CCTA exam, then you’ll report the 75580 and 75574 (Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed)) on the same claim.

Don’t Sleep on This Discarded Drug Rule

Question 3: Have the rules for reporting discarded drugs changed?

Answer 3: If your practice supplies and reports the drugs administered to patients, you should be familiar with using modifier JW (Drug amount discarded/not administered to

any patient) when the provider administers part of a single-dose container and discards the rest. Reporting the discarded amount with modifier JW allows you to receive payment from Medicare Part B for the portion not administered.

When the calendar flipped to July 1, 2023, Medicare put a new drug reporting requirement into effect. You now need to use the novel, related modifier JZ (Zero drug amount discarded/not administered to any patient) when there is no discarded amount from a single-dose container subject to modifier JW rules. You should submit either -JW or -JZ, depending on whether or not there is any drug wasted following administration.

Tip: Modifier JZ goes on one claim line with the HCPCS Level II code for the drug administered and the number of units given to the patient.

“Continue reporting two claim lines when some amount of the single-use vial is discarded. Report the number of units administered on one line and, using the same HCPCS code plus modifier JW, report the discarded units on a separate line,” notes Mary Pat Johnson, CPC, CPMA, COMT, COE, senior consultant with Corcoran Consulting Group.

Discover Correct IOUS Codes for 2024

Question 4: The 2024 CPT^® code set includes four new intraoperative ultrasound (IOUS) codes for reporting a physician’s ultrasound use during surgery. What codes will you assign to report these procedures starting January 1?

Answer 4: The 2024 CPT^® code set includes four new codes related to intraoperative ultrasound (IOUS) procedures.

You’ll assign 76984 (Ultrasound, intraoperative thoracic aorta (eg, epiaortic), diagnostic) when the physician uses images of the thoracic aorta with ultrasound during an operation to guide the surgical procedure or to diagnose a condition during the operation.

At the same time, if the physician uses cardiac IOUS, you’ll assign one of the following new CPT^® codes:

76987 (Intraoperative epicardial cardiac ultrasound (ie, echocardiography) for congenital heart disease, diagnostic; including placement and manipulation of transducer, image acquisition, interpretation and report)
76988 (… placement, manipulation of transducer, and image acquisition only)
76989 (… interpretation and report only)

According to the American College of Radiology (ACR), these services are “are used to evaluate cardiovascular structures, provide intraoperative guidance, and provide real-time perioperative surgical decision-making information that may affect the intraoperative strategy (e.g., changing cannulation strategies, altering bypass targets, and identifying additional defects).”

Focus on E/M Changes

Question 5: What did CPT^® change about how you report time-based office/outpatient evaluation and management (E/M) services in 2024?

Answer 5: CPT^® has decided to remove the time ranges from both the new and established office/outpatient E/M code descriptors and replace them with a single time that “must be met or exceeded.” This means that for codes such as 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/ or examination and straightforward medical decision making …), you’ll be working with a single time rather than a range.

For example, 99202 currently has a time range of 15-29 minutes. Beginning Jan. 1, 2024, the provider must meet or exceed 15 minutes of total service time before you can bill this code by time.

Note: CPT^® will not be changing the descriptor to 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional).