Cardiology Coding Alert

Wowing your payers with loads of good evidence is the key

You can persuade payers to reimburse for your distal protection device claims, even when you report unlisted-procedure codes 37799 or 93799. Experts let you in on their field-tested methods.

Get the Lowdown on Filter Wire Action

Distal protection devices are downstream filters that capture dislodged material that loosens during percutaneous interventions such as percutaneous transluminal coronary angioplasties (PTCA, 92982) and stenting (92980) -- especially during PTCA and stenting in saphenous vein grafts. The benefits for the patient are substantial: The filter catches dislodged debris, which can cause a blocked vessel, resulting in acute myocardial infarction, pulmonary embolus, or stroke.

Many practices already use the PercuSurge devices, and you could see more distal protection devices in your practice very soon, coding experts say. For instance, the U.S. Food and Drug Administration recently approved several filtering devices, including Boston Scientific's FilterWire EX.

Don't Be Daunted by Unlisted-Procedure Codes
 
Without a CPT code for distal protection, you'll need to go the extra mile to convince payers to reimburse for claims -- but persistence will pay off, coding experts say.

Some payers/carriers consider this filtering action included in the intervention. But others allow you to bill unlisted-procedure codes (37799, Unlisted procedure, vascular surgery) when the physician uses a protection device in peripheral vascular vessels or 93799 (Unlisted cardiovascular service or procedure) for filtering services in the coronary system.

Knowing the difference between 37799 and 93799 can be crucial. Krista Dauphinee, CPC, coding and compliance coordinator for Northeast Cardiology Associates in Bangor, Maine, says that her practice was having problems using 93799, and her state's Medicare carrier (NHIC of New England) instructed them to use 37799 code instead. "These [37799] claims have been getting paid," she says.

Learn These Payment Tips

Reimbursement varies widely, but there are rewards for educating payers about the procedure, particularly the skill involved and the benefits for patients, says Becky Heintzman, CPC, with Cardiology Specialists of NC in Thomasville, N.C. In other words, inundate payers with device instructional materials. Heintzman also recommends including FDA device approval letters in your packet to payers.

Note: To access the FDA approval letter for Boston Scientific's FilterWire EX, go to http://www.fda.gov/cdrh/pdf2/k023691.pdf.

Also, take the time to craft cover and appeal letters carefully for specific distal protection devices and talk to your physicians about documenting to support your claims, Heintzman says.

For example, the PercuSurge procedure adds steps to an intervention, Heintzman says. The physician must place the occluding balloon, inflate it, extract the contents, and then remove the occluder, in addition to the work of the intervention itself.  "My physicians are very good about dictating this information in reports, so it is easy for me to point out to payers why we should get paid more when this device is used," she says. 

Another tactic for convincing payers to reimburse for distal protection work is including in your cover letter a code for comparable services and the reimbursement rate for those services.
 
"I always say we equate the work and skill [for distal protection devices] to +92973 (Percutaneous transluminal coronary thrombectomy [list separately in addition to code for primary procedure]) and specifically ask for the same amount of money we charge for that code," Heintzman says. (The Medicare allowable for 92973 is  $170.54.) "Some payers agree with this and pay the amount I ask for, and others reduce the money," she says.