Cardiology Coding Alert

The Health Care Financing Administration (HCFA) will not eliminate the global period for pacemaker and implantable cardioverter-defibrillator (ICD) procedures as originally announced in its July 17 proposed rule (see HCFA Proposes Elimination of Pacemaker Global Surgery Periods on page 61 of the August 2000 Cardiology Coding Alert). Under HCFAs final rule, published in the Nov. 1, 2000, Federal Register, these procedures will keep their 90-day global periods, at least for now. The final rule also included several changes to reimbursement and coverage policies, notably affecting pacemaker studies, critical care guidelines and observation guidelines.

CPT 2001, also released in November, includes two new cardiology codes as well as new wording in the critical care section that confirms changes previously announced by HCFA.

The top changes in CPT 2001 and the final rule and their significance for cardiology practices and coders are outlined below.

New CPT Codes

Trans-esophageal Echocardiography Monitoring. Code 93318 (echocardiography, transesophageal [TEE] for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing [continuous] assessment of [dynamically changing] cardiac pumping function and to therapeutic measures on an immediate time basis) should be billed when TEE is used to monitor the patient during surgery.

During the repair of a leaky mitral valve performed in the hospital, for example, a TEE probe may be positioned after the endotracheal tube is placed, says Sandy Fuller, CPC, a practice coder with Abilene Cardiology Consultants, a 13-physician practice in Abilene, Texas. At several points during the session the cardiologist may be called in to guide the imaging and to interpret the TEE study. The probe would remain in place while the procedure takes place. In such cases, the cardiologist should bill 93318 with modifier -26 to indicate that he or she performed the professional component of the procedure.

The probe monitor may also be used during bypass or transplant surgery to acquire specific images at particular times or may be placed and used by the anesthesiologist to guide his or her management of the patient during surgery.

HCFA has not yet established a fee schedule for this service: Different carriers (both Medicare and private) may have widely varying coverage and reimbursement policies for this service. Before billing the service, coders should contact their carrier and make sure theyve read the operative report and can determine exactly what the cardiologist did.

Pacemaker Study Echo. Code 93662 (intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and inter-pretation [list separately in addition to code for primary procedure]) has been assigned 4.13 relative value units (RVUs) when billed with modifier -26 (professional component) or 8.19 RVUs if done in an office setting, and should be used when the electrophysiologist performs intracardiac echocardiography (ICE) [...]