Cardiology Coding Alert

Answer: There are no specific CPT codes for the three procedures involving the AngioJet system. Unlisted codes should be used for coronary and peripheral artery clot removals.

Possis, the company that manufactures the AngioJet system, has received FDA approval for three specific clot-removal procedures involving (1) coronary arteries (2) peripheral arteries and (3) arteriovenous (AV) dialysis grafts (such as AV fistulas), says Diane Elvidge, CPC, a coding specialist with Princeton Reimbursement Group in Minneapolis, which operates a reimbursement hotline about AngioJet for Possis.

Elvidge recommends 93799 (unlisted cardiovascular service or procedure) for coronary artery clot removals and 37799 (unlisted procedure, vascular surgery) for peripheral vessels. For AV dialysis grafts, CPT 2001 introduces a new code (36870, thrombectomy, percutaneous, arteriovenous fistula, autogenous or nonautogenous dialysis graft [includes mechanical thrombus extraction and intra-graft thrombolysis]).

Only a few carriers have published guidelines for billing AngioJet, and Possis is in the midst of a campaign to urge Medicare and private payers to cover the procedures, Elvidge says. Georgia Medicares policy now covers AngioJet for use in coronary arteries; providers are instructed to bill for the procedure using 93799. The policy, published in the November 1999 Georgia Medicare bulletin, also specifies that the claim will be paid at the same rate as CPT code 92982 (percutaneous transluminal coronary balloon angioplasty; single vessel; 21.36 relative value units) and that multiple surgery payment adjustment rules apply.

Note: When billing 93799, the description AngioJet should be noted in Item 19 of the HCFA 1500 claim form, or for electronic claims on the free form line.

Meanwhile, Trailblazer Health Enterprises, the Medicare Part B carrier in Texas, Maryland, Delaware, Virginia and the District of Columbia, as well as Palmetto Government Benefits Administrators of South Carolina, bundle AngioJet with any other intervention (i.e., percutaneous transluminal coronary angioplasty, atherectomy or stent), claiming in these circumstances the AngioJet is performed only to gain access for the intervention.

Elvidge notes that when AngioJet was approved last year, billing staff with many cardiologists assumed the procedure was a new type of atherectomy (92995) and billed it as such. Despite superficial similarities, however, the two procedures are quite different. Atherectomies are performed to remove plaque from the vessel wall, whereas AngioJets sole purpose is to remove blood clots.

Other practices have coded 92975 (thrombolysis, coronary; by intracoronary infusion, including selective coronary angiography) for the AngioJet procedure. This too is incorrect, Elvidge says, because saline the only material injected into the patient is not a thrombolytic or related agent (such as urokinase or ReoPro).