General Surgery Coding Alert

Focus on initial, subsequent, and final day.

If your general or vascular surgeon performs transcatheter infusion for thrombolysis in veins or arteries other than coronary, you should be implementing big CPT^® changes this year.

To make sure you’ve stopped using the old codes and know how to properly use the new codes, we’ve pulled together the following expert guidance.

Ring Out the Old Codes

Prior to CPT^® 2013 changes, you used the following two codes for your surgeon’s non-coronary thrombolysis treatment via transcatheter therapy:

·         37201 — Transcatheter therapy, infusion for thrombolysis other than coronary

·         37209 — Exchange of a previously placed intravascular catheter during thrombolytic therapy.

CPT^® 2013 deletes these codes, so you’ll need to learn a new way to code these services.

That’s not all: Because 37201 and 37209 were not “inclusive” of related services, you probably also listed one of the following codes to capture radiological guidance:

·         75896 — Transcatheter therapy, infusion, other than thrombolysis,  radiological supervision and interpretation

·         75898 — Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis

·         75900 — Exchange of a previously placed intravascular catheter during thrombolytic therapy with contrast monitoring, radiological supervision and interpretation.

For non-coronary transcatheter thrombolytic treatment last year, you could report 37201 with 75896 for infusion, 75898 for follow up, and 37209 with 75900 for catheter exchange if your surgeon performed both the surgical and radiological procedures.

Drop radiology: CPT^® 2013 deletes 75900. Codes 75896 and 75898 have not been deleted, but they have been revised to specify they apply to transcatheter therapy infusion “other than for thrombolysis,” says Julie Graham, BA, CPC, coder and compliance specialist for Concentra in Texas.

Ring In the New Codes

Beginning Jan. 1, you should have stopped using 37201 and 37209, and started using the following codes instead:

·         37211 — Transcatheter therapy, arterial infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, initial treatment day

·         37212 — Transcatheter therapy, venous infusion for thrombolysis, any method, including. radiological supervision and interpretation, initial treatment day

·         37213 — Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, continued treatment on subsequent day during course of thrombolytic therapy, including follow-up catheter contrast injection, position change, or exchange, when performed;

·         37214 — … cessation of thrombolysis including removal of catheter and vessel closure by any method.

The new codes apply to an entire day of treatment. Use a “midnight to midnight time period,” stated Sean P. Roddy, MD, FACS, of the Society for Vascular Surgery and member of the AMA CPT^® Advisory Committee, in the “Vascular Surgery and Interventional Radiology” presentation at the AMA’s CPT^® and RBRVS 2013 Annual Symposium.

Report ‘Initial,’ ‘Subsequent,’ and ‘Final’ Days

CPT^® 2013 breaks down the non-coronary transcatheter thrombolytic therapy codes by “initial treatment day” (37211 or 37212) and each “subsequent day during course of thrombolytic therapy” (37213) and final day when you cease thrombolysis (37214).

“That’s different from the old codes, when you would use 37201 each day for the transfusion, and report 37209 only when the surgeon exchanged the previously placed intravascular catheter,” says Marcella Bucknam, CPC, CPC-I, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, audit manager for CHAN Healthcare in Vancouver, Wash.

Now you’ll use the “subsequent day” code (37213) for each day of infusion after the first whether or not the surgeon performs a follow-up study or exchanges or repositions the previously placed intravascular catheter.

Capture cessation: Prior to CPT^® 2013, you didn’t have a code for infusion cessation — now you do. When the surgeon removes the catheter and closes the vessel, report 37214.

Know What’s Included

Each of the new codes 37211-37214 is for “any method,” and states, “including radiological supervision and interpretation.” That’s why you shouldn’t separately report radiology codes such as 75896 with the new codes like you did with 37201 and 37209.

You’ll also notice that 37213 and 37214 include follow-up catheter contrast injection, position change, or exchange, when performed. “You don’t separately report the catheter exchange anymore,” Bucknam emphasizes.

Distinguish Arteries and Veins

When your surgeon initiates transcatheter therapy for non-coronary thrombolysis, you need to know whether you’re dealing with an artery or a vein. That’s because CPT^® 2013 distinguishes 37211 for arterial infusion, and 37212 for venous infusion.

“The subsequent day and cessation codes (37213 and 37214) don’t distinguish between arteries and veins — the initial-day code establishes that,” Bucknam says.

Understand the Symbols

Each new code 37211-37214 is preceded by the hash-mark symbol (#). That means that these are re-sequenced codes, and are out of numerical order. Instead of appearing after 37210, you’ll find the codes between 37200 and 37202.

The codes also have the bulls-eye symbol, which indicates that moderate sedation services performed by the same provider are included in the service. You shouldn’t code them separately.