General Surgery Coding Alert

T-codes and VAD overhaul lead the charge.

With major changes to percutaneous ventricular assist device (VAD) codes plus new Category III code options for vascular surgeons, you need to dig in now for accurate reporting and pay this year.

Check out your new coding options with the following intel and advice from our experts.

Overhaul Percutaneous VAD Coding

The major theme of changes to percutaneous VAD codes in the range 33990 to 33997 is laterality and arterial/venous distinctions.

You’ll find these revisions (underline added) in the percutaneous VAD codes:

• 33990 (Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; left heart, arterial access only)
• 33991 (Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; left heart, both arterial and venous access, with transseptal puncture)
• 33992 (Removal of percutaneous left heart ventricular assist device, arterial or arterial and venous cannula(s), at separate and distinct session from insertion)
• 33993 (Repositioning of percutaneous right or left heart ventricular assist device with imaging guidance at separate and distinct session from insertion)

Corresponding to those changes, you’ll find the following two new codes in the section:

• 33995 (Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; right heart, venous access only).
• 33997 (Removal of percutaneous right heart ventricular assist device, venous cannula, at separate and distinct session from insertion)

Service: To choose the correct code, you first need to know if the surgeon is percutaneously inserting a VAD (33990, 33991, 33992, 33995), removing a VAD (33992, 33997), or repositioning a VAD (33993).

A/V choice: If you’re coding a percutaneous VAD insertion, you need to focus the arterial/venous distinction clarified in CPT^® 2021. “The key to proper code selection for a ventricular assist device in 2021 will be to decipher whether the access was arterial, arterial and venous, or venous,” says Robin Peterson, CPC, CPMA, manager of professional coding, Pinnacle Integrated Coding Solutions, LLC. “If the documentation is not clear, you’ll want to query the provider.”

Laterality: Finally, CPT^® 2021 adds distinction between the percutaneous insertion codes based on whether the procedure is for the left heart (33990, 33991, 33992) or right heart (new code 33995). You’ll also have two removal codes based on laterality — 33992 for left heart and new code 33997 for right heart.

No change: Both the code definitions and the Cardiac Assist section guidance assert that you should not separately report a percutaneous VAD removal code (33992, 33997) when the surgeon replaces the VAD at the same session. “As in the past, you should code a replacement using only the appropriate insertion code, which includes one new option in 2021 (33990, 33991, new code 33995),” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, billing specialty subject matter expert at Kareo in Irvine, Calif.

Grasp New ‘Temporary’ Code Choices

CPT^® 2021 adds three codes and deletes two codes in the Category III section that could impact how you report services your vascular surgeons provide.

T code refresher: You’ll find the T-codes section toward the back of your CPT^® book. T-codes, also called Category III Codes, are “temporary codes for emerging technology, services, procedures, and service paradigms. Category III codes allow for the collection of specific data,” according to CPT^®. Payment for these codes is not guaranteed, and you’ll need to work out the details with your payers before reporting any T-codes so you’ll know if the service is covered.

New codes: Vascular surgeons might perform procedures that you can report with one of the following CPT^® 2021 Category III codes:

• 0613T (Percutaneous transcatheter implantation of interatrial septal shunt device, including right and left heart catheterization, intracardiac echocardiography, and imaging guidance by the proceduralist, when performed).
• 0614T (Removal and replacement of substernal implantable defibrillator pulse generator).
• 0632T (Percutaneous transcatheter ultrasound ablation of nerves innervating the pulmonary arteries, including right heart catheterization, pulmonary artery angiography, and all imaging guidance).
• 0620T (Endovascular venous arterialization, tibial or peroneal vein, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed, all catheterization(s) and intraprocedural roadmapping and imaging guidance necessary to complete the intervention, all associated radiological supervision and interpretation, when performed)

“Endovascular venous arterialization is a non-surgical procedure for ‘end stage’ critical limb ischemia and essentially creates an arteriovenous fistula to help direct blood flow to the deep veins of the extremity in patients that most often do not have any other options of treatment,” Peterson says.

Finally, in 2021, you will no longer be able to report the following deleted injection T-codes:

• 0228T (Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level) and +0229T (… each additional level (List separately in addition to code for primary procedure))
• 0230T (Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level) and +0231T (… each additional level (List separately in addition to code for primary procedure)).