Medicare Compliance & Reimbursement

By now, you're quite aware of the new CPT codes related to cardiology -- but you may not know just when the time is right to use them.

If you've pored over the new cardiology codes, you know that the 2008 changes were extensive -- and that you had to start using them on Jan. 1. Here's a quick primer that can ensure that you're reporting these codes correctly.

New MRI codes: CPT 2008 deleted cardiac magnetic resonance imaging (MRI) codes 75552-75556 and replaced them with eight new codes. Described as the most impactful cardiology change for 2008 by Yvette Hofmeister, CPC, a cardiology coding analyst at OSU Internal Medicine in Columbus, OH, the new codes (75557-75564) cover cardiac MRI for both morphology and function.

According to the AMA's CPT Changes 2008: An Insider's View, the AMA added the new codes to reflect new technology that couldn't be described by 75552-75556.

What this means to you: You'll have to pay more attention to how your doctor documents cardiac MRI this year to make sure you're coding for further sequences, stress imaging and other additional services, when applicable.

When your cardiologist performs a procedure that involves a vascular access device, a venous access device, or a wireless physiologic sensor, you'll need to refer to four new codes.

Declotting by thrombolytic agent: You can report declotting by a thrombolytic agent, or implanted vascular access device or catheter, using new code 36593 (Declotting by thrombolytic agent).

Blood specimen: When your doctor collects a blood specimen, you'll have two new codes. For collection from a completely implantable venous access device (VAD), use 36591 (Collection of blood specimen from a completely implantable venous access device). Code 36592 (Collection of blood specimen using established central or peripheral catheter, venous) covers collection from an established central or peripheral venous catheter, which is "not otherwise specified."

Report BMP Lab in 2008: "The only test that a cardiologist would generally perform in an office is a basic metabolic panel (BMP)," says Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte. And CPT 2008 brought you a new code to reflect this test.

You'll use 80047 (Basic metabolic panel [calcium, ionized]) for a BMP with an ionized calcium test. Keep in mind that if the physician performs a BMP with a total calcium test, you should still report 80048.

If the cardiologist performed a modified maze procedure at the same session as another surgery in 2007, you probably had to write the maze off because existing codes 33254-33256 describe stand-alone procedures.

But this year your options expanded with three new add-on codes (33257-33259) for when your surgeon performs the modified maze along with a primary procedure.

In short: The three new codes break down into limited, extensive without cardiopulmonary bypass, and extensive with cardiopulmonary bypass.

Cutting-edge graft code: A cutting-edge aortic valve graft procedure, known as the Tirone David Procedure or the Yacoub Procedure, got its own code this year with the introduction of 33864 (Ascending aorta graft ...)

Physicians perform this procedure to treat aortic root diseases such as reconstruction or remodeling of the ascending aorta, while preserving the native aortic valve, according to CPT Changes 2008: An Insider's View.

You'll find three new category III codes for EKGs with 64 or more leads this year.

Although you'll still use 93000-93010 for a routine EKG with at least 12 leads, you'll report 0178T-0180T for an EKG with 64 or more leads.

Breakdown: New code 0178T covers an EKG with graphics and analysis and interpretation and report.

You'll use 0179T for tracing and graphics only, and 0180T for interpretation and report only.