Part B Insider (Multispecialty) Coding Alert

New cardiac MRI, ablation codes streamline cardio practices

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 cardiology change with the most impact for 2008 by Yvette Hofmeister, CPC, a cardiology coding analyst at OSU Internal Medicine in Columbus, Ohio, 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 the 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 of 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.

Apply New Operative Tissue Ablation Options

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.

Don't Overlook New Category III EKG Codes

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.