Practice Management Alert

Question: Our cardiology practice has been keeping a close eye on the American Medical Association’s (AMA) recommendations for coding in 2016. We are most interested in some of the category III codes (“T” codes) that the AMA might move to category I status. Will CPT ^®move any of the “T” codes to category I status?

Rhode Island Subscriber

Answer: In addition to some other changes relevant to cardiology practices, CPT^® 2016 reclassifies a pair of codes that should increase payment odds for your claims.

Change 1: CPT^® deleted 0262T (Implantation of catheter-delivered prosthetic pulmonary valve, endovascular approach) for 2016. When you are coding for this type of catheter implant in 2016, report 33477 (Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed) instead.

Change 2: Also, you should stop reporting 0311T (Non-invasive calculation and analysis of central arterial pressure waveforms with interpretation and report) when your practice performs arterial pressure waveform analysis. Instead, you’ll report 93050 (Arterial pressure waveform analysis for assessment of central arterial pressures, includes obtaining waveform[s], digitization and application of nonlinear mathematical transformations to determine central arterial pressures and augmentation index, with interpretation and report, upper extremity artery, non-invasive) for this service.

Benefit: Whenever CPT^® moves a code from category III to category I, it’s a big deal in the coding world. Category III codes represent procedures that CPT^® deems “experimental”; thusly, cardiology practices have a tough time getting paid for category III codes. If the code is “upped” to category I status, however, the procedure is no longer considered experimental.

As Advance Healthcare Network reports on its Website, category I codes are for “procedures that are consistent with contemporary medical practice and are widely performed,” while category III codes represent “temporary codes for emerging technology, services and procedures.”

Payment for these procedures might still be spotty, especially in 2016. The change is great news, however, as it means CPT^® is trying to get 33477 and 93050 into the procedural mainstream — which can only help payment possibilities.