Radiology Coding Alert

Question: How can we report TPVI procedure in a patient of Tetraog of Fallot with conduit stenosis and insufficiency? Is the code 0262T appropriate for this procedure? Can we report stenting with TPVI? What payment can we expect for TPVI?

Alaska Subscriber

Answer: You have a new code for transcatheter pulmonary valve implantation (TPVI) introduced this year. For this procedure, you will submit code 33477 (Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed). CPT^® added 33477 earlier this year and deleted your previous option 0262T (Implantation of catheter-delivered prosthetic pulmonary valve, endovascular approach).

Stenting and TPVI: Although you should not separately report stenting of the valve delivery site, if the patient has a pulmonary artery stenosis at a separate site with separate indications, you may report that separately with a code such as 37236 (Transcatheter placement of an intravascular stent[s] [except lower extremity artery[s] for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary], open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery).

Similarly, if the patient requires percutaneous transluminal angioplasty (PTA), you may report it separately, if it’s distinct from the TPVI, using a code such as 92997 (Percutaneous transluminal pulmonary artery balloon angioplasty; single vessel). However, if the PTA is related to the TPVI, you should not consider the additional PTA code.

Check guidelines: CPT^® provides a long list of guidelines with new code 33477. Be sure to read them carefully before you code. CPT^® designed 33477 as a comprehensive code that includes necessary work such as percutaneous access; advancing, repositioning, and deploying the device; and radiological guidance. As the previous section explained, there are times when reporting an additional code is correct, but be sure to check the guidelines for instructions before you make your final code choice.

Reimbursement and coverage: The reimbursement for proper use of the code is $1,345.17 based on Medicare’s national payment rate in 2016. There is a catch, though. Not all local MACs cover 33477, so be sure to check your payer’s LCDs. You may find 33477 listed in the LCD for non-covered services.

‘A’ indicator: Although Medicare lists 33477 with status A, meaning Active Code, the full definition of that status spells out why coverage is at the MAC’s discretion: “These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an ‘A’ indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy.”