Part 3: New 2020 CPT Codes | Cardiovascular System

This is Part 3 of a five part series on the new 2020 CPT codes. In this series we will explore the CPT changes for FY2019 and include examples to help the coder understand the new codes. 

This series includes:

• Part 1 - 5 new integumentary CPT codes added with 4 deletions and 1 revision.
• Part 2 - 11 new musculoskeletal CPT codes added with 1 deletion and 0 revisions.
• Part 3 - 11 new cardiovascular CPT codes added with 8 deletions and 2 revisions.
• Part 4 - 3 new digestive system codes with 1 deletion and 2 revised; 1 revised urinary system codes with new category III codes; 6 new with 20 deleted nervous system codes with 3 revisions; 2 new eye codes with 3 revisions; and finally a new category III auditory code.
• Part 5 - summary of Modifiers, Category III codes, Radiology, Medicine, Laboratory and Pathology, and Evaluation and Management.

Pericardiocentesis

Four new codes were developed for pericardiocentesis by age and whether patient has congenital cardiac anomaly or not.

• 33016 Pericardiocentesis, including imaging guidance, when performed
• 33017 Pericardial drainage with insertion of indwelling catheter, percutaneous, including fluoroscopy and/or ultrasound guidance, when performed, 6 years and older without congenital cardiac anomaly  (Usually for CHF.)
• 33018, birth through 5 years OR any age WITH congenital cardiac anomaly.   (code to this code if postop within 90 days of repairing the congenital cardiac defect)  See notes in CPT book after code.

The catheter needs to remain in place after the procedure.

• 33019 Pericardial drainage with insertion of indwelling catheter, percutaneous, including CT guidance

Coders should not report 33016-33018 with 93303-93325 when echocardiography is performed solely for the purpose of pericardiocentesis guidance.

(Do not report 33017-33019 with 75989, 76942, 77002, 77012, 77021)

Older codes 33010, 33011 were deleted. (They had been initial and subsequent)

The codes include imaging as many other codes now do.  Coders must be aware if the patient has or had a congenital anomaly repaired within 90 days.

Ascending Aorta Graft

Three new codes were developed for ascending aorta graft and transverse aorta graft:

• 33858 Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed; for aortic dissection
• 33859 for aortic disease other than dissection (eg, aneurysm)

Deleted 33860 Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed

The new codes differentiate this procedure by what it is performed for. The basic procedure is the same as 2019, just the reason was added.

Deleted 33870 Transverse arch graft, with cardiopulmonary bypass

• 33871 Transverse aortic arch graft, with cardiopulmonary bypass, with profound hypothermia, total circulatory arrest and isolated cerebral perfusion with reimplantation of arch vessel(s) (eg, island pedicle or individual arch vessel reimplantation) 
  The new codes now differentiate between an ascending aortic graft done for aortic dissection vs one done for diseases other than dissection such as an aneurysms.

Endovascular Repair of Iliac Artery

Two new codes for IBE or iliac branched endograft. One is an add-0n code for repair at time of aorto-iliac endograft and one done at another time on its own.  This is an endograft that has BRANCHES, one for internal iliac and one for external iliac branch. Please see this website for photos and example:https://evtoday.com/articles/2017-aug-supplement/techniques-of-endovascular-aortoiliac-repair-using-an-iliac-branch-endoprosthesis

• +34717 Endovascular repair of iliac artery at the time of aorto-iliac artery endograft placement by deployment of an iliac branched endograft including pre-procedure sizing and device selection, all ipsilateral selective iliac artery catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation and distally in the internal iliac, external iliac, and common femoral artery(ies), and treatment zone angioplasty/stenting, when performed, for rupture or other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation, penetrating ulcer, traumatic disruption), unilateral (List separately in addition to code for primary procedure) (IBE)
• 34718 Endovascular repair of iliac artery, not associated with placement of an aorto-iliac artery endograft at the same session, by deployment of an iliac branched endograft, including pre-procedure sizing and device selection, all ipsilateral selective iliac artery catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation and distally in the internal iliac, external iliac, and common femoral artery(ies), and treatment zone angioplasty/stenting, when performed, for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation, penetrating ulcer), unilateral  (IBE)

Exploration of Artery

One revised code and two new codes describe exploration of artery without any other surgical repair.  They are categorized by arteries of neck, of upper extremity and lower extremity.  This is much easier than trying to create codes for each specific artery.  Older codes were deleted.

▲ 35701 Exploration (not followed by surgical repair,), with or without lysis of artery; neck (e.g., carotid artery, subclavian)

• 35702 Exploration (not followed by surgical repair,), artery; upper extremity (eg, axillary, brachial, radial, ulnar)
• 35703 Exploration (not followed by surgical repair,), artery; lower extremity (eg, common femoral, deep femoral, superficial femoral, popliteal, tibial, peroneal)

Deleted:

35721 Exploration (not followed by surgical repair), with or without lysis of artery; femoral artery

35741 Exploration (not followed by surgical repair), with or without lysis of artery; popliteal artery

35761 Exploration (not followed by surgical repair), with or without lysis of artery; other vessels

Heart Valve Repairs

There are several new codes for different methods of different valve repairs:

• 0543T  Transapical mitral valve repair, including transthoracic echocardiography, when performed, with placement of artificial chordae tendineae. This website helps the coder understand the repair: https://www.semanticscholar.org/paper/Transapical-beating-heart-chordae-implantation-in-a-Lancellotti-Radermecker/17289628020b757c742e2d2bc0410902c5840d16
• 0544T Transcatheter mitral valve annulus reconstruction with  implantation of adjustable annulus reconstruction device, percutaneous approach including transseptal puncture. This website helps the coder understand the repair:  https://www.edwards.com/gb/devices/transcatheter-valve-repair/cardiobandmitralsystem
• 0545T Transcatheter TRICUSPID valve annulus reconstruction with  implantation of adjustable annulus reconstruction device, percutaneous approach
• +0569T Transcatheter tricuspid valve repair, percutaneous approach, initial prosthesis
• +0570T each additional prosthesis during the same session (code in addition to +0569T) These websites will assist coders with tricuspid valve repairs. https://www.cathlabdigest.com/article/Percutaneous-Valve-Innovations-Tricuspid-Valve-Intervention   https://www.icrjournal.com/articles/Transcatheter-Tricuspid-Regurgitation-Treatment

(Do not report with 93451 thru 93461, 93566 for diagnostic left and right heart catheterization procedures intrinsic to the valve repair procedure.  Do not report with 93454, 93563, 93564 for coronary angiography procedures intrinsic to the valve repair procedure.)

Prior to 2020, only OPEN tricuspid valve repair procedures were available.  We now have codes for percutaneous tricuspid valve repair.

Cardioverter Defibrillator with Substernal Electrode

Note that there are now THREE different types of cardioverter-defibrillators:

Transvenous implantable  (ICD)

Subcutaneous implantable (S-ICD)

Substernal implantable (new in 2020)

Substernal defibrillator has the lead subcutaneously tunneled and placed in the substernal anterior mediastinum, without entering the pericardial cavity. The generator is placed subcutaneously in the chest area as other defibrillator generators are.   Coders must make sure they are coding the appropriate type and method of device and must read the operative note carefully.  The new range of codes are Category III codes start with 0571T for insertion of this system through 0580T for removal of substernal pulse generator only. There are 10 new codes for insertions, removal, repositioning, programing, interrogation, etc.  Coders must become familiar with all of these codes.  This website will assist the coder in substernal electrode placement:  https://www.dicardiology.com/article/future-cardiac-rhythm-management-device-technology

Iliac Arteriovenous Anastomosis Implant

• +0553T Percutaneous transcatheter placement of iliac arteriovenous anastomosis implant, inclusive of all radiological S&I, intraprocedural roadmapping, and imaging guidance necessary to complete intervention is a new code.  This is a transcatheter creation of an iliac AV anastomosis via an implant.  It is different from other procedure since this procedure creates an anastomosis in the iliac vein and artery using an implanted device.  This is used to treat patients with resistant hypertension.  The AV coupler device leads to decreased total vascular resistance and improved arterial compliance.  Do not report with 36005, 36011, 36012, 36140, 36245, 36246, 37220, 37221, 37224, 37226, 37238, 37248, 75710, or 75820.  This website will help coders understand this new device:  https://www.researchgate.net/figure/A-Arteriovenous-coupler-and-introducer-The-ROX-coupler-is-a-self-expanding-nitinol_fig1_306048039

The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.