Part 3: New 2020 CPT Codes | Cardiovascular System
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador
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. There are 11 new cardiovascular CPT codes added with 8 deletions and 2 revisions.
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)
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
In Part 4 of this series, we will discuss the remaining new surgical CPT codes for 2020.
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.
This is Part 1 of a 4 part series on the FY2021 changes to ICD-10 and the IPPS. In this part, we discuss some of the new ICD-10-CM diagnosis changes. Here is the breakdown: 72,616 total ICD-10-CM codes for FY2021; 490 new codes (2020 had 273 new codes); 58 deleted codes (2020 had 21 deleted codes); 47 revised codes (2020 had 30 revised codes)
Acute pulmonary edema is the rapid accumulation of fluid within the tissue and space around the air sacs of the lung (lung interstitium). When this fluid collects in the air sacs in the lungs it is difficult to breathe. Acute pulmonary edema occurs suddenly and is life threatening.
“Client S” is a small, not-for-profit, 40 bed micro-hospital in the Southeast. HIA performed a 65-record review this year for Client S and found an opportunity with 15 of them. 9 had an increased reimbursement with a total of $43,228 found.
The coma scale codes (R40.2-) can be used in conjunction with traumatic brain injury codes, acute cerebrovascular disease or sequelae of cerebrovascular disease codes. These codes are primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma scale may also be used to assess the status of the central nervous system for other non-trauma conditions, such as monitoring patients in the intensive care unit regardless of medical condition.
In the past, there had been an Excludes1 note at I46.- Cardiac arrest that excluded R57.0, Cardiac shock. HIA had also received a letter from AHA on a case in the past that had stated that only I46.- Cardiac arrest would be coded if both were documented. In addition, the Third Quarter Coding Clinic page 26 had a similar case that asked if both could be coded, and AHA had instructed that only I46.9, cardiac arrest, cause unspecified would be coded if both were documented and that the CDC would be looking at possible revision to the Excludes1 note.
A higher CMI corresponds to increased consumption of resources and increased cost of patient care, resulting in increased reimbursement to the facility from government and private payers, like CMS. We know that documentation directly impacts coding.
Lately we have seen several cases where the endarterectomy was assigned along with the coronary artery bypass (CABG) procedure when being performed on the same vessel to facilitate the CABG. A coronary artery endarterectomy is not always performed during a CABG procedure, so when it is performed it becomes confusing as to whether to code it separately or not.
Assign code Z20.828, “Contact with and (suspected) exposure to other viral communicable diseases” for all patients who are tested for COVID-19 and the results are negative, regardless of symptoms, no symptoms, exposure or not as we are in a pandemic.
The Centers for Medicare & Medicaid Services (CMS) announced new procedure codes for treatments of COVID-19 – effective as of August 1, 2020. Among the new codes are Section X New Technology codes for the introduction or infusion of therapeutics including Remdesivir, Sarilumab, Tocilizumab, transfusion of convalescent plasma, as well as introduction of any other or new therapeutic substances for the treatment of COVID-19.
One common element in many value-based programs is risk adjustment using Hierarchical Condition Categories (HCCs) to create a Risk Adjustment Factor (RAF) score. This method ranks diagnoses into categories that represent conditions with similar cost patterns.
Why are so many AKI records being denied? It’s hard to give one answer for why so many AKI records are being denied lately, but most appear to be due to the multiple sets of criteria available for use in determining if a patient has AKI, as well as physician documentation. As stated in Part 3 of this series, there are three main criteria/classifications used to diagnose AKI.
In previous parts of this series we looked at the definitions of AKI/ARF, causes, coding and sequencing, and the common clinical indicators that patients present with that are diagnosed with this condition. In Part 4, we will look at the documentation that should be present to report the diagnosis without fear of denial, as well as when a query is needed to clarify the diagnosis.
If the facility does a COVID-19 test, and test is negative, do I need a diagnosis code. The answer is yes, you will report a Z-code. The Z-code depends on the record documentation and circumstances of testing. For any patient receiving a COVID-19 test, if negative, there MUST e a Z-code to describe why the test was taken. (Test negative for COVID-19 and MD does not override negative results).
In the first parts of this series we looked at definitions of AKI/ARF, causes, coding and sequencing. In Part 3, we will look at what clinical indicators would possibly be present to support the diagnosis of AKI/ARF.
The FY2021 IPPS Proposed Rule is out and here are some highlights from it regarding ICD-10 Code proposals. We will know if these changes are permanent after the public comment period is over on July 10, 2020 and CMS prepares the Final Rule, usually out by August 1.
As discussed in Part 1 of this series, AKI/ARF is a common diagnosis that coders see daily. In Part 2, we are going to focus on the different types/specificity of AKI/ARF. We’ll learn what they mean, as well as how to code the diagnosis.
This is part 1 in a series focused on coding of acute kidney injury (AKI) and/or acute renal failure (ARF). AKI/ARF is reported often, but is also one of the most common diagnosis found in denials.
With the proliferation of COVID-19 cases, we thought we would put together a quick reference listing of some of the common scenarios that coders have asked about. As with all coding, coders should follow Official Guidelines for Coding and Reporting and the COVD-19 Frequently Asked Questions document by the AHA.
Effective March 1, Medicare will pay physicians for telehealth services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19. This great for providers whose patients are reluctant to visit the office.
The biggest reasons why some hospital systems are moving to single path coding is to eliminate duplicative processes and to optimize productivity. In addition, costs are reduced when only one coder “touches” the record and completes both types of coding.
Effective with 4/1/2020 discharges, ICD-10-CM code U07.0 is used to report vaping -related disorders. ICD-10-CM code U07.0 (vaping related disorder) should be used when documentation supports that the patient has a lung-related disorder from vaping. This code is found in the new ICD-10-CM Chapter 22. U07.0 will be in listed in the ICD-10-CM manual under a new section: Provisional assignment of new disease of uncertain etiology or emergency use.
The US government and public-health officials are urging consumers to utilize telemedicine for remote treatment, fill prescriptions and get medical attention during the new coronavirus pandemic. The goal is to keep people with symptoms at home and to practice social distancing if their condition doesn’t warrant more intensive hospital care.
Coronavirus: Tips for working from home. Companies around the world have told their employees to stay home and work remotely. Whether you’re a new to this concept or a work from home veteran, here’s some tips to staying productive from our #HIAfamily.
This is part two of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we discuss mismatches and how to best go about resolving them. In part three we will provide a case example of best practice interaction.
This is part one of a three part series in which we address how coders can better interact with Clinical Documentation Integrity (CDI) professionals. Many times these departments are separate and the remote environment makes it difficult to interact efficiently between the two departments. In part one, we will discuss the history and objectives of CDI so the coder has a better understanding of CDI’s role.
One reason that coders should report chronic conditions (including history and status codes) on outpatient records is the HCC’s—Hierarchical Condition Categories. The quick and easy explanation of what HCC’s are is each HCC is mapped to certain ICD-10-CM codes or code ranges. HCC coding is designed to estimate future health care costs for patients.
For Part 5 of this 5-part series, we will look at Chapter 4 within ICD-10-CM—E00-E89—Endocrine, Nutritional, and Metabolic Diseases. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
For Part 4 of this 5-part series, we will look at Chapter 10 within ICD-10-CM—J00-J99—Diseases of the Respiratory System. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
For Part 3 of this 5 part series, we will look at Chapter 9 within ICD-10-CM—I00-I99—Diseases of the Circulatory System. This chapter contains so many of the everyday diagnoses that we code such as hypertension, heart disease and stroke.