Part 3 – New 2019 CPT Codes: Cardiovascular System

Pat Maccariella‑Hafey
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 2019 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 9 new cardiovascular CPT codes added with 2 deletions and 3 revisions.

Permanent Leadless Pacemaker

Two new codes, 33274, Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (e.g., fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (e.g., interrogation or programming), when performed and 33275, Transcatheter removal of permanent leadless pacemaker, right ventricular replace category III codes 0387T, 0388T from last year. A permanent leadless pacemaker is delivered via a catheter through the femoral vein and positioned inside of the right ventricle of the heart. For a description of the device, review the information on this website:  https://medicalxpress.com/news/2017-05-world-smallest-leadless-pacemaker-yields.html

Cardiac Rhythm Monitor

Two new codes, 33285, Insertion, subcutaneous cardiac rhythm monitor including programming. (Also known as cardiac event monitor or (ILR) insertable loop recorder) and 33286 Removal, subcutaneous cardiac rhythm monitor were created for this device. It is a small 1 2/3 inch long device that is subcutaneously placed in a pocket via parasternal incision. This device continuously records electrocardiographic rhythm triggered by irregular heart rates for up to three years. More info can be found here:  https://www.mayoclinic.org/tests-procedures/implantable-loop-recorder/pyc-20384986

Pulmonary Artery Pressure Monitor

Code 33289, Transcatheter implantation of wireless pulmonary artery pressure sensor for long term hemodynamic monitoring including deployment and calibration of the sensor, right heart catheterization, selective pulmonary catheterization, radiological S&I and pulmonary artery angiography when performed was created for this subcutaneously placed device. Like the cardiac monitor, it is placed in a pocket via a small parasternal incision. It continuously records the pulmonary artery pressure and heart rate. It is used mainly in class III heart failure patients.    CardioMEMS is one such device.

Replace Aortic Valve by Translocation of Pulmonary Valve

Code 33440 Replacement aortic valve, by translocation of autologous pulmonary valve and transventricular aortic annulus enlargement of the left ventricular outflow tract with valved conduit replacement of pulmonary valve (Ross-Konno procedure). In layman’s terms it means that they will take out the diseased aortic valve and replace with patient’s own pulmonary valve. Patient will then get a pig valve in the place of the pulmonary valve. The reason for trading valves is because the pulmonary valve get less ‘traffic’ and is better able to handle the pig valve in its place rather than the high traffic aortic valve.

Aortic Arch Hemiarch Graft

Add on code +33866 Aortic hemiarch graft including isolation and control of the arch vessels, beveled open distal aortic anastomosis extending under one or more of the arch vessels, and total circulatory arrest or isolated cerebral perfusion (List separately in addition to primary procedure). Aortic hemiarch graft may be necessary in addition to ascending aortic graft. It requires total circulatory arrest or isolated cerebral perfusion, incision into the transverse arch under one or more of the arch vessels such as innominate, left common carotid, or left subclavian; and extension of the ascending, aortic graft under the aortic arch without a cross clamp (an open anastomosis). For more information, see https://www.emoryhealthcare.org/centers-programs/aortic-center/types-of-aortic-repairs/ascendingaorta.html

Peripherally Inserted Central Venous Catheter (PICC)

Revised and new codes were added to accommodate PICC insertion without guidance or with guidance.  The codes are: 36568, 36569, Insertion of PICC without port or pump, added “without imaging guidance”  (PICCs placed with magnetic or other guidance that is not imaging)

• 36572, Insertion of PICC without port or pump, including all imaging guidance, image documentation, and all associated radiological S&I required to perform the insertion, younger than 5 years of age
• 36573, Age 5 years or older

▲ 36584, Replacement, complete, of PICC without port or pump, through same venous access,  added “including all imaging guidance image documentation, and all associated radiological S&I required to perform the replacement.

The imaging guidance is usually fluoroscopy or ultrasound. Midline catheters are NOT central catheters and should be reported with 36400, 36405, 36406 or 36410, the venipuncture codes.

Coronary Fractional Flow Reserve (FFR)

Add on code +0523T Intraprocedural coronary fractional flow reserve (FFR) with 3D functional mapping of color-coded FFR values for the coronary tree, derived from coronary angiogram data, for real-time review and interpretation of possible arteriosclerotic stenosis(es) intervention. (List separately in addition to primary procedure)  has been added. This study provides real time color values of the coronary tree to help assist the cardiologist in assessing the coronary vessels.

Femoral-Popliteal Stent Grafts

New code 0505T, Endovenous femoral-popliteal arterial revascularization, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed all catherization(s) and intraprocedural roadmapping and imaging guidance necessary to complete the intervention, when performed, with crossing of the occlusive lesion in an extraluminal fashion, was added for this new type of stent grafting.

This stent graft treats femoropopliteal artery stenosis/occlusion and aneurysms.  Usually a crossing device is used. Note that the graft must go INTO the adjacent vein, usually the femoral vein. If not, it is NOT 0505T. See this website for a good photo of this type of graft: https://www.businesswire.com/news/home/20180222005540/en/PQ-Bypass-Announces-Patient-Treated-Landmark-DETOUR

Wireless Cardiac Stimulation

There are several new codes for wireless cardiac stimulation:

• 0515T Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, imaging S&I, complete system (includes electrode and generator-transistor and battery)  (EBR WiSE CRT system)
• 0516T electrode only
• 0517T pulse generator (battery and/or transmitter)only
• 0518T Removal of only pulse generator component(s) (battery and/or transmitter) of wireless cardiac stimulator for left ventricular pacing
• 0519T Removal and replacement of only pulse generator component(s) (battery and/or transmitter) of wireless cardiac stimulator for left ventricular pacing
• 0520T pulse generator component(s) (battery and/or transmitter) including placement of a new electrode
• 0521T Interrogation of device in person analysis, review, report, record, etc.
• 0522T Programming device evaluation in person

Note that these codes involve LEFT VENTRICULAR pacing instead of the right side.  The left side is a better target for delivery of electric pulses in helping pace the heart, which is why this procedure was created.

Please refer to these websites for more information: medgadget.com/2015/10/wise-wireless-technology-left-ventricle-pacing-without-coronary-sinus-leads-approved-eu-video.html
ebrsystemsinc.com/

Endovascular Chemical Ablation

There is one new code, 0524T, Endovenous catheter directed chemical ablation with balloon isolation of incompetent extremity vein, open or percutaneous, including all vascular access, catheter manipulation, diagnostic imaging, imaging guidance, and monitoring.  This differs from mechanical occlusion chemical ablation (36473, 36474) in that it uses a balloon, inflated, to isolate the incompetent vein from the other veins in the deep system when delivering the embolizing or sclerosing agents.

Intracardiac Ischemia Monitoring

Several new codes were created:

• 0525T Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming and imaging S&I, complete system
• 0526T electrode only
• 0527T implantable monitor only
• 0528T Programming device evaluation in person of intracardiac ischemia monitoring system with iterative adjustment of values, analysis, etc.
• 0529T Interrogation device evaluation in person of intracardiac ischemia monitoring system with analysis, review and report
• 0530T Removal of complete intracardiac ischemia monitoring system
• 0531T Removal of electrode only
• 0532T Removal of implantable monitor only

This device is used to detect and alert patients during a major ischemic coronary event such as a STEMI or NSTEMI.  The device can detect and alert patients of both symptomatic and asymptomatic ischemic coronary events.

The information contained in this post 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.