Part 3 – New 2019 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 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
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.
Severe sepsis occurs when sepsis progresses and signs of organ dysfunction/failure develop. One site stated that approximately 30% of patients with severe sepsis do not survive. Patients may develop one organ dysfunction/failure, multi-system organ failure and/or septic shock.
In Part 2 of our Sepsis Series, we are going to focus on sequencing of sepsis when the diagnosis is clearly documented. Later in the series we will look at what to do when the diagnosis is not clearly documented.
In this series, we will learn what sepsis is or causes of sepsis, how to sequence the diagnosis in ICD-10-CM, what are the clinical indicators for sepsis, is a query necessary before reporting the diagnosis of sepsis, and how to prevent denials on sepsis records.
In the previous three parts of this four part series, we discussed the new ICD-10-CM diagnosis code changes, ICD-10-PCS procedure code changes and FY2020 IPPS changes. In this last Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments for FY2020.
In the previous two parts of this four part series, we discussed the new ICD-10-CM diagnosis code changes and ICD-10-PC procedure code changes. In this session we will review the major IPPS changes for FY2020. On August 2, 2019, CMS published the Final Rule for IPPS (CMS-1716) FY2020 IPPS Final Rule.
In Part 1 of this 4 part series we discussed some of the new ICD-10-CM diagnosis changes. In Part 2 we present the significant ICD-10-PCS procedure code changes. There are 72,184 total ICD-10-CM codes for FY2020.
This is Part 1 of a 4 part series on the FY2020 changes to ICD-10 and the IPPS. In this part, we discuss some of the new ICD-10-CM diagnosis changes. There are 72,184 total ICD-10-CM codes for FY2020.
We have finished with the step-by-step coding tidbits on coding of spinal fusions. If you were not able to catch Parts 1-13 of this series focused on spinal fusions, please visit hiacode.com/topics/series/spinal-fusion-coding/.
In Part 12, we focused on intra-operative peripheral neuro monitoring used during spinal fusion surgery. In Part 13, we are going to focus on harvesting of autograft and is it coded. Remember in Part 6, we learned that autograft is bone from the patient.
In Part 11, we focused on identifying the computer assisted navigation used during spinal fusion surgery. In Part 12, we are going to focus on intra-operative peripheral neuro monitoring.
In Part 10, we focused on identifying whether or not hardware from a previous spinal fusion is coded. In Part 11, we are going to discuss computer assisted navigation.
In Part 9, we focused on identifying if decompression was also performed and if so, on which body part. In Part 10, we are going to focus on identifying if hardware was removed from a previous fusion site.
In Part 8, we focused on identifying if a discectomy was performed, and if so, if it was a partial or a total discectomy. In Part 9, we are going to focus on identifying if a decompression was performed, and if so, was it of the spinal cord, spinal nerves or both?
In Part 7, we focused on identifying any instrumentation that may be used during a spinal fusion. In Part 8, we are going to focus on identifying if a discectomy is performed and if this is an excision or a resection of the disc.
In Part 6, we focused on identifying the type of bone graft product used for the spinal fusion. In Part 7, we are going to focus on identifying any instrumentation or device used.
In Part 5, we focused on identifying the approach being used for the spinal fusion. In Part 6, we are going to focus on identifying the type of bone graft used for the spinal fusion.
In Part 4, we focused on determining the spinal column being fused. In Part 5, we are going to focus on identifying what approach is being used to complete the spinal fusion (anterior, posterior or both).
This past year, HIA implemented “Buddy Up,” a program designed to help the new hire have a smooth transition into their new HIA roles with the assistance of a “buddy.” What is a Buddy? The Buddy is simply a peer who can guide the new hire in order to make them feel more comfortable. We are very proud of this program and have many success stories that we would like to share. Take a look at the wonderful feedback we have received below.
In Part 3, we focused on determining the level of the fusion(s) and how to determine the number of vertebrae fused. In Part 4, we are going to focus on identifying which column is being fused (anterior, posterior or both).
Part 3: Spinal Fusion Coding — Determine the Level(s) or Region of Fusion and Number of Vertebrae Fused
In Part 1, we learned the diagnoses associated with the need for spinal fusions, and in Part 2 the need to identify if the fusion is an initial or refusion of the vertebrae. In Part 3, we are going to focus on determining the level(s) of fusion, as well as the number of vertebrae fused.
In Part 2, we are going to look at the differences between initial fusion and a refusion. In ICD-9, there were specific codes to show if the fusion was an initial fusion, or if it was a refusion. In ICD-10-PCS, initial fusions and refusion procedures are coded to the same root operation “fusion.”
This is Part 1 of a 14 part series focusing on education for spinal fusions. Spinal fusion coding is a tough job for coders. There are so many diseases/disorders that result in the need for spinal fusion, and even more choices in reporting the ICD-10-PCS codes.
The official definition from the Centers for Medicare & Medicaid Services (CMS) states that a Medicare overpayment is a payment that exceeds amounts properly payable under Medicare statutes and regulations. When Medicare identifies an overpayment, the amount becomes a debt you owe the Federal government.
Coding complications of transplanted organs has always been a coding dilemma. With the implementation of ICD-10-CM that didn’t change. However, coders have multiple directives to help in determining what a complication of the transplant is vs. non-transplant conditions and diseases.
We interviewed our most productive coders, reviewers and members of our education team, asking them what steps they take to find a rhythm that works for them. This week, we talked with Beth Martilik, MA, RHIA, CDIP, CCS, Assistant Director of Education, about the steps she takes to find her routine.
With the implementation of ICD-10-CM came more codes for reporting many different conditions and diseases, and atrial fibrillation is one of those. For many years there was only one code available for reporting this condition, even when the physician further specified the type of atrial fibrillation that the patient had. In ICD-10-CM, there are four codes to report atrial fibrillation.
We have a case where the physician removes mucoid casts found during bronchoscopy. We have also seen mucus plugs removed during bronchoscopy. The MD performs bronchial washings then removes a large amount of tenacious and thick mucoid casts via bronchoscopy. Is this coded drainage, extirpation or excision? What body part is used?
The key to making the query process more efficient is to look for words or documentation while reviewing the record that may signal a potential query opportunity and to note the finding at that time. By the time a coder reaches the end of a record, documentation may have been found to eliminate the need for the query.
Question: This patient is noted to have “Lymphangitic carcinomatosis of lungs with mediastinal lymph nodes.” How would I code the diagnosis? Would I code metastatic cancer to the lung (C78.01) or metastatic cancer to the lymph nodes (C77.1)?