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.
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 the final part of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we provide an actual example of an effective communication response to CDI.
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 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.
For Part 2 of this 5-part series, we will look at Chapter 1 within ICD-10-CM—A00-B99—Certain Infectious and Parasitic 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 1 of this 5-part series, we will look at Chapter 21 within ICD-10-CM—Z00-Z99—Factors influencing health status and contact with health services. There is no possible way to include every guideline or coding reference for this chapter, but I’ll do my best to touch on some off the most common issues.
The HIM world has been buzzing recently with discussion of “Social Determinants of Health” and coded data. What does this mean for coders and the HIM field?
In response to the recent occurrences of vaping related disorders and in consultation with the World Health Organization (WHO) Framework Convention on Tobacco Control, the WHO Family of International Classifications (WHOFIC) Network Classification and Statistics Advisory Committee (CSAC) was convened to discuss a diagnosis code for vaping related illness for immediate use.