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.
Last week, we looked at tidbits for reporting the ICD-10-CM codes for pregnancy/obstetric records. Now we will look at some for the ICD-10-PCS reporting of these records. In reporting the appropriate ICD-10-PCS codes a coder must know what is included in the terminology of products of conception (POC).
Chances are, we all know someone affected by heart disease and stroke, because about 2,300 Americans die of cardiovascular disease each day, an average of 1 death every 38 seconds. But together we can change that.
There was a time when coding delivery records was considered simple. Many times, these types of records were given to the newer coders. However, as coding becomes more complex, this is no longer the case. With the implementation of ICD-10-CM came more codes for very detailed and specific issues that occur during pregnancy, childbirth and the puerperium.
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Allison Curry, RHIT, CCS, Coding Specialist at Health Information Associates, about the steps she takes to find her routine.
One way to shorten a lengthy query is by avoiding repetition in the supporting documentation. Does the same diagnosis really need to be mentioned multiple times in the clinical indicators? Is it necessary to list the results of a chest x-ray twice? Does listing the same documentation multiple times give further specification or explanation to the query?
Tobacco use can lead to tobacco/nicotine dependence and serious health problems. Quitting smoking greatly reduces the risk of developing smoking-related diseases. Tobacco/nicotine dependence is a condition that often requires repeated treatments, but there are helpful treatments and resources for quitting.
This is Part 5 of a five part series on the new 2019 CPT codes. For the remaining areas we will just briefly summarize the section. Due to the intricate nature of these sections in CPT, it is recommended that the coder read the entire section notes associated with the new codes.
This is Part 4 of a five part series on the new 2019 CPT codes. In this series we will explore the CPT changes for FY 2019 and include examples to help the coder understand the new codes. There is 1 new lymphatic code, 2 new digestive system codes with 3 deletions, 3 new urinary system codes with one deletion and 7 deleted nervous system codes with 2 revisions.
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Tilina Sablan, RHIT, CCS, Coding Specialist with Health Information Associates, about the steps she takes to find her routine.
This is Part 2 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 4 new musculoskeletal CPT codes added with 2 deletions and 0 revisions.
This is Part 1 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 were 15 new integumentary CPT codes added with 3 deletions and 1 revision.
In part 5 of our series, we look at DRG 64—Intracranial hemorrhage or cerebral infarction with MCC. For this DRG recommendation the majority (almost all) were recommended to DRG 65 (Intracranial hemorrhage or cerebral infarction with CC) with deletion of the reported MCC.
The majority of the recommendations from DRG 190 (Chronic obstructive pulmonary disease w/MCC) was to DRG 189 (Pulmonary edema and respiratory failure) with re-sequencing of respiratory failure as the PDX or adding as a new code and sequenced as PDX.
The majority of the recommendations from DRG 853 (Infectious & parasitic disease with O.R. procedure with MCC) were to DRG 871 (Septicemia w/o MV 96+ hours with MCC) with deletion or revision of the PCS code. Some of these required physician query.
The majority of the recommendations from DRG 872 (Septicemia w/o mechanical ventilation 96+ hours w/o MCC) were to DRG 871 (Septicemia w/o mechanical ventilation 96+ hours with MCC) with the addition of an MCC to the account. Not all of these required a physician query and were present in the medical record documentation without any clarification needed prior to coding.
The majority of the recommendations from DRG 871 (Septicemia w/o MV 96+ hours with MCC) were to DRG 872 (Septicemia w/o MV 96+ hours w/o MCC) with the recommendation to delete the reported MCC or query for clarification to support the MCC that had been reported.
Every year, we make plans to live a healthier, more organized, and balanced life. For some of us, we end up falling short of those expectations. This year, to keep us on track with our New Year’s goals, we have put together a few of the most common New Year’s resolutions along with their ICD-10 diagnoses codes. Check out our tips and tricks for a healthy 2019!
Top 5 ProFee diagnosis changes found in recent HIA reviews: 1. I10 – Essential (Primary) Hypertension; 2. E11.9 – Type 2 Diabetes Mellitus Without Complications; 3. K29.60 – Other Gastritis Without Bleeding; 4. R13.19 – Other Dysphagia; 5. I25.10 – Atherosclerotic Heart Disease of Native Coronary Artery Without Angina Pectoris.
What is the principal procedure? The procedure that is performed for definitive treatment or is taking care of a complication is the principal procedure. Procedures for diagnostic or exploratory purposes that are performed in addition to a procedure being performed for definitive treatment, would be reported in addition to the principal procedure.
A query question that is directive in nature, indicating what the provider should document, rather than asking for his/her professional determination of clinical facts, constitutes a leading query. The provider should not be made to feel obligated to document anything.
When I start coding a chart, I enter all account information in log and do any abstracting—disposition, admitting, and attending—take care of all of that first. ED, H&P, consult, progress reports, and discharge summary.
Some Speed Reading Tips: Once you start reading, don’t stop! Read the text straight through. If you have any question after you have completed reading the material, go back and reread the relevant sections. Reread the marked sections of the text (the items you indicated that you didn’t quite understand). Write a small summary at the beginning of the chapter – consisting about 3-4 sentences.
A burr hole is a small hole that is made in the skull with a drill by the surgeon. First, (after prepping the site) the scalp is cut (incised) at the desired location by the surgeon. The surgeon will then drill 1 or 2 small holes in the skull at this area to reach the dura.
The cause/etiology of GI bleeding is not always easily determined. During procedures, to work the bleeding up, there are often multiple potential sources of bleeding found but not identified as the culprit. Many of these findings have “with” or “in” in the main or subterms.
On December 1, 2018, the HIA team based at our headquarters in Pawleys Island, South Carolina received a visit from a surprise guest – meet Otis, HIA’s very own Elf on a Shelf. Otis will be sticking around until Christmas to keep an eye on all of us. We have a feeling he may get into some trouble! Check back daily to see what Otis is up to. #OtisOnOtisDrive
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our new series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Crystal Junkins, CCS, CPC, Coding Specialist with Health Information Associates, about the steps she takes to find her routine.
COPD is a respiratory condition where there is chronic obstruction to airflow in the lungs. Air is breathed into the lungs but a patient with COPD has trouble emptying air out of the lungs. This can also cause patients with COPD to have CO2 retention. COPD is an irreversible and progressive disease in which the lung function worsens as time goes on.
Tissue findings interpreted by a pathologist are not equivalent to the attending physician’s medical diagnosis based on the patient’s clinical condition. If the attending physician has not indicated the significance of an abnormal finding within a pathology report…
It’s that time of the year where HIM professionals take a peek at what changes are coming for CPT in the new year, 2019. Did you know that CPT started in 1966 with about 3,500 codes? For 2019, there are a total of 10,294 CPT codes.