Part 3: New 2021 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 2021 CPT codes. In this series we will explore the cardiovascular system CPT changes. There are 5 new cardiovascular CPT codes added with 0 deletions and 4 revisions.
Three new codes were developed for shunting procedures:
- 33741 Transcatheter arterial septostomy (TAS) for congenital cardiac anomalies to create effective atrial flow, including all imaging guidance by the proceduralist, when performed, any method (eg, Rashkind, Sang-Park, balloon, cutting balloon, blade) (Use 93462 for transseptal puncture)
- 33745 Transcatheter intracardiac shunt (TIS) creation by stent placement for congenital cardiac anomalies to establish effective intracardiac flow, including all imaging guidance by proceduralist, when performed, left and right heart diagnostic catheterization for congenital cardiac anomalies, and target zone angioplasty, when performed, (eg, atrial septum, Fontan fenestration, right ventricular outflow tract, Mustard/Senning/Warden baffles); initial intracardiac shunt (Extensive notes at Shunting Procedures section!)
- +33746 each additional intracardiac shunt location (list separately)
Coders must review the method used to create the shunt to assign the correct code. Also, these procedures are for patients with congenital heart problems such as transposition of great vessels or hypoplastic left heart syndrome. There are extensive notes for these codes so be sure to read them. For example, all catheterization, US imaging, fluoro and diagnostic cardiac catheterization is included in 33745. A diagnostic cath usually is not done during 33741 but if it is, the coder CAN report it. The coder can’t report it with 33745 as that code includes it.
Also, if multiple stents are used in 33745, only report the code once regardless of how many stents.
Percutaneous Ventricular Assist Device (VAD)
One new code and several revisions to existing codes were made for percutaneous ventricular assist device. The coder must be careful to identify what side of heart is involved as can be seen below.
- 33995 Insertion of ventricular assist device, percutaneous, including radiological S&I;
- right heart, venous access only
▲ 33990 left heart, arterial access only
▲ 33991 left heart, both arterial and venous access, with transeptal puncture
▲ 33992 Removal of percutaneous left heart ventricular assist device, arterial or arterial and venous cannula(s), at separate and distinct session from insertion. (Includes removal of cannulas)
- 33997 Removal of percutaneous right heart ventricular assist device, venous cannula, at separate and distinct session from insertion
▲ 33993 Repositioning of percutaneous right or left heart ventricular assist device with imaging guidance at separate and distinct session from insertion.
The VAD provides hemodynamic support to the right heart, left heart or both. The approach can be open or percutaneous. There are extensive notes. For example, repositioning of the VAD at time of insertion is not separately reportable.
Interatrial Septal Shunt Device
There is a new code for this type of shunt, also called or known as an “IASD”
- 0613T Percutaneous transcatheter implantation of interatrial septal shunt device, including right and left heat catheterization, intracardiac echocardiography, and imaging guidance by the proceduralist, when performed. Coders must be sure to read the extensive exclusion notes.
An interatrial shunt device reduces left atrial pressure, improves hemodynamics and prevents adverse remodeling in an ovine heart failure model. … A modified technique of stent fenestration of the interatrial septum improves patients with pulmonary hypertension.
Replacement of Substernal Defibrillator Generator
There was no code previously for just the removal and replacement of substernal generator alone. 0580T is for removal WITHOUT replacement. The AMA created this new code:
- 0614T Removal and replacement of substernal implantable defibrillator pulse generator
(Do note report 0614T with 33262, 0571T, 0572T, 0575T, 0576T, 0577T, 0580T) These are the other codes are for insertion of device with electrodes, programming, repositioning, etc.
Automated Quantification of Plaque
There are several new codes for automated quantification of plaque:
- 0623T Automated quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, using data from coronary computed tomographic angiography; data preparation and transmission, computerized analysis of data, with review of computerized analysis output to reconcile discordant data, interpretation and report
- 0624T data preparation and transmission
- 0625T computerized analysis of data from coronary computed tomographic angiography
- 0626T review of computerized analysis output to reconcile discordant data, interpretation and report
This is a web-based service instead of an in person service in which CTA data are analyzed using computerized algorithms to assess the extent and severity of coronary artery disease.
Endovascular Venous Arterialization
A new category III code was created for tibial or peroneal venous arterialization. This is for a patient that has chronic total occlusion. It is a connection from artery to vein is performed using various methods. A covered stent introduced into vessel to connect the two.
- 0620T Endovascular venous arterialization tibial, or peroneal vein, 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 catheterization(s) and intraprocedural roadmapping and imaging guidance necessary to complete the intervention, all associated S&I when performed
Transcatheter Ultrasound Ablation of Nerves of Pulmonary Arteries
- 0632T Percutaneous transcatheter ultrasound ablation of nerves innervating the pulmonary arteries, including right heart catheterization, pulmonary angiography, and all imaging guidance
We have seen this done to other nerve areas such as the knee. This is just a code for a new site.
In Part 4 of this series, we will discuss the remaining new surgical CPT codes in the surgery section for 2021.
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.
Did you get a chance to read the FY2022 IPPS Final Rule? There is an interesting topic that was discussed regarding unspecified ICD-10-CM laterality diagnosis codes, to be exact. In this coding tip we discuss that subject and possible ramifications of it in the coding world.
In Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments. Prepare yourself as this is rather lengthy due to continuation of NTAP that would normally expire.
Coders are instructed, at this time, to follow the AHA Frequently Asked Questions Regarding ICD-10-CM/PCS Coding for COVID-19. Lately, we have seen missing PCS codes for the new technology drugs that were introduced on August 1, 2020 and thereafter.
With the creation and implementation of ICD-10-CM, multiple codes are available to describe the type of pulmonary emboli that occur.
Hypercoagulable states are blood disorders that increase the risk of deep vein thrombosis or embolic disease. The state is either inherited or acquired. About 80% of patients with blood clots have been found to have either an inherited or acquired clotting disorder. These blood clots can be lethal and some require life-long therapy. Hypercoagulable state is also known as thrombophilia.
Encephalopathy is a general term and means brain disease, brain damage or malfunction. Physicians often use encephalopathy and altered mental status interchangeably. When coders see this documentation in the healthcare records, they typically need to query the physician for clarification of the diagnosis.
Spinal procedure coding can be daunting for coders. The spine itself can be quite complicated anatomically and the procedures done to address spinal conditions can be even more complicated!
In June CMS released the final ICD-10-PCS codes for FY2022, which begins October 1, 2021. We are giving you a sneak peek at the changes. HIA will have a full educational module on these changes available later this summer.
CMS released the IPPS proposed rule on 4/27/21 outlining the proposed changes to the Inpatient Prospective Payment System for FY2022, which begins October 1, 2021. Later this year, sometime in August, CMS will release the Final Rule. Currently CMS is reviewing responses to their proposed rule and will address them in the final rule.
A medical coding audit is a process that includes internal or external reviews of medical coding and billing accuracy, procedures or policies in place, and any other component that affects the medical record documentation. Medical coding audits…
Anticoagulants and antiplatelets are used for the prevention and treatment of blood clots that occur in blood vessels. Oftentimes, anticoagulants and antiplatelets are referred to as “blood thinners,” but they don’t actually thin the blood at all. These drugs slow down the body’s process of making clots. Their main function is to keep the patient’s blood from clotting or turning into solid clumps of cells. These drugs do this by interfering with either fibrin or platelets in the blood.
Carotid artery disease is a vague category that can incorporate many different carotid artery issues. Some physicians may feel that they are being clear the patient has plaque, stenosis, or occlusion of the artery, but in ICD-10-CM the specificity must be included in the documentation.
10 ICD-10 Codes for Superheroes. Superman: T78.2XXA Anaphylactic reaction; substance: kryptonite. Batman: F44.81 Dissociative identity disorder. Robin: F60.7 dependent personality. The Hulk: L30.4 Erythema intertrigo. Wonder Woman: T24.032A Burn of unspecified degree of left lower leg. Black Panther S93.401A Sprain…
Practices have not seen many revisions to the Evaluation and Management (E/M) office / outpatient visit guidelines in three decades – until now. As of January 1, there are new E/M coding guidelines. We’ll get to those in a bit, but first let’s look at why they changed.
Pseudoseizures are a form of non-epileptic seizure. These are difficult to diagnose and oftentimes extremely difficult for the patient to comprehend. The term “pseudoseizures” is an older term that is still used today to describe psychogenic nonepileptic seizures (PNES).
With the implementation of ICD-10-CM came different codes and coding rules for many diagnoses. One of these is the coding of bowel obstruction when the patient presents for this condition that is caused by another condition.
This is Part 5 of a five part series on the new 2021 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 2021 CPT codes. In this series we will explore the CPT changes in the urinary, nervous, ocular and auditory systems. There are 2 new urinary/male reproductive system codes with no revisions or deletions; 3 new female reproductive codes with 2 deletions, 0 new with 4 deleted nervous system codes with 5 revisions; 5 new eye category III codes; and finally a 2 new auditory codes with one deletion.
This is Part 2 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include some examples to help the coder understand the new codes. There are 0 new musculoskeletal CPT codes added with 0 deletions and 2 major revisions along with an extensive update to arthroscopic loose body removal requirements. For the respiratory system, there were 2 new codes, one code deletion and no revisions.
This is Part 1 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include examples to help the coder understand the new codes. For 2021 in general, there were 199 new CPT codes added, 54 deleted and 69 revised.
We have seen many updates and changes to COVID-19 (SARS-CoV-2) since the pandemic started. On January 1, 2021 we will see even more changes as outlined in this post. Also the CMS MS-DRG grouper will be updated to version 38.1 to accommodate the changes.
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 FY2021 IPPS changes. In this last Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments for FY2021.
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 FY2021.
This is Part 2 of a 4 part series on the FY2021 ICD-10 Code and IPPS changes. In this part, the ICD-10-PCS procedure codes are presented. For FY2021 ICD-10-PCS there are 78,115 total codes (FY2020 total was 77,571); 556 new codes (734 new last year in FY2020)…
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.