Sweeping Changes Coming for Interventional Cardiology Codes
October 31, 2012
This content is from the Fall 2012 issue of SCAI News & Highlights.
Sweeping changes are coming for interventional cardiology coding in 2013. For starters, SCAI was successful in securing Category I codes for percutaneous ventricular assist procedures (pVAD) (33990–33993) and transcatheter aortic valve repair (TAVR) (33361–33365). In addition, there are new codes for diagnostic cervico-cerebral angiography (36221–36228) and non-coronary thrombolysis (37211–37214). But the most significant change for 2013 is the complete restructuring of the codes and coding conventions for reporting percutaneous coronary interventions (PCI).
In 2011, the Centers for Medicare and Medicaid Services (CMS) targeted the existing PCI codes for revaluation. SCAI’s CPT and RVS Update Committee (RUC) experts, Arthur Lee, M.D., FSCAI, Clifford Kavinsky, M.D., Ph.D., FSCAI, and James Blankenship, M.D., FSCAI, worked closely with physicians from ACC to champion a new family of more granular PCI codes through the CPT and RUC processes.
The New PCI Codes
The new family of 13 PCI codes contains two subsets of codes. The first eight codes (see Table 1 below) were patterned after the coding conventions established for new lower limb revascularization codes that went into effect in 2011. These codes support reporting revascularization for each major coronary artery(ies) and branch(es) treated. The major coronary arteries are now identified as the left main, left anterior descending, left circumflex, right, and ramus intermedius arteries. All revascularization procedures performed in all segments (proximal, mid, distal) of a single major coronary artery through the native coronary circulation are reported with one code.
The final five codes (see Table 2 below) define these same services when provided to certain specific patient populations – those who have had coronary artery bypass graft(s) (CABG), those having active ST-elevated myocardial infarction (STEMI), and those with chronic total coronary artery occlusion. The AMA CPT coding manual for 2013 features two full pages of advice in the cardiovascular coding section about how to use the new codes. SCAI recommends that every interventionalist and his or her staff should read them.
Please note: SCAI is committed to making every reasonable effort to provide accurate information regarding the use of CPT®, and the rules and regulations set forth by CMS for the Medicare program. However, this information is subject to change by CMS and does not dictate coverage and reimbursement policy as determined by local Medicare contractors or any other payor. SCAI assumes no liability, legal, financial, or otherwise, for physicians or other entities who utilize this information in a manner inconsistent with the policies of any payors or Medicare carriers with which the physician or other entity has a contractual obligation. CPT codes and their descriptors are copyright 2012 by the American Medical Association.