Read Cardiology Services Update text version

CPT® and RBRVS 2012 Annual Symposium November 16-18, 2011

Cardiology Services Update

Kenneth P. Brin, MD, PhD, FACC CPT Editorial Panel James Blankenship, MD, MACC, FSCAI Relative Value Update Committee

Cardiology Services Update

· Medicine/Cardiovascular

· Cardiac catheterization table now included in book · Deleted transmyocardial transcatheter closure of ventricular septal defect (category III codes) · Noninvasive Physiologic Studies and Procedures · Echocardiography

· Surgery/Cardiovascular System

· Pacemaker or Pacing Cardioverter-Defibrillator

Cardiac Catheterization Code Table Now Included in CPT Professional 2012

Cardiology Services Update

Medicine · Cardiac Catheterization

· Injection Procedures

· Editorial revision to codes 93561, 93562--language change from "thermal dilution" to "thermodilution" · Editorial revision to parenthetical note following code 93562 now listing the specific cardiac catheterization codes with which the thermodilution codes 93561, 93562 should not be reported

· Deletion of category III codes 0166T, 0167T reporting transmyocardial transcatheter closure of ventricular septal defect and insertion of parenthetical directing use of 33999

· Noninvasive Physiologic Studies and Procedures

· With the creation of new codes describing pulmonary function testing, 93720-93722 describing plethysmography have been deleted

Cardiology Services Update

Medicine

· Echocardiography--stress echo performed by the same practitioner as the stress test

· In the non-facility setting, 93551 was created to report when a complete cardiovascular stress test (93015) and a stress echo (93550) are performed by the same practitioner. · Guidelines revised to clarify the in-facility situation--when the same practitioner performs both the professional component of the complete stress test and of the stress echo

· Professional components by same physician ­ 93351-26

· The parenthetical note following code 93351 has been revised to reflect these revisions.

Cardiology Services Update

Pacemaker or Pacing Cardioverter-Defibrillator

· Several code pairs in this group were identified by the Joint CPT/RUC Workgroup Screen on Codes Reported Together Frequently

· Revised Guidelines including new definitions

· Radiological supervision and imaging is included in these codes

· Numerous revised codes · Numerous new codes · New Table to help with coding

Cardiology Services Update

Pacemaker or Pacing Cardioverter-Defibrillator

· Revised Guidelines ­ Key Points

· Reporting of removal/insertion/replacement/upgrade of pulse generator, lead(s) · Device evaluation codes 93279-93299 not reported separately at time of insertion/replacement/upgrade · Defibrillator threshold testing (DFT) codes 93640, 93641 may be reported separately for insertion/replacement/upgrade · Moderate sedation symbol added to many of these codes · Radiological S&I included in codes 33206-33249 (71090 deleted); for fluoro guidance for diagnostic lead evaluation, use 76000

Cardiology Services Update

Pacemaker/ICD Procedure Table

Cardiology Services Update

Pacemaker or Pacing Cardioverter-Defibrillator

· Note: As always, the introductory language and code descriptions provides supersede any table information; if you have a question, please refer to those.

Device X-rays Single lead ICD 3-lead ICD

Pacemakers

Pacemakers--Treating Heart Block

Implantable Cardiac Defibrillator

Symbol Reminder

· Revised codes have a ""symbol · New codes have a "" symbol · Services including moderate sedation have a " " symbol

Cardiology Services Update

Cardiology Services Update

Pacemaker

· 33206-33208

· · · 33206 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial 33207 33208 ventricular atrial and ventricular

· (Codes 33206-33208 include subcutaneous insertion of the pulse generator and transvenous placement of electrode[s]) · (For removal and replacement of pacemaker pulse generator and transvenous electrode(s), use 33233 in conjunction with either 33234 or 33235 and 33206-33208) · (Do not report 33206-33208 in conjunction with 33227-33229)

Cardiology Services Update

Cardiology Services Update

Cardiology Services Update

Cardiology Services Update

Coronary Sinus (LV) Electrode Insertion (1)

· 33224 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or pacing cardioverter-defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator) · (When epicardial electrode placement is performed, report 33224 in conjunction with 33202, 33203)

Cardiology Services Update

Coronary Sinus (LV) Electrode Insertion (2)

· +33225 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverterdefibrillator or pacemaker pulse generator (including upgrade to dual chamber system and pocket revision) (List separately in addition to code for primary procedure) · (Use 33225 in conjunction with 33206, 33207, 33208, 33212, 33213, 33214, 33216, 33217, 33221, 33222, 33230, 33231, 33233, 33234, 33235, 33240, 33249) · 33226 Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator)

Cardiology Services Update

Pacemaker or Pacing Cardioverter-Defibrillator

· Correction: Bowties missing around the following notes in the CPT 2012 Professional and Standard Editions:

· 33227 Code is out of numerical sequence. See 33202-33249 · 33228 Code is out of numerical sequence. See 33202-33249 · 33229 Code is out of numerical sequence. See 33202-33249 · 33230 Code is out of numerical sequence. See 33202-33249 · 33231 Code is out of numerical sequence. See 33202-33249

These notes are new for 2012.

Cardiology Services Update

Pacemaker Removal and Replacement Codes (generator change)

· 33233 Removal of permanent pacemaker pulse generator only

· 33227-33229

· # 33227 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system · # 33228 · # 33229 dual lead system multiple lead system

· (Do not report 33227-33229 in conjunction with 33233) · (For removal and replacement of pacemaker pulse generator and transvenous electrode[s], use 33233 in conjunction with either 33234 or 33235 and 33206-33208)

Cardiology Services Update

Cardiology Services Update

Cardiology Services Update

Pacing Cardioverter-Defibrillator Replacement (generator change alone)

· 33262-33264

· # 33262 Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator pulse generator; single lead system · # 33263 · # 33264 dual lead system multiple lead system

· (Do not report 33262-33264 in conjunction with 33241) · (For removal of electrode[s] by thoracotomy in conjunction with pulse generator removal or replacement, use 33243 in conjunction with 33241, 33262-33264)

Cardiology Services Update

Pacing Cardioverter-Defibrillator Replacement (generator change alone)

· 33262-33264 (continued)

· (For removal of electrode[s] by transvenous extraction in conjunction with pulse generator removal or replacement, use 33244 in conjunction with 33241, 33262-33264) · (For repair of implantable cardioverter-defibrillator pulse generator and/or leads, see 33218, 33220)

Cardiology Services Update

Cardiology Services Update

Pacemaker/ICD Procedure Table

Relative Value Units for New or Changed Cardiology Codes

How Pacing/Defibrillator Systems Look Before Dr Brin's Explanation

How Pacing/Defibrillator Systems Look After Dr Brin's Explanation

Pacemaker/ICD Procedure Table

Leads Only

Transvenous Procedure Insert transvenous single lead only without pulse generator Insert transvenous dual leads only without pulse generator Insert transvenous multiple leads only without pulse generator Pacemaker Defibrillator Insert transvenous leads alone 33216 33217 33217 + 33224* 14.88 RVUs

(no change)

33216 33217 33217 + 33224* 14.88 RVUs

(no change)

Removal transvenous lead(s) only . . . Single lead system . . . Dual lead system 33234 33235 33244 33244

Note: Codes in blue* are modified existing codes; codes in red** are new codes

Pacemaker/ICD Procedure Table

Generator only

Transvenous Procedure With existing single lead Pacemaker 33212* 5.26 RVUs

(was 5.52)

Defibrillator 33240* 6.05 RVUs

(was 7.64)

Initial pulse generator insertion alone with existing leads

With existing dual leads

33213* 5.53 RVUs

(was 6.37)

33230** 6.32 RVUs 33231** 5.80 RVUs

With existing multiple leads

33221** 5.80 RVUs

Note: Codes in blue* are modified existing codes; codes in red** are new codes

Pacemaker/ICD Procedure Table

Generator only

Transvenous Procedure With existing single lead With existing dual leads With existing multiple leads Pacemaker 33227** 5.50 RVUs 33228** 5.77 RVUs 33229** 6.04 RVUs Defibrillator 33262** 6.06 RVUs 33263** 6.33 RVUs 33264** 6.60 RVUs Removal AND REPLACEMENT of pulse generator with existing leads

Removal of pulse generator only Removal pulse generator only (without replacement) 33233* 3.39 RVUs

(no change)

33241* 3.29 RVUs

(no change)

Note: Codes in blue* are modified existing codes; codes in red** are new codes

Pacemaker/ICD Procedure Table

Generator and leads

Transvenous Procedure Pacemaker Defibrillator Initial pulse generator insertion or replacement plus insertion of transvenous lead(s) . . . single lead 33206* (atrial) 7.39 RVUs

(no change)

33249* 15.17 RVUs

(no change)

33207* (ventricular) 8.05 RVUs

(no change)

(whether single or dual)

. . . dual leads

+ 33208* 8.77 RVUs

(no change)

. . . multiple leads

+ 33208* + 33225* 17.10 RVUs

(no change)

33249* + 33225* 23.50 RVUs

(no change)

Note: Codes in blue* are modified existing codes; codes in red** are new codes

Pacemaker/ICD Procedure Table

Generator and leads

Transvenous Procedure (Upgrade includes removal of existing pulse generator for pacer) Pacemaker Defibrillator Upgrade single chamber system to dual chamber system 33214 33241* + 33249* 18.46 RVUs

(no change)

Note: Codes in blue* are modified existing codes; codes in red** are new codes

Pacemaker/ICD Procedure Table

Removal and replacement of both pulse generator and transvenous leads

Transvenous Procedure Removal of pulse generator Pacemaker 33233* 3.39 RVUs

(no change)

Defibrillator 33241* 3.29 RVUs

(no change)

Coded with multiple codes

Removal of lead(s)

33234 (single) or 33235 (dual)

33244

Pacemaker/ICD Procedure Table

Removal and replacement of both pulse generator and transvenous leads

Transvenous Procedure When coronary sinus lead is placed: Pacemaker 33225* 8.33 RVUs

(no change)

Defibrillator 33225* 8.33 RVUs

(no change)

Information

Cardiology Services Update

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