Cardiology Compliance Question of the Week
Archive
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September 29, 2008
Question:
Last week in your answer about the new NCD on artificial hearts you mentioned
the term "coverage with evidence development." What does this
mean?
Answer:
On July 12, 2006, the Centers for Medicare & Medicaid Services (CMS)
released a guidance document entitled National Coverage Determinations [NCD]
with Data Collection as a Condition of Coverage: Coverage with Evidence
Development (CED). This document concerns the circumstances under which
CMS would issue a NCD requiring, as a condition of coverage, collection
of additional patient data to supplement standard claims data.
At http://www.cms.hhs.gov/CoverageGenInfo/03_CED.asp,
you can see the NCDs that fit into this category.
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September 22, 2008
Question:
Can you bring me up to date on the CMS decision about coverage of artificial
hearts?
Answer:
Medicare issued a national coverage determination on May 1, 2008, to establish coverage for artificial hearts when implanted under "coverage with evidence development" (CED). The Centers for Medicare and Medicaid Services (CMS) will maintain a Web site that will list all studies that are approved to meet CED criteria. Coverage is only available when artificial hearts are implanted as part of one of the listed clinical studies. On December 1, 2008, CMS will implement this policy.
More information on this new NCD can be found in Transmittal 1592 (issued September 10) at http://www.cms.hhs.gov/transmittals/downloads/R1592CP.pdf.
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September 15, 2008
Question:
What codes should be assigned for removing an obstruction from a central
venous device?
Answer:
According to the 2008 CPT manual, you would assign one of the following
codes:
36595 Mechanical removal of pericathether obstructive material (e.g., fibrin
sheath) from central venous device via separate venous access
36596 Mechanical removal of intraluminal (intracathether) obstructive material
from central venous device through device lumen
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September 8, 2008
Question:
Can the disconnection and reconnection of leads be billed separately from
pacemaker devices?
Answer:
Disconnection of leads, reconnection of leads, reprogramming of parameters,
and testing of leads and pulse generator are included in the codes for pacemaker
devices.
For ICD or CRT-D devices, defibrillator threshold testing of lead(s) and/or pulse generator is separately billable by codes 93640-93642.
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September 1, 2008
Question:
When should code 93508 be used for catheter placement?
Answer:
As its CPT descriptor indicates, code 93508 is assigned for catheter placement
in coronary artery(s), arterial coronary conduit(s), and/or venous coronary
bypass graft(s) for coronary angiography without concomitant left heart
catheterization. It should be used when coronary artery, arterial coronary
conduit or venous bypass graft angiography is performed without the left
heart catheterization (i.e., when the physician does NOT cross over the
aortic valve into the left ventricle). He/she only "shoots" the
coronaries to get a clear look or second glance for diagnostic purposes.
As with other cardiac catheterization codes, the injection codes and the
IS&R codes are also appropriate to code in addition to the catheter
placement code (e.g., 93508-26, 93545 and 93556-26).
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August 25, 2008
Question:
For chest CAD, will physicians need to document "CAD done concurrently
with chest x-rays" vs. "CAD done at different time"? What
is the difference in documentation meaning concurrently vs. remote?
Answer:
Yes. I would recommend that if submitting either code 0174T or 0175T that the physician clearly define when the CAD service is provided. "Concurrently" means that the CAD would be done at the same patient encounter as the initial performance of the chest x-ray (albeit on different pieces of equipment). "Remote" means that the chest x-ray was performed at one location and then the data/information would be sent to another location for the additional post-processing and analysis.
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August 18, 2008
Question:
Where can I find information about coverage for PTA of renal arteries?
Answer:
Medicare covers percutaneous transluminal angioplasty (PTA) of renal arteries for patients with an inadequate response to a thorough medical management of symptoms and for whom surgery is the likely alternative. This national coverage determination (NCD) can be found in section 20.7 of the Medicare National Coverage Determinations Manual at http://www.cms.hhs.gov/manuals/downloads/ncd103c1_Part1.pdf.
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August 11, 2008
Question:
Does Medicare cover CTA when used to diagnose coronary artery disease?
Answer:
According to the Centers for Medicare & Medicaid Services (CMS), all claims for cardiac computed tomographic angiography (CTA) used to diagnose coronary artery disease (CAD) will continue to be determined by local Medicare contractor discretion. Section 220.1 of the National Coverage Determinations Manual includes coverage information for CTA. Also, the official instruction regarding the CTA for CAD policy may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R85NCD.pdf.
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August 4, 2008
Question:
I have a question about a recent compliance question regarding code 93650
(AV node ablation). It states you should also code for "mapping as
appropriate." Can we bill for intracardiac mapping 93609 with code
93650?
Answer:
The simple answer to this question is yes. Here's what the Heart Rhythm Society's (http://www.hrsonline.org/) 2008 publication, Coding Guide for Heart Rhythm Procedures and Services, examples 10A thru 10D, states: If mapping is performed, use 93613 or 93609 when medically necessary.
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July 28, 2008
Question:
Can you provide guidance on coding for arterial-venous grafts?
Answer:
To indicate arterial-venous grafts, select a code from the 33517-33523 range. Two codes must be used: one indicating the number of grafts and the appropriate arterial graft code from range 33533-33536. If billing for the professional component, do not use modifier 51 because the "list in addition" note instructs the coder to list this service without the multiple procedure designator.
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July 21, 2008
Question:
Can additional codes be assigned when tissue ablation and atrial reconstruction
are performed together?
Answer:
When operative tissue ablation and reconstruction of atria are performed
at the same time as other cardiac procedures, the following additional codes
can be assigned with the primary procedure.
- CPT code 33257 describes a limited (i.e., modified maze) procedure;
- An extensive (e.g., maze) procedure without cardiopulmonary bypass is
assigned to code 33258.
- An extensive (e.g., maze) procedure with cardiopulmonary bypass is assigned
to code 33259.
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July 14, 2008
Question:
Does the procedure described by CPT code 36593 include the guidance, or
does the guidance have to be coded separately?
Answer:
As you can see below, the description of the new (for 2008) code 36593 does not mention guidance:
36593 Declotting by thrombolytic agent of implanted vascular access device or cathether
If imaging guidance was truly used for this procedure and it was documented, code separately for it as well as 36593. However, imaging guidance is generally not used when performing this procedure.
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July 7, 2008
Question:
Our Medicare payer is denying our claims for PTA based on facility recertification
due dates. Does CMS authorize this practice, or is it unique to our payer?
Answer:
As you may know, certifying and recertifying facilities for Medicare payment for percutaneous transluminal angioplasty (PTA) of carotid arteries concurrent with stenting is solely under the jurisdiction of the Centers for Medicare & Medicaid Services (CMS). When CMS certifies a facility, the facility name and effective date appear on a list of approved facilities on the CMS website. If CMS disapproves a facility at any time, that facility is placed on a separate list of formerly approved facilities indicating the time period during which the facility was certified (also accessible on the CMS website). Therefore, as long as a facility appears on the approved list, it is considered certified by CMS whether or not recertification is in pending status. Your Medicare contractors are expected to consult the two facility lists in determining certification status, and they should not deny claims based on any other certification factors such as erroneously applied expiration date edits.
However, according to a CMS memo, some Medicare contractors are misapplying the initial certification and recertification requirements and inappropriately denying claims when a facility is not immediately recertified at the end of a two-year period.
For more details about the inappropriate denials, go to http://www.cms.hhs.gov/Transmittals/downloads/R349OTN.pdf.
For the PTA national coverage determination (NCD), go to http://www.cms.hhs.gov/manuals/downloads/ncd103c1_Part1.pdf.
Section 20.7 includes the recertification steps a facility must follow every
two years to maintain Medicare coverage of CAS procedures.
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June 30, 2008
Question:
Can you define ablation and discuss coding for it?
Answer:
Ablation is the isolation, removal and/or destruction of heart muscle cells. The physician directs a high-energy catheter to ablate tissue in a precise area of tissue. Electrophysiological (EP) testing is repeated after the ablation to verify that the arrhythmia cannot be induced at the site(s) thereby documenting the ablation's success.
Noninvasive and invasive diagnostic and therapeutic procedures provide
valuable assistance in treatment and management of specific types of cardiovascular
disease.
Code 93650 (intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement) is specific and describes ablation of AV node function for a complete heart block and includes temporary pacing.
Also, you should code for:
- A permanent pacemaker insertion as applicable
- Mapping as appropriate
- Comprehensive diagnostic EP procedure as appropriate
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June 23, 2008
Question:
What codes can be assigned for single-site electrophysiology (EP) studies?
Answer:
CPT codes 93600 through 93618 typically describe specific recording and/or pacing from one particular intracardiac site. Usually, there is only one catheter used (hence, single-site studies). It is important to note that most EP studies are comprehensive and involve the use of multiple catheters to record and pace from two, three or more sites (right and left atrial sites and/or right and left ventricular sites). However, there will be times when a single-site EP study is performed and, as such, the range of codes mentioned above are applicable.
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June 16, 2008
Question:
Can both the hospital and physician report HCPCS level II code G0275 and
G0278?
Answer:
Yes, when a cardiac catheterization has been performed, the hospital and
the physician may report the following codes.
G0275 Renal artery angiography (unilateral or bilateral) performed at the
time of cardiac catheterization, includes catheter placement, injection
of dye, flush aortogram and radiologic supervision and interpretation and
production of images (list separately in addition to primary procedure)
G0278 Iliac artery angiography performed at the time of cardiac catheterization, includes catheter placement, injection of dye, radiologic supervision and interpretation and production of images (list separately in addition to primary procedure)
These codes are used in conjunction with a cardiac catheterization only. The intent of code G0275 is for the evaluation of the renal arteries and ostia from a non-selective injection (e.g. catheter is in the aorta).
In addition to the information in the code descriptor above, code G0278 describes a procedure that includes catheter placement (e.g. in the distal aorta or in the ipsilateral extremity; access site). This code is a diagnostic and may not be used for merely evaluating the extremity vessel, access site, for the purpose of deploying a vascular closure device.
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June 9, 2008
Question:
Are the G codes for drug-eluting stents billable to regular insurance,
or are they only for Medicare patients?
Answer:
The G codes are for Medicare outpatient hospital services only, and you
should report the following HCPCS Level II code for drug-eluting stent(s)
procedures. (Note: These codes should not be used for physician billing
or reporting. See below for those codes.)
G0290 Transcatheter placement of an intracoronary drug-eluting stent(s),
percutaneous, with or without other therapeutic intervention, any method;
single vessel.
If an additional vessel is stented (per the American College of Cardiology
definition of an additional vessel) using a drug-eluting stent, assign the
following add-on code:
+G0291 Transcatheter placement of an intracoronary drug-eluting stent(s),
percutaneous, with or without other therapeutic intervention, any method;
each additional vessel (List separately in addition to the code for primary
procedure.)
Angioplasty or atherectomy performed in conjunction with stenting of the same vessel is not separately coded. Only the more complex procedure (i.e., stenting) is coded. These Level II HCPCS codes are specifically for outpatient Medicare hospital billing.
The physician will report the following codes based on the number of vessels
stented, regardless if the stent is drug-eluting or not.
92980 Transcatheter placement of an intracoronary stent(s), percutaneous,
with or without other therapetuic intervention, any method; single vessel
92981 each additional vessel (List separately in addition to code for primary
procedure.)
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June 2, 2008
Question:
When Holter monitors are used, how hospital and physician codes would be
assigned?
Answer:
Different codes are chosen based on the type of device used. CPT Codes 93224-93227 describe the use of various electrocardiographic monitoring devices by continuous original ECG waveform with superimposition scanning.
When the equipment is owned by the hospital, it should charge codes 93225
(24-hour EKG monitoring, includes hook-up, recording and disconnection)
and 93226 (scanning analysis with report).
The physician who reviews the Holter monitoring for the hospital will report
the CPT code 93227 (physician review and interpretation).
If the Holter monitoring is performed in a clinic setting and the equipment is owned by the physician, the following code is applicable:
93224 Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage, with visual superimposition scanning; includes recording, scanning analysis with report, physician review and interpretation.
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May 26, 2008
Question:
Can intracardiac echo be performed during interventional procedures? If
so, how would this be coded?
Answer:
Yes, intracardiac echocardiography can be performed during interventional or diagnostic procedures such as comprehensive electrophysiology procedures, ablations, or repair of septal defects. CPT code 93662 (intracardiac echocardiography during a diagnostic procedure or therapeutic intervention, including imaging supervision and interpretation) is an add-on CPT code as indicated by the "+" sign before the code in the CPT manual. It should be used in combination with a primary procedure code such as EP procedures or intracardiac catheter ablation procdures, for example: 93621, 96322, 93651, 93652, 93580, or 93851.
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May 19, 2008
Question:
Can you provide information about the event recording described by cardiography
codes 93268 through 93272? This would be for a hospital setting.
Answer:
These codes describe devices that record ECG waveforms when activated by the patient. Codes 93268-93272 are for the devices that have a continuous memory loop so that when symptomatic events occur, the patient can activate the device and the ECG activity can be stored by the device. It can be transmitted via telephone for analysis, review, measurement and interpretation. Usually, an event recorder is worn for a period of weeks. The physician prepares a report and forwards it to the patient's medical record.
Typically, when performed in a hospital setting the following codes are
reported:
93270 Patient demand single or multiple event recording with presymptom
memory loop, 24-hour attended monitoring, per 30 day period of time; recording
(includes hook-up, recording, and disconnection)
93271 monitoring, receipt of transmissions, and analysis
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May 12, 2008
Question:
How do you report more than one EKG performed in the same day?
Answer:
On its online frequently asked questions, CMS stated that providers may report the first EKG without a modifier. Any additional EKGs performed in the same day are reported with modifier -76 (repeat procedure or service by same physician) appended to the CPT code.
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May 5, 2008
Question:
Is it appropriate for a hospital to assign code 93555 when an injection
procedure has been performed during cardiac catheterization?
Answer:
Hospital staff billing for these procedures sometimes wonder whether they can or should report codes 93555 and 93556 because the definition of these codes state, "imaging supervision, interpretation and report." Often, they wrongly assume that they should not submit these codes because they are not providing a report, which the physician does. However, even though the cardiologist does supply the report, the hospital must assign either or both codes 93555 and 93556 depending on the procedure performed. Otherwise, they will encounter rejected claims.
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April 28, 2008
Question:
Can an angioplasty or atherectomy performed in conjunction with stenting
of the same vessel be coded separately?
Answer:
No, it may not be separately coded. Only the more complex procedure (i.e., stenting) is coded. Physicians should report codes 92980 and/or 92981 as they apply and based on the number of vessels stented, whether the stent is drug-eluting or not. For Medicare hospital outpatient billing, use codes G0290 and G0291.
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April 21, 2008
Question:
Are the G codes for drug-eluting stents billable to regular insurance,
or are they only for Medicare patients?
Answer:
G codes are used for Medicare outpatient hospital services only.
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April 14, 2008
Question:
Can CPT code 93571 be reported with a catheterization?
Answer:
Codes 93571 and 93572 are add-on codes and are commonly referred to as "flow wire" or FFR. The procedure can be performed during a cardiac catheterization, a coronary angiogram or other therapeutic intervention such as an angioplasty or coronary stent replacement. Code +93571 may be used once during a diagnostic procedure while code +93572 may be used for each additional vessel (list separately in addition to code for primary procedure). The key to remember here is that these must be used with a primary procedure code.
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April 7, 2008
Question:
Did CMS recently revise the national coverage for CCTA?
Answer:
The Centers for Medicare & Medicaid Services (CMS) decided not to revise
its national coverage determination (NCD) for cardiac computed tomography
angiography (CCTA) for coronary artery disease (CAS-00385N). In its announcement,
CMS stated that no change was "appropriate at this time and that coverage
should be determined by local contractors through the local coverage determination
process or case-by-case adjudication."
For details about this decision, go to https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp&id=206&
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March 31, 2008
Question:
Are category III codes 0178T, 0179T and 0180T for the 64-lead electrocardiograms
paid for by Medicare and other payers?
Answer:
Yes, CMS has established payment for these new Category III codes, but some other third party payers may consider this procedure investigational. Be sure to evaluate payment policies prior to performing this procedure to determine planned outcomes.
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March 24, 2008
Question:
If a physician owns the equipment that generates the 64-lead ECG, which
of the new category III codes provided in last week's answer should be reported?
Answer:
If the physician owns the equipment and employs the personnel who perform the graphics and analysis, report Category III code 0178T (electrocardiogram that uses 64 leads or greater, with graphic presentation and analysis; with interpretation and report). This code would be used when the physician then interprets the ECG using the graphics and analysis for interpretation and dictates a report. Report category III code 0180T if the physician is performing only the interpretation and report.
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March 17, 2008
Question:
I heard that the American Medical Association (AMA) created three new codes
for reporting an ECG that uses 64 leads, but I cannot locate these codes
in CPT. Can you help?
Answer:
For 2008, the AMA added the three Category III codes listed below for,
as the first part of the description says, an "electrocardiogram that
uses 64 leads or greater, with graphic presentation and analysis."
0178T …with interpretation and report
0179T … tracing and graphics only, without interpretation and report
0180T … interpretation and report only
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March 10, 2008
Question:
I've heard that Medicare will add several cardiology codes to the hospital
preadmission payment window. Can you provide details about this?
Answer:
In Transmittal 1429 (http://www.cms.hhs.gov/Transmittals/downloads/R1429CP.pdf),
the Centers for Medicare & Medicaid Services (CMS) announced that it
has revised certain aspects of its preadmission services policy effective
July 1. Before July 1, Medicare fiscal intermediaries (FIs) and/or Part
A/B Medicare administrative contractors (MACs) will remove 048X from the
list of diagnostic payment window edits and replace it with the following:
0481 Cardiology, cardiac catheter lab/other cardiology with CPT codes listed
below
0482 Cardiology, stress test
0483 Cardiology, echocardiology
0489 Cardiology, cardiac catheter lab/other cardiology with CPT codes listed
below
Medicare contractors will include the following CPT codes for revenue codes 0481 and 0489 in the diagnostic payment window edits: 93501, 93503, 93505, 93508, 93510, 93526, 93541, 93542, 93543, 93544, 93556, 93561, or 93562.
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March 3, 2008
Question:
What codes should be assigned for cardiac catheterizations?
Answer:
The codes for diagnostic cardiac catheterization procedures can be found, for the most part, in the medicine section of the CPT manual (93501- 93572). To correctly bill for these services and ensure claims payment, it's important to be aware of Medicare edits, and look for correct code combinations. For example, if an injection procedure has been performed (codes in the 93539 to 93545 series), the Medicare payer checks to see that either or both of the appropriate imaging supervision, interpretation and report codes (93555 and 93556) also have been submitted.
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February 25, 2008
Question:
I need some help with the code assignments for the following report for a carotid arteriogram. Which of the following codes would you use: 36216RT, 36215LT, 75671 or 75680?
History: Stenosis, carotid
Contrast: 40 ml of visipaque
Indication: Carotid stenosis
Findings: Informed consent was obtained, and the patient was prepped in the usual sterile manner. From a right femoral approach, injection of the right and left common carotid arteries was performed. There is no evidence of carotid artery stenosis. VasoSeal was used at the groin. The patient tolerated the procedure well, and there was no evidence of complication.
Impression: No evidence of carotid artery stenosis.
Answer:
The physician never clearly states that the catheter/device was placed
into either the right or left common carotids. However, that is, more than
likely, what happened. (Note that the also physician can get this same info
from multiple injections from the arch.) We recommend that you assign the
following codes:
36200 Introduction of catheter, aorta
75680 Angiography, carotid, cervical bilateral, radiological supervision
and interpretation
However, we also recommend that you check with the physician to clarify
that he or she really performed a selective study before assigning 36215-59
and 36216 for the placements and injections.
Also, for the placement of the closure device, you may want to consider
submitting G0269 (placement of occlusive device into either a venous or
arterial access site, post surgical or interventional procedure). We are
hearing more and more that non-Medicare payers are reimbursing clients for
this as well.
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February 18, 2008
Question:
What codes can a physician use when a stress test is performed in the doctor's office or clinic?
Answer:
Code 93015 is considered the global code, which can be used when the physicians own the equipment and employ personnel in their own offices. Codes 93016 and 93018 are component codes of 93015 and should be used separately to identify the individual parts of the procedure that the physician performs if they do not own the equipment or employ the personnel in a hospital setting.
What takes place is that a recording of the activity of the heart (ECG) and blood pressure readings are taken while the patient's heart is evaluated under stress. This may be accomplished while the patient is walking on a treadmill, pedaling a stationary bicycle or stress can be induced by a pharmacological means (i.e., drugs injected). The ECG is considered part of the code for the stress test and should not be coded separately.
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February 11, 2008
Question:
I'm finding more and more PET/CTs are being done for cardiac reasons. Should just the cardiac PET code 78492 be assigned-or would it be 78814 or 78492 with a cardiac CTA code?
Answer:
The cases we have seen are best defined as the anatomic site-specific codes for myocardial studies--that is, those in the 784xx codes. Remember: Do not use the WM or EF codes for PET procedures, even if done, calculated and reported.
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February 4, 2008
Question:
Can you provide some background information on the new ECG that uses 64-plus leads?
Answer:
Current information available regarding this new ECG test is that it can detect some heart attacks (ST elevation myocardial infarction) that might be missed by the traditional 12-lead electrocardiogram, which only views the anterior portion of the heart. It shows information in waveforms and includes 3-D color images to identify possible ischemia and/or infarction. Its use in the emergency room and/or cardiology can assist in diagnosing and managing patients with chest pain symptoms.
Electrodes (64 or more) are attached to the chest area (front and back) in the form or shape of a vest covering the entire chest area. For example, the PRIME ECG® uses an 80-lead vest. The result is an analysis of the heart in a 360-degree view.
There are new Category III codes that should be reported when this technology
is used:
- 0178T Electrocardiogram, 64 leads or greater, with graphic presentation
and analysis; with interpretation and report
- 0179T tracing and graphics only, without interpretation and report
- 0180T interpretation and report only
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January 28, 2008
Question:
Does Medicare cover pacemaker evaluations?
Answer:
There is a national coverage determination (NCD) for cardiac pacemaker evaluation services (post-implant). (See Section 20.8.1 at http://www.cms.hhs.gov/manuals/downloads/ncd103c1_Part1.pdf.) However, there is no NCD for an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy (CRT) evaluation services (post-implant). In the absence of national coverage guidelines, providers should consult their local Medicare contractor's guidance.
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January 21, 2008
Question:
Can you provide some background on the development of the QR modifier, and when it should be used?
Answer:
In Transmittal 1418 (change request 5805) issued on Friday, January 18, 2008, the Centers for Medicare & Medicaid Services (CMS) announced that modifier QR (as well as QA and QV) are discontinued effective January 1, 2008. According to that transmittal, Medicare payers are to implement this change no later than April 7, 2008.
Instead, CMS has created modifiers Q0 and Q1 to identify investigational and routine clinical services provided in a clinical research study approved by Medicare. For more information on this, go to http://www.cms.hhs.gov/transmittals/downloads/R1418CP.pdf.
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January 14, 2008
Question:
What are the Medicare requirements for reporting receipt of a partial credit for a device?
Answer:
Effective for dates of service on or after January 1, 2008, CMS's partial
credit policy requires hospitals to report HCPCS modifier FC on the same
line with the procedure code for all cases meeting the following criteria.
- The implanted device is on the list of devices subject to warranty or
recall adjustment.
- The procedure code in which the device is used is on the list of creditable
APCs.
- The hospital receives a credit of 50 percent or more of the cost of the
new replacement device.
Medicare will reduce its payment by 50 percent of the estimated cost of
the device included in the APC payment when hospitals report the FC modifier.
More on this policy can be found in Transmittal 1377 at www.cms.hhs.gov/transmittals/downloads/R1377CP.pdf.
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January 7, 2008
Question:
What code should be assigned for transcatheter placement of a wireless physiologic sensor?
Answer:
Use new code 34806 -- transcatheter placement of a wireless physiologic sensor in aneurysmal sac during endovascular repair, including radiological supervision and interpretation, instrument calibration, and pressure data collection. For analysis, interpretation and report of the sensor, use new code 93982-noninvasive study of implanted wireless pressure sensor in aneurysmal sac following endovascular repair, complete study including recording, analysis of pressure and waveform tracings, interpretation and report.
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December 31, 2007
Question:
In a previous answer you said that most of the revisions made to code descriptions in the cardio section of the 2008 CPT were made to codes for coronary artery bypass. What exactly was revised?
Answer:
The phrase "list separately in addition to code for arterial graft(s)" was deleted. In its place, the AMA inserted the phrase "list separately in addition to code for primary procedure." This new phrasing applies to codes 33517-33523.
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December 24, 2007
Question:
Can a code for another service accompany the new code 36591-blood specimen collection from a completely implantable venous access device?
Answer:
According to the 2008 CPT manual, the answer is no. Specifically, "Do not report 36591 in conjunction with any other service."
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December 17, 2007
Question:
How many code additions, deletions and revisions does the cardiology section of the 2008 CPT manual contain? Are the majority in one section over another?
Answer:
The cardiovascular system subsection of surgery (code range 33010-37799) includes nine new codes and eight revised codes. Six of the eight revisions were made to the codes assigned for coronary artery bypass (33517-33523). In addition, the American Medical Association deleted codes 36540 and 36550 from the CV section.
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December 10, 2007
Question:
Would the new 2008 code 36591 be assigned for blood collection from a PICC?
Answer:
No, it would not. The American Medical Association created a new code for that. Assign code 36592 for a blood specimen collection using established central or peripheral catheter, venous, not otherwise specified. For an arterial catheter, use 37799 (unlisted procedure, vascular surgery).
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December 3, 2007
Question:
When a blood specimen has been collected from a central venous catheter, what code should be assigned?
Answer:
Beginning January 1, 2008, you should assign code 36591-collection of blood specimen from a completely implantable venous access device. This includes a central venous catheter or a catheter with a port.
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November 26, 2007
Question:
What procedure is a physician referring to when he includes the phrase "flow wire" in documentation?
Answer:
The following CPT codes 93571 and 93572, which are add-on codes, are commonly referred to as "flow wire" or "FFR."
93571+ Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; initial vessel
+93572 each additional vessel
This procedure can be performed during a cardiac catheterization, a coronary angiogram or other therapeutic interventions such as an angioplasty or coronary stent replacement. The key to remember here is that it must be assigned with a primary procedure code.
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November 19, 2007
Question:
What code is reported for the insertion of an additional lead into the cardiac venous system for left ventricular pacing?
Answer:
In addition to one of the codes from the series 33206-33208, report code 33225 (insertion of pacing electrode, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator (including upgrade to dual chamber system). This add-on code describes insertion of the cardiac venous lead at the time the pacemaker is implanted.
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November 12, 2007
Question:
In regard to physician payment under Medicare, what is the global period for pacemaker procedures? Are there any special billing guidelines connected with this?
Answer:
Most pacemaker procedures (e.g., 33200-33208) have a 90-day global period. When a patient receives services related to an existing pacemaker (e.g., repositioning of electrodes), billing records should be checked to determine whether the service falls within the global period of the pacemaker insertion. Depending upon the circumstances, it may be appropriate to apply modifier 58 (staged or related procedure), 59 (distinct procedure), 76-77 (repeat procedure), 78 (return trip to OR for a related procedure), or 79 (unrelated service during postoperative period).
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November 5, 2007
Question:
Last week you provided information on the new MS-DRG system and its effect on cardiac rhythm management procedures. Can you provide an example to better clarify?
Answer:
For example, if a patient has diabetes mellitus, the only diagnosis codes
that will be classified as an MCC are diabetic ketoacidosis and hyperosmolarity.
Hyperglycemic coma is a CC, and insulin-dependent diabetes is assigned as
a non-CC. Additionally, common secondary diagnoses that previously affected
DRG assignment that will no longer affect the new MS-DRGs include the following:
- Fluid overload (276.6)
- Dehydration (276.51)
- Hypovolemia (276.52)
- Atrial fibrillation (427.31)
However, atrial flutter (427.32) is designated as a CC. Acute myocardial
infarction, initial episode (410.01-410.91) is classified as an MCC.
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October 29, 2007
Question:
How does the new MS-DRG system that CMS implemented on October 1 affect cardiology rhythm management (CRM) procedures?
Answer:
The biggest impact is the following three different levels of severity
established by CMS.
- The highest-weighted level in the hierarchy is major complication or comorbidity
(MCC)
- The middle-level is complication or comorbidity (CC)
- The lowest is no complication or comorbidity (non-CC)
Unlike the MS-DRG system, the DRG system contained a list of 108 major cardiovascular diagnoses (MCVs), which drove most cardiac procedure DRGs. In the MS-DRG system, 60 MCVs crosswalk to the new MCC list, 40 crosswalk to the new CC list and eight are considered non-CCs.
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October 22, 2007
Question:
In regard to the October 8 question regarding whether hospitals may get paid for code G0269: You stated that they would not get paid by Medicare. Even though they won't receive payment, shouldn't they still report it?
Answer:
Yes, you are correct. Code G0269-- placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g. Angio-Seal, Perclose, vascular plug)--should be reported even though it won't get paid by Medicare.
Here's another tip not mentioned in the previous answer. Remember to bill all payers identically, whether or not there is payment assigned to a CPT or HCPCS code. Appropriate coding reflects a level of care and also demonstrates a correlation between procedures and devices.
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October 15, 2007
Question:
Can code 93227 be billed separately?
Answer:
This code is considered a component of code 93224. Codes 93224-93227 describe
the use of various electrocardiographic (ECG) monitoring devices by continuous
original ECG waveform with superimposition scanning. Code 93224 includes
the component codes 93225, 93226, and 93227.
- 93224 Electrocardiographic monitoring for 24 hours by continuous original
ECG
waveform recording and storage, with visual superimposition scanning; includes
recording, scanning analysis with report, physician review and interpretation
- 93225 recording (includes hook-up, recording and disconnection)
- 93226 scanning analysis with report
- 93227 physician review and interpretation
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October 8, 2007
Question:
Can hospitals get reimbursed for code G0269 -- placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g. Angio-Seal, Perclose, vascular plug)?
Answer:
There is no separate Medicare reimbursement for G0269 when billed by the hospital. It is an incidental, and therefore packaged, service. However, non-Medicare payers may pay for it. Check with all of your payers before submitting a charge for these services. As always, request that this clarification be in a written format, as opposed to verbal and file accordingly.
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October 1, 2007
Question:
I have another question related to esophageal Doppler monitoring of cardiac output for ventilated patients in the ICU and operative patients with a need for intra-operative fluid optimization. Will Medicare pay for these if the procedure is performed in an ASC?
Answer:
When performed in an ambulatory surgical center (ASC) for operative patients with a need for intra-operative fluid optimization, ultrasound diagnostic procedures are covered when performed by an entity other than the ASC and may be globally billed using code 76999. Technical and professional components may be separately billed using code 76999-TC and code 76999-26, respectively. This information can be found in Transmittal 73 at http://www.cms.hhs.gov/transmittals/downloads/R73NCD.pdf.
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September 24, 2007
Question:
Last week's question and answer related to new coverage indications for ultrasound diagnostic procedures. Can you provide any billing information about this new coverage?
Answer:
The Centers for Medicare & Medicaid Services (CMS) provided the following
guidelines in Transmittal 73, September 6, 2007, at http://www.cms.hhs.gov/transmittals/downloads/R73NCD.pdf.
These relate to the new coverage for esophageal Doppler monitoring of cardiac
output for ventilated patients in the ICU and operative patients with a
need for intra-operative fluid optimization.
- Professional services only are separately payable using code 76999--unlisted
ultrasound procedure (e.g., diagnostic, interventional)--and shall be billed
with modifier 26 (professional component).
- Medicare contractors shall return as unprocessable procedures globally
billed using code 76999.
- Medicare contractors shall deny technical services billed with code 76999-TC
when performed in hospitals.
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September 17, 2007
Question:
What is Medicare's policy on esophageal Doppler monitoring of cardiac output for ventilated patients in the ICU?
Answer:
Effective for claims with dates of service on and after May 17, 2007, esophageal
Doppler monitoring of cardiac output for the following are considered reasonable
and necessary by Medicare:
- Ventilated patients in the ICU; and
- Operative patients with a need for intra-operative fluid optimization.
The Centers for Medicare & Medicaid Services recently amended the NCD for ultrasound diagnostic procedures and included the above as covered. For other covered indications, see Transmittal 73 at http://www.cms.hhs.gov/transmittals/downloads/R73NCD.pdf.
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September 10, 2007
Question:
What code would I assign if two or more blockages in the same major coronary artery are treated with balloon angioplasty?
Answer:
These procedures are collectively coded as one service with the single vessel code 92982. If blockages are treated in two or more separate coronary arteries (at the same session), the service is coded using the single-vessel code to identify the first vessel, and the "add-on" code or 92984 to identify each additional vessel. (Be sure to code by vessel NOT intervention. Many physicians want to code each intervention, and CPT guidelines say that is incorrect.)
Note: More information on this topic and others can be found in MedLearn's 2007 edition of Peripheral and Cardiology Coder
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September 3, 2007
Question:
Does code 92982 for PTCA include catheter placement?
Answer:
Yes, code 92982 (percutaneous transluminal coronary balloon angioplasty; single vessel) as well as add-on code 92984 (each additional vessel) include the placement of catheters for the purpose of coronary angioplasty and the injection of dye to determine catheter/balloon placement and the effectiveness of the therapy.
Note: More information on this topic and others can be found in MedLearn's 2007 edition of Peripheral and Cardiology Coder
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August 27, 2007
Question:
If CMS finalizes its proposal to enlarge the APC bundles, will cardiology be affected?
Answer:
Yes, other diagnostics including cardiac services in addition to medical imaging services and radiation oncology will be affected if this provision of the 2008 proposed rule for the outpatient prospective payment system is finalized. For those unaware of the proposal, it goes like this.
The Centers for Medicare & Medicaid Services (CMS) has identified seven categories of what it calls "supportive ancillary services." It proposes to package payment for specific codes in these categories into the primary diagnostic or therapeutic modality that they typically support. Codes in the following categories are affected: guidance services, image-processing services, intraoperative services, imaging supervision and interpretation services, diagnostic radiopharmaceuticals, contrast agents, and observation services.
The proposed rule for the 2008 OPPS can be found at http://www.cms.hhs.gov/HospitalOutpatientPPS/HORD/list.asp#TopOfPage. Scroll down to CMS-1392-P.
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August 20, 2007
Question:
In regard to cardiovascular screening, has Medicare set frequency limits on performing the tests mentioned in the answer to last week's question?
Answer:
The Centers for Medicare & Medicaid Services decided, against expert
advice to the contrary, to limit the frequency of performance to one of
each individual test or one panel every five years. Although it stated that
it would consider future changes if necessary, it gave the following as
reasons for deciding upon the every-five-years' frequency.
- Each test in the lipid panel can predict the risk for CV disease independently.
- Clinical findings indicate that cholesterol values of elderly persons,
who make up most of the Medicare population, change slowly as they age.
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August 13, 2007
Question:
Can an endarterectomy be coded separately?
Answer:
The 2007 CPT code manual index lists two types of endarterectomies: coronary
artery and pulmonary. The codes for these procedures are listed below.
- 33572 Coronary endarterectomy, open, any method, of left anterior descending,
circumflex, or right coronary artery performed in conjunction with coronary
artery bypass graft procedure, each vessel (List separately in addition
to primary procedure)
- 33916 Pulmonary endarterectomy, with or without embolectomy, with cardiopulmonary
bypass
If you are asking about a coronary endarterectomy, you can see by the descriptor
for code 33572 that it is only an add-on code. The parenthetical note following
the code indicates that it may be used in conjunction with 33510-33516,
and 33533-33536.
Review the physician documentation to see if a pulmonary stenosis was repaired
by a patch or graft. If documentation indicates this was done, assign code
33917 (repair of pulmonary artery stenosis by reconstruction with a patch
or graft). If only the pulmonary endarterectomy was performed, assign code
33999 (unlisted procedure cardiac surgery).
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August 6, 2007
Question:
What CPT codes and ICD-9-CM codes may be reported for cardiovascular screening?
Answer:
The Medicare Modernization Act (MMA) of 2003 mandated that screening blood tests may be ordered for the early detection of cardiovascular (CV) disease or abnormalities associated with an elevated risk. The following codes are covered under this benefit (effective January 1, 2005).
Codes - Descriptions
80061- Lipid panel
82465 - Total cholesterol, serum or whole blood, total
83718 - Lipoprotein, direct measurement; high-density cholesterol (HDL cholesterol)
84478 - Triglycerides
Claims must include the above CPT codes plus one of the following V codes.
V81.0 Special screening for ischemic heart disease
V81.1 Special screening for hypertension
V81.2 Special screening for other and unspecified cardiovascular conditions
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July 30, 2007
Question:
Can you provide any fiscal intermediary (FI) billing requirements for cardiovascular disease screening?
Answer:
Since January 1, 2005, FIs have recognized codes 80061, 82465, 83718 and 84478 for this screening and pay for it once every 60 months. A claim should be submitted as follows, according to Chapter 18 of the Medicare Claims Processing Manual, Section 100.3: The line item shall contain 80061, 82465, 83718 or 84478 with a diagnosis code of V81.0 (special screening for ischemic heart disease), V81.1 (special screening for hypertension), or V81.2 (special screening for other and unspecified cardiovascular conditions reported in the header and pointed to the line item).
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July 23, 2007
Question:
What codes should be billed for cardiovascular disease screening?
Answer:
For cardiovascular disease screening, use the following CPT codes:
- 80061 Lipid panel
- 82465 Cholesterol, serum or whole blood, total
- 83718 Lipoprotein, direct measurement, high density cholesterol
- 84478 Triglycerides
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July 16, 2007
Question:
I need help coding for the following scenario: The patient undergoes stenting of the LAD, and angioplasty of the RCA (right coronary artery).
Answer:
The single-vessel code for stenting is used (92980), because it has the highest level of complexity. The "each additional vessel" code is used for the angioplasty, as per CPT coding guidelines, which state "… to report additional vessels treated by angioplasty or atherectomy only during the same session as the stent, see 92984 or 92996 respectively…"
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July 9, 2007
Question:
I am looking for guidelines on how to code interventions performed in the left main coronary artery (LMCA). Can you help with this?
Answer:
Medicare policy does not define how to code interventions performed in the LMCA or in the ramus branch, which arises from the left main artery apart from the left anterior descending (LAD) or left circumflex (LCX). Some local carriers have added a modifier LM to describe interventions performed in the LMCA. The American Medical Association's publication CPT Assistant (August 1996) defined four coronary vessels: the LMCA, RCA (right coronary), LAD, and LCX, but most Medicare carriers typically recognize three: the RCA, the LAD, and LCX.
Only one intervention can be coded for each major artery per session, no matter how many blockages are treated on that artery or its branches during that session. The modifiers that should be used to denote the location of the intervention are -LD, -RC, and -LC respectively.
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July 2, 2007
Question:
Can you tell me whether Medicare pays separately for code 93640 (electrophysiological evaluation of single- or dual-chamber pacing cardioverter defibrillator leads)?
Answer:
No, neither code 93640 nor 93641 is paid separately. The Centers for Medicare & Medicaid Services considers these procedures packaged services because they are always performed during an operative procedure for ICD initial implantation or replacement or with implantation, revision or replacement of leads. Therefore, they are packaged into the surgical procedure with which they are performed.
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June 25, 2007
Question:
Is there a national coverage determination (NCD) for cardiac pacemaker evaluation services?
Answer:
Yes, there is an NCD for these post-implant services. It can be found in Chapter 1, Part 1, Section 20.8.1, of the Medicare NCD Manual at http://www.cms.hhs.gov/manuals/downloads/ncd103c1_Part1.pdf.
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June 18, 2007
Question:
When submitting Medicare claims, where are we supposed to put the referring physician's name?
Answer:
The referring or ordering physician's name and UPIN must be present on item 17 and 17a of the claim for all diagnostic services, including consultations. Also be aware of the new requirements for use of national provider identifiers (NPIs). To learn more about NPIs and how to obtain your own, see the MLN Matters article SE0679 at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0679.pdf.
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June 11, 2007
Question:
Is it appropriate to report code 93724 for electronic analysis of an antitachycardia pacemaker system?
Answer:
No, you should not report this code for electronic analysis of the pacemaker system. Codes 93731 and 93734 describe electronic analysis of dual- and single-chamber pacemakers, respectively, without reprogramming. Codes 93732 and 93735 describe electronic analysis of dual- and single-chamber pacemakers, respectively, with reprogramming.
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June 4, 2007
Question:
Is it appropriate to report code 33724 with 32020?
Answer:
According to the CPT manual, code 33724-repair of isolated anomalous pulmonary venous return-may not be reported in conjunction with the following. Do not report with the following codes, which can be found in the heart and pericardium subsection of the cardiovascular system codes: 32020, 33210, and 33211.
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May 28, 2007
Question:
Please provide details bout the procedure described by CPT code 33222 - revision or relocation of skin pocket for pacemaker.
Answer:
In the case of 33222, complications, although infrequent, may arise from the initial placement of a pacemaker generator, such as infection, bleeding, or erosion. The physician opens the existing pocket and removes the pacemaker generator. The pocket may be revised if the intent is to reuse it. A separate pocket may be prepared, and the existing leads are extended by a connector through a subcutaneous tunnel and connected to the existing or new pacemaker generator. The pacemaker generator is placed back in the pocket, and the incision is closed. The intent of 33222 is separate and distinct from replacements, removals or upgrades to the insertion of a new left ventricular lead. CCI edits prohibit the use of 33222 with the codes 33212, 33213, 33233 or 33224.
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May 21, 2007
Question:
Last week you mentioned new facility criteria for those seeking coverage of ventricular assist devices (VADs). Can you provide more details about the criteria?
Answer:
Briefly, the new criteria are as follows:
- At least one surgeon on the hospital's VAD team must have experience implanting
at least 10 VADs (as a bridge to transplantation or as destination therapy)
or artificial hearts during the recent 36 months;
- Hospitals must participate in the Interagency Registry for Mechanical
Assisted Circulatory Support (INTERMACS), a registry funded by the National
Heart Lung and Blood Institute of the National Institutes of Health;
- Hospitals must obtain Joint Commission certification under the Disease
Specific Certification Program for VADs by March 27, 2009; and
- Hospitals listed on the existing approved facilities list must meet the
updated criteria.
For more on VADs, go to http://www.cms.hhs.gov/MedicareApprovedFacilitie/05_VADrecert.asp#TopOfPage.
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May 14, 2007
Question:
Does Medicare cover ventricular assist devices?
Answer:
On March 27, 2007, the Centers for Medicare & Medicaid Services (CMS)
updated the national coverage determination (NCD) for artificial hearts
and related devices (NCD Manual 100-3 §20.9), specifically the section
related to ventricular assist devices (VADs). The updated policy only impacts
the facility criteria for hospitals seeking coverage of VADs when implanted
under the destination therapy clinical criteria. All currently approved
facilities must demonstrate to CMS that they meet the updated criteria.
For details on this revised NCD, go to http://www.cms.hhs.gov/MedicareApprovedFacilitie/05_VADrecert.asp#TopOfPage
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May 7, 2007
Question:
The president of our group asked me the following question about an arrangement for over-reading of CTA. In the hospital setting, the cardiologists are reading CTAs. The hospital is speaking with the radiologists about over-reads of these exams. Has anyone else had this experience? Also, how is the hospital reimbursing the radiologists?
Answer:
From your question, it sounds as if cardiologists are already credentialed
providers and that the hospital is now (after the cardiologists have begun
providing such interpretations), querying about over-reads. This would suggest
that the hospital has some questions about either the adequacy or quality
of interpretations (or both). If so, this should be addressed as a quality
issue on those merits, before conceding your radiologists to the subservient
role of doing quality assurance clean-up for other providers.
This also sounds like an opportunity for your radiologists (if interested
and appropriately trained) to position themselves to provide single-provider
complete cardiac CT interpretations. Some practices have, for a variety
of reasons, worked out co-read or over-read arrangements, and each practice
must proceed within its own comfort zone and with the advice of counsel
to ensure that such arrangements are compliant. Recognize, however, that
published credentialing criteria and the CPT codes for these services were
all designed with a single, fully-trained provider (whether radiologist
or cardiologist) in mind.
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April 30, 2007
Question:
I am looking for guidelines for billing the new 2007 code 35306-thromboendarterectomy, including patch graft, if performed; each additional tibial or peroneal artery. Can you provide any?
Answer:
According to the 2007 CPT manual, this code should be listed in addition to the primary procedure code. It should be used in conjunction with 35305-tibial or peroneal artery, initial vessel. The CPT manual also states that 35306 should not be reported in conjunction with 35485 and 35500.
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April 23, 2007
Question:
Would you tell me whether code 36569 is the correct code for the following procedure?
A patient was seen in our facility for a peripherally inserted central catheter (PICC) and no subcutaneous port was inserted. A hospital-employed registered nurse performed the procedure.
Answer:
According to AHA Coding Clinic® for HCPCS (third quarter, 2006), the answer is "it depends" on who you are billing, your state's guidelines, and your hospital's bylaws. If appropriate in these areas, then, yes, code 36569 is appropriate if the PICC insertion is incident to a physician's service, says AHA. Be sure to check with your payer for reporting guidelines.
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April 16, 2007
Question:
Can you provide me with the CPT code for magnetic resonance angiography (MRA) of the heart?
Answer:
As you probably know, five codes exist for cardiac magnetic resonance imaging (MRI); 75552, 75553, 75554, 75555 and 75556. Unfortunately, none states MRA, so an unlisted procedure code will have to be used.
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April 9, 2007
Question:
Is it appropriate for physicians to bill separately for echocardiography contrast agents?
Answer:
Effective October 1, 2000, physicians may separately bill for contrast agents used in echocardiography. Physicians should use HCPCS Code A9700 (supply of injectable contrast material for use in echocardiography, per study). The type of service code is 9. This code will be carrier-priced. This answer can be found in Chapter 12, Section 30.4 of the Medicare Claims Processing Manual.
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April 2, 2007
Question:
The cardiology Q&A for February 26 raises questions about remote monitoring. On June 9, 2006, CMS issued Transmittal 979 that identified the CPT codes that must be used when billing remote monitoring services for pacemakers and ICDs. It appears this question only relates to TTM services but the word 'remote' caught my eye. Do you think you could clarify this?
Answer:
TTM is transtelephonic monitoring services. There are separate codes for pacemaker transtelephonic monitoring. Transmittal 979 describes internet, web or radiofrequency transmission of data, which is not TTM. Remote includes the internet or server type transfer of information hence CMS only refers to the regular pacemaker and ICD interrogation codes. It has not established a separate code as it did for transtelephonic. Rather it is including in the interrogation codes remote and in-office with the same code and payment rate. Remote does not include TTM services according to the CMS transmittal definition and code inclusion.
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March 26, 2007
Question:
Does Medicare cover EC-IC arterial bypass surgery?
Answer:
Extracranial-intracranial (EC-IC) arterial bypass surgery is not a covered
procedure when it is performed as a treatment for ischemic cerebrovascular
disease of the carotid or middle cerebral arteries, which includes the treatment
or prevention of strokes. In Section 20.2 of the National Coverage Determinations
Manual, CMS states the following.
"The premise that this procedure which bypasses narrowed arterial segments,
improves the blood supply to the brain and reduces the risk of having a
stroke has not been demonstrated to be any more effective than no surgical
intervention. Accordingly, EC-IC arterial bypass surgery is not considered
reasonable and necessary … when it is performed as a treatment for
ischemic cerebrovascular disease of the carotid or middle cerebral arteries."
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March 19, 2007
Question:
What codes would be assigned for the replacement of a dual-chamber pacemaker generator?
Answer:
The following codes would be appropriate: 33233--removal of permanent pacemaker pulse generator and 33213--insertion or replacement of pacemaker pulse generator only; dual chamber.
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March 12, 2007
Question:
What code is assigned to report the donor pneumonectomy portion of the heart-lung transplantation?
Answer:
The heart/lung allotransplantation procedure has three distinct components that the physician performs. The first component is the donor pneumonectomy. In this component, the physician harvests the allograft from the cadaver, performs cold preservation of the organ and maintains a cold environment until transplantation. To describe the donor cardiectomy pneumonectomy procedure, you would report 33930-donor cardiectomy-pneumonectomy (including cold preservation).
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March 5, 2007
Question:
What can you tell me about event monitors, including what codes are assigned for them?
Answer:
Event monitors are devices that record electrocardiographic (ECG) waveforms when activated by the patient. Codes 93268-93272 may be assigned for devices that have a continuous memory loop. When symptomatic events occur, the patient can activate the device, which stores the ECG activity. It can be transmitted via telephone for analysis, review, measurement and interpretation. Usually, an event recorder is worn for a period of weeks. The physician prepares a report and forwards it to the patient's medical record.
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February 26, 2007
Question:
Does Medicare cover remote monitoring of cardiac rhythm monitors?
Answer:
Currently, Medicare does not have a national coverage determination (NCD)
for remote monitoring of CRM technology other than transtelephonic pacemaker
analysis.
Most of these procedures and devices are covered at the local Medicare contractor
level. Some contractors cover a CPT follow-up device code, and others cover
an unlisted CPT code. Check with your local payer for current guidelines.
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February 19, 2007
Question:
Can you provide guidelines for billing electrocardiograms?
Answer:
There are several scenarios for billing, including the following:
- Report 93000-routine ECG with at least 12 leads; with interpretation
and report-when the following are true: the physician owns the equipment,
employs the personnel who perform the tracing, interprets the EKG, and dictates
a report.
- Report 93005 when a tracing only is performed (i.e., no interpretation
and report).
- Report 93010 if the physician is only performing the interpretation and
report.
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February 12, 2007
Question:
When ambulatory blood pressure monitoring is performed in the hospital, do we assign a code from the 93784-93790 range?
Answer:
For hospital billing, assign one of the following codes 93786 and 93788 are used. The revenue code that would appear in Form Locator (FL) 42 of the UB-92/UB-04 is 920, which describes "other diagnostic service."
- 93786 Ambulatory blood pressure monitoring, utilizing a system such as
magnetic tape and/or computer disk, for 24 hours or longer; recording only
- 93788 Ambulatory blood pressure monitoring, utilizing a system such as
magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis
with report
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February 5, 2007
Question:
What codes can be used to bill for echocardiography contrast?
Answer:
The following Level II Q codes are available for use for hospital outpatient
billing. Separate payment is based on the HCPCS code assigned to a dose-specific
description per 1 milliliter (ml).
Q9955 Injection, perflexane lipid microspheres, per ml (Imagent)
Q9956 Injection, octafluoropropane microspheres, per ml (Optison)
Q9957 Injection, perflutren lipid microspheres, per ml (Definite)
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January 29 , 2007
Question:
What is the global period for pacemaker procedures? Are there any related
billing guidelines?
Answer:
For physician reimbursement under Medicare, most pacemaker procedures (e.g.,
CPT codes 33200-33208) have a 90-day global period.
When a patient receives services related to an existing pacemaker (e.g., repositioning of electrodes), billing records should be checked to determine whether the service falls within the global period of the pacemaker insertion. Depending upon the circumstances, it may be appropriate to apply modifier 58 (staged or related procedure), 59 (distinct procedure), 76-77 (repeat procedure), 78 (return trip to the operating room for a related procedure), or 79 (unrelated service during postoperative period).
When an additional lead is inserted into the cardiac venous system for
left ventricular pacing, code 33225 is reported in addition to one of the
codes from the series 33206-33208. Code 33225 is an add-on code that describes
insertion of the cardiac venous lead at the time the pacemaker is implanted.
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January 22, 2007
Question:
Can you provide any general guidelines regarding use of codes 93600-93662?
Answer:
CPT codes 93600 through 93612 typically describe specific recording and/or
pacing from one particular intracardiac site and usually only one catheter
is used. It is important to note that most electrophysiological (EP) studies
are comprehensive and involve the use of multiple catheters to record and
pace from two, three or more sites (right and left atrial sites and/or right
and left ventricular sites).
CPT code 93619 through 93622 describe specific recording and/or pacing
from more than one particular intracardiac site and usually involve the
use of two to four or more catheters to record and pace from two or more
sites within the heart.
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January 15, 2007
Question:
I have a question about insertion of permanent pacemakers. Do they have
a global period? What is the proper way to code these?
Answer:
For physician reimbursement under Medicare, most pacemaker procedures (e.g.,
CPT® codes 33200–33208) have a 90-day global period. When a patient
receives services related to an existing pacemaker (e.g., repositioning
of electrodes), billing records should be checked to determine whether the
service falls within the global period of the pacemaker insertion. Depending
upon the circumstances, it may be appropriate to apply modifier 58 (staged
or related procedure), 59 (distinct procedure), 76 or 77 (repeat procedure),
78 (return trip to OR for a related procedure), or 79 (unrelated service
during postoperative period).
When an additional lead is inserted into the cardiac venous system for
left ventricular pacing, code 33225 is reported in addition to one of the
codes from the series 33206-33208. Code 33225 is an add-on code that describes
insertion of the cardiac venous lead at the time the pacemaker is implanted.
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January 8, 2007
Question:
Does Medicare cover cardiac output monitoring by thoracic electrical bioimpedance
(TEB)?
Answer:
In Transmittal 63 (December 15, 2006), the Centers for Medicare & Medicaid
Services (CMS) announced that it had reconsidered the Medicare coverage
policy for TEB for drug-resistant hypertension and decided to retain current
coverage as written in section 20.16 of the National Coverage Determinations
(NCD) Manual.
Effective for dates of service on and after November 24, 2006, the current policies for cardiac output monitoring by TEB listed in the above section will remain the same. Medicare A/B MACs and carriers will continue to make reasonable and necessary determinations for the use of TEB related to drug-resistant hypertension only. All other coverage and non-coverage policies at section 20.16 remain in effect.
For more on this, see
http://www.cms.hhs.gov/transmittals/downloads/R63NCD.pdf
and the companion provider information memo MM5414 at
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5414.pdf.
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January 1, 2007
Question:
I have a question related to last week's Q&A on the topic of 3-D mapping.
Can code 93613 be reported with 93609?
Answer:
No, do not report 3-D mapping (93613) in addition to traditional mapping
(93609). 3-D mapping should be reported in addition to diagnostic EP studies
and/or therapeutic ablation procedures as applicable. Report with codes
93620, 93651, and 93652.
Also note that intracardiac mapping (93609 and 93613) is not included in
the comprehensive EP evaluation CPT codes (93619-93622). Therefore, they
should be reported in addition to these diagnostic procedure codes. Mapping
should be clearly documented within the report as well as the procedure
log. Mapping should be reported with the above-listed comprehensive codes
and with the ablation codes 93651 and 93652. Mapping is not typically reported
with the ablation code 93650 (AV node ablation). Additionally, mapping add-on
codes are typically not reported with CPT codes 93000-93603 or 93610-93612
or 93615-93618.