Part 2: Catch up on reporting of ablations and newer technology procedures.
by David Dunn, MD, FACS, CIRCC, CPC-H, CCC, CCVTC
As we learned in Part 1 of this two-part series (see “Changes Plus More Changes for Cardiology in 2013,” page 40-43, January’s Cutting Edge), the new year brings significant changes to cardiology coding. This month, we cover CPT® coding in 2013 for transcatheter aortic valve replacement (TAVR), ventricular assist devices, electrophysiology ablations, subcutaneous defibrillators, intracardiac ischemia monitoring systems, and left atrial (LA) hemodynamic monitoring systems.
Transcatheter Aortic Valve Replacement/Implantation (TAVR/TAVI)
Codes 0256T-0259T are deleted for 2013, replaced by new codes for TAVR/TAVI. To make it easier to differentiate the services, here’s a list of the new codes with abbreviated descriptors:
33361 TAVR, percutaneous femoral approach
33362 TAVR, open femoral approach
33363 TAVR, open axillary approach
33364 TAVR, open iliac approach
33365 TAVR, transaortic approach (eg, median sternotomy)
0318T TAVR, open transapical approach (eg, left thoracotomy)
+33367 Cardiopulmonary bypass support for TAVR, percutaneous peripheral arterial and venous cannulations
+33368 Cardiopulmonary bypass support for TAVR, open peripheral cannulations
+33369 Cardiopulmonary bypass support for TAVR, central (eg, aorta, right atrium, pulmonary artery) cannulations
Here are some tips for applying these new codes correctly:
- The only currently approved device is the Sapien valve. It’s indicated for patients with severe aortic stenosis who are not surgical candidates (determined by a cardiothoracic surgeon).
- The three add-on codes for cardiopulmonary bypass (C-P bypass), when performed, are also based on approach. Only one C-P bypass code is submitted during TAVR.
- Open femoral (34812) and open brachial access (34834) are included in the TAVR codes.
- Temporary pacemaker placement for rapid pacing during TAVR, as well as catheter placements and balloon valvuloplasty, are included.
- Swan-Ganz placement and aortic/left ventricular (LV) measurements and imaging to guide and complete the TAVR are included.
- If a complete heart catheterization is performed, you may report it if no prior diagnostic study was performed or a suboptimal study is documented, or if there has been a clinical change in the patient since the prior study or during the procedure.
- Code for other percutaneous coronary/cardiac interventions that are performed and medically indicated.
- You may code for ventricular assist device or intra-aortic balloon pump (33990, 33991, 33967, 33970), if performed.
- TAVR requires two physicians to complete the procedure. Codes 33361-33365 and 0318T Implantation of catheter-delivered prosthetic aortic heart valve, open thoracic approach, (eg, transapical, other than transaortic) require modifier 62 Two surgeons for physician billing. For example, each physician would report 33361-62 for a percutaneous TAVR. The C-P bypass codes do not have this requirement.
Example: An elderly patient with severe aortic stenosis, who is not a surgical candidate, presents for a TAVR procedure. This is performed with C-P bypass via femoral cut-downs and rapid pacing with a temporary pacer. The TAVR is performed via percutaneous approach.
Correct codes would be:
33361 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach
+33368 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with open peripheral arterial and venous cannulation (eg, femoral, iliac, axillary vessels) (List separately in addition to code for primary procedure)
Note: Do not report the temporary pacemaker.
Ventricular Assist Device (VAD)
Codes 0048T and 0050T for VAD are deleted and replaced by new, Category I CPT® codes. For easy reference, here are abbreviated descriptors:
33990 Insert VAD, percutaneous, arterial access only, ie, Impella® device
33991 Insert VAD, percutaneous, both arterial and venous access with transseptal puncture, ie, TandemHeart™ device
33992 Removal of VAD
33993 Repositioning of VAD
Follow these tips for proper coding:
- VADs are for use in patients with impaired LV function. The new aforementioned codes are for percutaneous VADs.
- Impella® device is via arterial access only, with a single catheter that forcefully removes blood from the LV via the distal portion of the catheter and discharges it into the proximal aorta.
- TandemHeart™ device has both venous and arterial access. The venous catheter is placed into the LA via a transseptal puncture and removes oxygenated blood from the left LA back to the TandemHeart™ device (external on patient), and then returns it into a second catheter, placed usually via the femoral artery.
- You may report 34812 Open femoral artery exposure for delivery of endovascular prosthesis, by groin incision, unilateral when an open arterial exposure is performed to accommodate the larger catheters used in percutaneous VADs.
- Routine closure of artery is not reported separately.
- Removal and repositioning codes can only be used when at a different encounter. If on the same date of service but a different encounter, append modifier 59 Distinct procedural service to either 33992 Removal of percutaneous ventricular assist device at separate and distinct session from insertion or 33993 Repositioning of percutaneous ventricular assist device with imaging guidance at separate and distinct session from insertion.
- If VAD is placed prophylactically for an intervention and removed at its conclusion, do not report 33992.
- Repositioning of a percutaneous VAD without imaging guidance is not a reportable procedure.
- If an existing VAD is removed and replaced with a new VAD, code this as a new device placement. Do not report 33992 because the removal is bundled into the new device placement code.
Electrophysiology ablation codes 93651 and 93652 are deleted. New abbreviated versions of the codes are:
93653 Comprehensive electrophysiologic (EP) evaluation with ablation of supraventricular tachycardia (SVT)
93654 Comprehensive EP evaluation with ablation of ventricular tachycardia
+93655 Additional ablation of discrete mechanism of arrhythmia distinct from the primary ablation treated
93656 Comprehensive EP evaluation with ablation of atrial fibrillation via pulmonary vein isolation
+93657 Additional ablation of left or right atrium for a-fib remaining after pulmonary isolation at same setting
Use these helpful tips for proper EP ablation coding:
- The five new ablation codes all include a diagnostic EP study at the time of ablation.
- Do not submit any combination of 93653, 93654, and 93656 together. If an additional mechanism is ablated, use add-on code +93655 or +93657.
- With ablation of SVT (93653), you may report mapping (+93609 Intraventricular and/or intra-atrial mapping of tachycardia site(s) with catheter manipulation to record from multiple sites to identify origin of tachycardia (List separately in addition to code for primary procedure) or +93613 Intracardiac electrophysiologic 3-dimensional mapping (List separately in addition to code for primary procedure)), transseptal procedure (+93462 Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure)), and LV pacing/recording (+93622 Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left ventricular pacing and recording (List separately in addition to code for primary procedure)), when performed.
- Ablation of VT (93654) includes 3-D mapping (93613) and LV pacing/recording (93622), when performed. You can report transseptal procedure (93462), when performed.
- Pulmonary vein isolation for a-fib (93656) includes the transseptal procedure (93462) and LA pacing/recording (+93621 Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left atrial pacing and recording from coronary sinus or left atrium (List separately in addition to code for primary procedure)), when performed. You can report mapping (93609 or 93613) and LV pacing/recording, when performed.
- There is a “gray zone” regarding 93623; CPT® states this code may be reported with 93656, but National Correct Coding Initiative (NCCI) Version 19.0 states not to report 93623 with any of the new ablation codes.
- Add-on code +93655 may be reported with 93653, 93654, or 93656, when performed.
- Add-on code +93657 may be reported only with 93656, when performed.
- Some of the parentheticals may need updating. For example, a parenthetical note instructs you to use +93622 only with 93620, but the CPT® introductory section states +93622 may be added to 93653. Likewise, only 93620 may be used with 93621, per a parenthetical note following 93621.
Example: A patient presents with atrial fibrillation. A complete EP study is performed, followed by a transseptal puncture under intracardiac echocardiography (ICE) into the LA. A 3-D map is created, followed by ablations performed to achieve pulmonary vein isolation. After this was done, there was evidence of continued a-fib and a decision was made to perform additional right atrial ablations. The a-fib then ceased.
The correct coding in this case is:
93662 Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (List separately in addition to code for primary procedure)
Note: Do not code for the EP study (93620) or transseptal procedure (93462); they are included in 93656.
This year, CPT® adds new Category III codes for S-ICD systems. Shortened descriptions are:
0319T Insertion of complete system
0320T Insertion of electrode only
0321T Insertion of generator only
0322T Removal of generator
0323T Removal and replacement of generator
0324T Removal of electrode
0325T Repositioning of electrode and/or generator
0326T EP evaluation (defibrillation threshold testing)
0327T Interrogation of device
0328T Programming of device with iterative adjustments
This is a newer type of defibrillator for treatment of arrhythmias that is totally implanted in the subcutaneous tissues, including the defibrillating lead.
To apply the above codes, follow these tips:
- The generator and one lead are placed subcutaneously. This allows for easier insertion over traditional transvenous insertion of electrode, and results in fewer potential complications, such as venous stenosis and infected leads within the heart because the lead is in the subcutaneous tissues.
- This system does not allow pacing, as in a conventional defibrillator.
- To report removal of an existing subcutaneous lead and generator plus replacement with a new system, report 0322T, 0324T, and 0319T.
- At generator end of life, report replacement with 0323T when the depleted generator is removed and a new generator is inserted.
- Use the repositioning code 0325T when performed repositioning of an electrode and/or generator occurs at a different encounter than at the original insertion.
- Defibrillation threshold testing (DFT testing) involves induction of arrhythmia and evaluation of sensing and pacing for arrhythmia termination, as well as reprogramming as necessary, and is reported with 0326T.
- Report 0327T and 0328T at a different encounter than at the original placement for interrogation or programming of S-ICD (this is not DFT testing).
Intracardiac Ischemia Monitoring Device (IMD)
Also new for 2013 are Category III codes (with our abbreviated descriptions) for IMD:
0302T Insertion of complete system, or removal and replacement of both device and electrode
0303T Insertion of electrode only, or removal and replacement of electrode
0304T Insertion of device only, or removal and replacement of device
0305T Programming of device with iterative adjustment
0306T Interrogation of device
0307T Removal of IMD system
IMD (AngelMed Guardian® system) consists of an electrode placed into the right ventricle and a device. It monitors electrocardiogram signals for acute ST elevation changes and warns the patient via vibratory and auditory alerts. This allows the patient to potentially seek earlier treatment of impending ischemic events.
Consider these tips when applying the above codes:
- The removal of an existing IMD system and replacement with a new system is reported by the single code, 0302T.
- Report codes 0305T and 0306T at a different encounter than at original placement for interrogation or programming of IMD.
Left Atrial Hemodynamic Monitor
Finally, you’ll find new Category III codes for left atrial hemodynamic monitor. Easier-to-follow abbreviated descriptions are:
0293T Insertion of LA hemodynamic monitor, complete with module and pressure sensor lead
0294T Insertion of pressure sensitive lead at time of insertion of pacing cardioverter-defibrillator
This system monitors LA pressures to identify changes in patients with heart failure to allow potential earlier treatment.
Tips to apply these codes correctly include:
- You may use the above codes alone, or when inserted into combination-type defibrillator devices.
- Transseptal code 93462 is bundled with these codes, as is ICE (93662).
- Use 0294T with 33230 Insertion of pacing cardioverter-defibrillator pulse generator only; with existing dual leads, 33231 Insertion of pacing cardioverter-defibrillator pulse generator only; with existing multiple lead, 33240 Insertion of pacing cardioverter-defibrillator pulse generator only; with existing single lead, 33262-33264 Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator pulse generator …, and 33249 Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber.
David Dunn, MD, FACS, CIRCC, CPC-H, CCC, CCVTC, is vice president of ZHealth. He oversees physician coding and instructs ZHealth educational programs, and contributes to Dr. Z’s Medical Coding Series. A graduate of Texas A&M University, he completed his M.D. at the University of Texas, his surgical residency at Scott & White Hospital, and his vascular surgery fellowship at Baylor College of Medicine. A diplomat of the American Board of Surgery, Dr. Dunn is also certified in vascular surgery. He is a fellow of the American College of Surgeons and a member of the Southern Association for Vascular Surgery. He is president-elect of the AAPC National Advisory Board.
February 1st, 2013
By David B. Dunn, MD, FACS, CIRCC, CPC-H, CCC, CCVTC
Part 1: Reporting coronary artery interventions is altered significantly.
The new year brings major changes to the Cardiovascular System section in American Medical Association’s (AMA) 2013 CPT®, with several deleted codes and 56 new codes—including 30 CPT® codes, 17 Category III codes, and nine HCPCS Level II C codes. This month, we’ll focus on updates affecting coronary artery interventions: 2013 will require us to essentially alter the way we’ve reported such procedures for many years.
Number of Major Arteries Increases
Per CPT®, we now have five major coronary arteries for intervention coding (instead of three, as in years past). They are:
- Left main (LM)
- Left anterior descending (LD)
- Left circumflex (LC)
- Right coronary (RC)
- Ramus intermedius (RI)
You may report an intervention in each of these vessels, when performed, and in up to two branches of the LD (diagonals), LC (marginals), and RC (posterior descending, posterolaterals). Every bypass graft represents a major coronary artery for coding purposes.
There are now specific, separate code categories to report:
- Percutaneous coronary intervention (PCI) in the native circulation
- Intervention performed in a bypass graft, or of the native circulation via a bypass graft
- Total/subtotal occlusion during acute myocardial infarctions (MI)
- Chronic total occlusions (CTO)
Physicians must document concisely to ensure accurate reporting with this new and complex system for coronary intervention reporting.
New Codes in Review
Let’s review the new base (primary procedure) and add-on codes for coronary artery interventions. Note: C codes (cited in parenthesis, with CPT® codes for nondrug-eluting stents) report drug-eluting stents for Medicare in the facility setting.
The base codes for initial intervention(s) are:
- 92920 – Angioplasty
- 92924 – Atherectomy
- 92928 – Stent (C9600)
- 92933 – Atherectomy and stent (C9602)
- 92937 – For any combination PCI of, or via, a bypass (C9604)
- 92941 – For any combination PCI during an acute MI (C9606)
- 92943 – For any combination PCI for CTO (C9607)
The reporting hierarchy, from highest to lowest, for these base codes is:
92943 = 92941 > 92933 > 92924 > 92928 > 92937 > 92920
Source: Distributed during the AMA CPT® 2013 Annual Symposium, based on revised relative value unit (RVU) valuations.
The add-on codes for additional intervention(s) are:
- +92921 – Angioplasty
- +92925 – Atherectomy
- +92929 – Stent (+C9601)
- +92934 – Atherectomy and stent (+C9603)
- +92938 – For any combination PCI via bypass graft (+C9605)
- +92944 – For any combination PCI for CTO (+C9608)
The reporting hierarchy for these add-on services, from highest to lowest, is:
92944 = 92938 > 92934 > 92925 > 92929 > 92921
Tips for Proper Reporting
1. Angioplasty, when performed, is included in each base and add-on code.
2. “Any combo” designation for codes 92937-92944 Percutaneous transluminal revascularization … means that angioplasty, atherectomy, and stent are included when performed for interventions via a bypass graft, during an acute MI, or of a CTO.
3. When choosing the base code for each artery treated, select the one that includes the most intensive service provided.
4. All interventions within one major coronary artery or branch are reported with one code. For example, if an angioplasty is performed in a proximal RC stenosis, and a stent is placed in a distal RC stenosis, report only the highest level base code, 92928 Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch.
5. Report a base code for each major native coronary vessel intervention, or of a single branch if the major coronary artery is not treated.
6. Report an add-on code for interventions in up to two additional branches of the LD, LC, and RC, when performed. For example, if a stent is placed in a stenosis in the native LC and angioplasty is performed in two branches of the LC (e.g., OM1, OM2) report 92928, 92921 Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (List separately in addition to code for primary procedure) x 2. The second unit of 92921 does not require modifier 59 Distinct procedural service because this is an add-on code.
7. Code for two interventions when a bifurcation lesion is treated.
8. Code for one intervention for treatment of a bridging lesion where the stenosis extends from one vessel into another vessel treated with a single intervention.
9. If one area of a major coronary vessel is treated via the native circulation, and a different area is treated via a bypass graft, report both. For example, if a proximal LD stenosis is stented via the native LD, and a distal LD stenosis is stented via a saphenous vein bypass graft, report 92928 and 92937 Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel.
10. Use base code 92937 for intervention of, or via, a bypass graft. This would include any combination of angioplasty, atherectomy, and/or stent. Add-on code 92938 Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft (List separately in addition to code for primary procedure) reports additional intervention in a branch subtended by the bypass graft.
11. A sequential (jump) graft that has more than one distal anastomosis is considered one graft.
12. Intervention for a total/subtotal occlusion during an acute MI is coded 92941 Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel for a single vessel. This would include any combination of angioplasty, atherectomy, and/or stent. Code 92941 also includes manual aspiration thrombectomy, when performed.
13. Mechanical thrombectomy (e.g., AngioJet®), when performed, may be reported additionally with +92973 Percutaneous transluminal coronary thrombectomy mechanical (List separately in addition to code for primary procedure)).
14. CTO means no antegrade flow is present, and no current ST elevation or Q wave acute MI.
15. The base code for a CTO intervention (92943 Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel) includes any combination of angioplasty, atherectomy, and/or stent. Add-on code 92944 Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (List separately in addition to code for primary procedure) reports additional CTO interventions.
16. Closure of the arteriotomy is always included, and imaging related to closure device is not reported.
17. Only report diagnostic angiography if not previously performed or if there has been a documented clinical change since the prior angiography. For example, a patient has a recent coronary angiogram and the plan is for medical treatment. The patient returns via the emergency room with new onset angina and a coronary angiogram is performed prior to coronary artery bypass grafting (CABG). Report 93454 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial venous grafts) including intraprocedural injection(s) for bypass graft angiography. Do not code for angiography for a planned, staged PCI or for routine re-look angiography, and do not report for sizing, confirmatory, guiding, positioning, road-mapping, or completion angiography.
18. When performed, you may also report:
Intravascular Ultrasound (IVUS) +92978 Intravascular ultrasound (coronary vessel or graft) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; initial vessel (List separately in addition to code for primary procedure) and +92979 Intravascular ultrasound (coronary vessel or graft) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; each additional vessel (List separately in addition to code for primary procedure);
Intravascular Doppler/Pressure +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 (List separately in addition to code for primary procedure) and +93572 Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; each additional vessel (List separately in addition to code for primary procedure);
Optical Coherence Tomography (OCT) +0291T Intravascular optical coherence tomography (coronary native vessel or graft) during diagnostic evaluation and/or therapeutic intervention, including imaging supervision, interpretation, and report; initial vessel (List separately in addition to primary procedure) and +0292T Intravascular optical coherence tomography (coronary native vessel or graft) during diagnostic evaluation and/or therapeutic intervention, including imaging supervision, interpretation, and report; each additional vessel (List separately in addition to primary procedure); and
Near Infrared Spectroscopy (NIRS) +0205T Intravascular catheter-based coronary vessel or graft spectroscopy (eg, infrared) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation, and report, each vessel (List separately in addition to code for primary procedure) (each vessel).
19. Do not report an additional CPT® code for embolic protection device (EPD), when used.
20. For Medicare facility coding, use HCPCS Level II codes C9600–C9608 when a drug-eluting stent is placed. The other CPT® stent codes denote nondrug-eluting stents.
21. Add modifier 59 to duplicated base codes when multiple major coronary arteries are intervened upon with the same type of intervention.
22. The following codes have been deleted for 2013: 92980, 92981, 92982, 92984, 92995, 92996, G0290, and G0291.
Three Examples to Show the Way
1. A patient presents with evidence of an acute MI. A diagnostic coronary angiogram is performed and reveals acute thrombus resulting in a total occlusion of the RC. Also noted is a 75 percent stenosis of the LC. An AngioJet® mechanical thrombectomy is performed in the RC, and a DES is placed in the residual 90 percent stenosis. A second DES is placed in the LC stenosis.
Coding: 93454, 92973, C9606-RC (92941-RC for physician), and C9600-LC (92928-LC for physician)
Rationale: Code for initial coronary angiogram (93454) and for DES of the RC in the setting of an acute MI related to the RC (C9606 or 92941). Because this is a mechanical thrombectomy, it is reported with 92973. Also code for DES in the LC stenosis (not the cause of the acute MI) with C9600 or 92928.
2. A patient has had prior angiography revealing hemodynamically significant stenosis in the LD, diagonal, and RC, and is here for elective PCI. Nondrug-eluting stents are placed into the LD and diagonal. IVUS is performed in the diagonal to confirm adequate stent expansion. An angioplasty is performed in the RC.
Coding: 92928-LC, 92929-LC, 92978-LC, and 92920-RC
Rationale: The patient is here for planned PCIs. Base code 92928 is for the left circumflex stent. The add-on code 92929 is for the additional stent in the diagonal branch. IVUS (92978) is reported for the LC for confirmation of the adequate stent deployment. Lastly, another base code 92920 is for angioplasty in the RC.
3. A patient has had prior CABG surgery and presents with increasing angina. A left heart cath is performed with normal LV pressures. Angiography reveals a LIMA attached to the LD with an 85 percent stenosis within the LIMA graft. It also reveals a patent saphenous vein bypass graft to the RC, but a distal 70 percent stenosis of the posterolateral branch. A rotational atherectomy is performed and subsequently a non-drug eluting stent is placed in the LIMA. Via the RC vein bypass graft, the posterolateral has a nondrug-eluting stent placed.
Coding: 93458, 92937-LD, 92937-59-RC
Rationale: Code 93458 for initial left heart cath. Atherectomy and nondrug-eluding stent are performed in the LD via the LIMA graft; therefore, report combination code 92937-LD. Lastly, the stenosis in the posterolateral branch is approached via the saphenous vein graft. A nondrug-eluding stent is placed; therefore, report base code 92937 again. Append modifier 59 to the second unit of 92937 because the same base code is needed to describe a stent in the second major coronary artery.
New Robust System with Robust Coding
2013 brings a paradigm shift in coronary arterial intervention coding. The new system is more robust, with increased opportunities for reporting of multiple interventions, and more specific coding for graft interventions, PCI during acute MI, and CTO revascularization. With more detailed procedural reporting by the physicians and due diligence by coders, mastering this new system should be rewarding to the coder, physician, and facility.
David Dunn, MD, FACS, CIRCC, CPC-H, CCC, CCVTC, is vice president of ZHealth. He oversees physician coding and instructs ZHealth educational programs, as well as contributes to Dr. Z’s Medical Coding Series. A graduate of Texas A&M University, he completed his M.D. at the University of Texas, his surgical residency at Scott & White Hospital, and his vascular surgery fellowship at Baylor College of Medicine. A diplomat of the American Board of Surgery, Dr. Dunn is also certified in Vascular Surgery. He is a fellow of the American College of Surgeons and a member of the Southern Association for Vascular Surgery. He is president-elect of the AAPC National Advisory Board.
January 1st, 2013
If UnitedHealthcare is among your list of payers, you’ll want to take note of several policy updates the insurer says it will implement on or before the fourth quarter of 2012. From prior authorization changes to supply codes no longer separately payable, the July 2012 Network Bulletin is a must-read. Here are the highlights:
Notification and Prior Authorization Program Changes
Effective Nov. 1, certain UnitedHealthcare commercial customers will be required to obtain prior authorization and/or advance notification for attended sleep testing performed in a health care facility. Unattended home sleep testing will not require prior authorization, nor will providers be required to submit a patient information worksheet (PIW).
Effective Aug. 13, the UnitedHealthcare Commercial Radiology Notification Program and Medicare Advantage Radiology Prior Authorization Program are expanding to include Connecticut, New Jersey, and New York.
Effective Oct. 1, UnitedHealthcare will require providers to obtain prior authorization for echocardiograms, stress echos, diagnostic catheterizations, and electrophysiology implants when furnished in an outpatient facility or physician office. Prior authorization will be required for electrophysiology implants regardless of where the service is performed. Note, however, that prior authorization is not required for these services when rendered in an emergency room (ER), observation unit, or urgent care facility.
A complete list of plans that are subject to this prior authorization requirement is available at UnitedHealthcareOnline.com.
Clinical and Surgical Pathology
Effective fourth quarter 2012, UnitedHealthcare’s Laboratory Rebundling policy will be revised to include dermatologists as eligible for reimbursement when reporting clinical and surgical pathology consultation codes (CPT® 80500-80502 and 88321-88325).
In accordance with National Correct Coding Initiative (NCCI) edits, UnitedHealthcare’s CCI editing policy will be revised in the fourth quarter to deny CPT® codes 29874 Arthroscopy, knee, surgical; for removal of loose body or foreign body (eg, osteochondritis dissecans fragmentation, chondral fragmentation) and 29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty) when they are reported with other reimbursable knee arthroscopy procedures (29866-29889). After this edit is in place, a modifier override will not be allowed as it has been in the past.
UnitedHealthcare says it will expand its current list of supply codes that are not separately payable when reported with an evaluation and management (E/M) service and/or procedure provided on the same day in a physician or other health care professional’s office. The complete list of codes that will be added to the Supply Policy Non Reimbursable Code List can be found on pages 55-59 in July’s Network Bulletin.
July 13th, 2012