cardiology updates, 2011; top ten errors to...

Cardiology 2011UpdatesTop Ten Errors to Avoid

Presented by Alice Marie Reybitz, RN, BA, CPC®, CPC-H®, CPC-HI®

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Top Ten Errors to Avoid

1. Reporting deleted codes from any of the Cardiovascular Sections

2. Unbundling radiology codes where they have been bundled

3. Ignoring the ENTIRELY new section of the CPT book, Endovascular revascularization

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Top Ten Errors

4. Use of incorrect diagnosis codes for the new Endovascular Revascularization

5. Using any of the Transluminal Atherectomy Codes

6. Not accounting for the changes and revisions to the Vascular Injection Procedures

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Top Ten Errors

7. Coding Cardiac Catheterization by the old rules

8. Ignoring the new “rules” in the parenthetical directions for Bypass and Composite Grafts

9. Avoiding the three new codes for billing of a hybrid repair of a complex congenital anomaly

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Top Ten Errors

10. NOT reading through the guidelines and new codes and NOT educating your coding staff on the changes that were many this year

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ICD-9 Updates

• Circulatory System

– 447.70-Aortic ectasia, unspecified site

– 447.71-Thoracic aortic ectasia

– 447.72-Abdominal aortic ectasia

– 447.73-Thoracoabdominal aortic ectasia

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ICD-9 Updates

• Injury and Poisoning, Complications of Medical Care

– Transfusion reactions

• 999.60-999.85

• Personal History (V codes)

– Corrected congenital malformation of the heart and circulatory system

• V13.65

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ICD-9 Updates

• V Codes, Other conditions influencing health status

– V49.86-Do Not Resuscitate Status

• V Codes, Body Mass Index

– V85.41-Body Mass Index 40.0-44.9, adult

– V85.42-Body Mass Index 45.0-49.9, adult

– V85.43-Body Mass Index 50.0-59.9, adult

– V85.44-Body Mass Index 60.0-69.9, adult

– V85.45-Body Mass Index 70 and over, adult

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CPT Updates

• Single Ventricular and Other Complex Cardiac Anomalies

– 33620-Application of right and left pulmonary artery bands (hybrid approach, stage 1)

– 33621-Transthoracic insertion of catheter for stent placement with catheter removal and closure (hybrid approach, stage 1)

– 33622-Reconstruction of complex cardiac anomaly with palliation of single ventricle with aortic outflow obstruction and aortic arch hypoplasia, creation of anastomosis, removal of right and left pulmonary bands (hybrid approach, stage 2)

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CPT Updates

• Thoracic Aortic Aneurysm

– 33860-Ascending aortic graft with cardiopulmonary bypass, includes valve suspension, when performed

– 33863-Ascending aortic graft with cardiopulmonary bypass, with aortic root replacement using valved conduit and coronary reconstruction

– 33864-Ascending aortic graft with cardiopulmonary bypass, with valve suspension, with coronary reconstruction and valve-sparing aortic root remodeling

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CPT Updates

• Arteries and Veins

– 34900-Endovascular repair of iliac artery, using ilio-iliac tube endoprosthesis

• Thromboendartectomy

– Revision Notes

• Transluminal Angioplasty

– 35454, 35456- deleted

– 35459, 35470, 35473,and 35474-deleted

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CPT Updates

• Transluminal Atherectomy

– All codes deleted and directions revised

• Bypass Grafts

– Editorial revisions that effect their use

• Composite Grafts

– Editorial revisions that effect their use

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CPT Updates

• Vascular Injection Procedures

– Parenthetical notes to direct the coder

• Intra-Arterial—Intra-Aortic

– Revisional language to assist the coder in correct choices for Cardiac Catheterization Procedures

• Central Venous Access Procedures

– Parenthetical directions to assure correct usage

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CPT Updates

• Transcatheter Procedures

– Introduction of the new section, Endovascular Revascularization

• Many revisions and parenthetical notes

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CPT Updates

• Endovascular Revascularization

– New Codes; 37220-37235

– New guidelines

– New parenthetical notes to assist in the change

– Notes to assist the coder in the codes that may be billed together

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Clinical Example

• 72 year old diabetic male presents with gangrene of the right 2nd and 3rd toes. Diagnostic studies performed reveal a severe trifurcation (tibial/peroneal artery) disease.

• The posterior tibial artery is totally occluded. Both the peroneal and anterior tibial arteries are patent, however each has a high grade stenosis at the proximal calf area.

• It is discussed with the patient and it is decided to perform a revascularization procedure on the right leg at the tibial/peroneal artery with transluminal angioplasty

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CPT Updates

• Radiology

– Vascular Procedures

• Many revisions and parenthetical notes to support the Endovascular Revascularization Section

– Transcatheter Procedures

• Many revisions to support the new Endovascular Revascularization Section

– Transluminal Atherectomy

• Completely deleted with directions on what to use for correct coding

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CPT Updates

• Medicine

– Cardiovascular

• Therapeutic Services and Procedures– Changes made and revisions done to accommodate the

Cardiac Catheterization Changes

• Cardiography– Some Category III codes added this year

• Cardiovascular Monitoring– NEW subsection, guidelines, etc.

– Implantable and Wearable Monitoring Devises got some revisions to their use

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CPT Updates

• Cardiac Catheterization

• New codes

– 93451-93464

• Revisions

– A complete restructuring

• Parenthetical Notes

– Give very explicit directions for billed with and NOT billed with

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Clinical Examples

OLD way

• RHC, including a drug and exercise study- 93501 and 93555

• LHC, including the septal puncture, drug and exercise study -93510 or 93511 or 93514 or 93524 with 93543 and 93555

NEW way

• RHC-93451, 93463, 93464

• LHC- 93452, 93462, 93463, and 93464

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CPT Updates

• Injection Procedures

– New codes, 93563-93568

– Many parenthetical notes and revisions

• Intracardiac Electrophysiological Procedures/Studies

– Revisions to support the Cardiac Catheterization Procedures

• Non-Invasive Vascular Diagnostic studies

– Extensive revision.

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CPT Updates

• Intracardiac Electrophysiological Procedures/Studies

– Revisions to support the Cardiac Catheterization Procedures

• Non-Invasive Vascular Diagnostic studies

– Extensive revision.

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CPT Updates

• Extremity Arterial Studies

– Revisions and parenthetical notes

– Direct the coder to the proper codes for certain situations

– These are for the non-invasive studies

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Category III

• 0078T-0080T-revised

• +0205T-revised

• 0223T-0225T-new codes for Acoustic Cardiology Studies

• 0234T-0238T-new codes, atherectomies by any method

• 0254T-0255T-new codes, endovascular repair of iliac artery bifurcation procedures

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Category III

• 0256T-0259T- new codes to describe the implantation of a catheter delivered prosthetic heart valve

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Review

• Cardiac Catheterization got a huge makeover.

• The supporting codes reported for many cardiac procedures have been bundled and revised

• A complete review of your coding and billing practices in Cardiology is necessary to keep up with the changes

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Cardiology Updates, 2011; Top Ten Errors to Avoid

alice.reybitz@aapc.com

800-626-2633, ext. 168

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