00 A TCR Prelim .fm Page 4 Friday,N ovem ber14,2008 12:33 PM
Coding Companion for Cardiology/Cardiothoracic/ Vascular Surgery A comprehensive illustrated guide to coding and reimbursement
2009
00 A TCR TO C.fm Page i Friday,N ovem ber14,2008 12:31 PM
Contents Getting Started with Coding Companion ............................. i Breast .................................................................................. 1 General Musculoskeletal ...................................................... 2 Neck and Thorax ................................................................. 4 Larynx ............................................................................... 23 Trachea and Bronchi.......................................................... 27 Lungs and Pleura ............................................................... 53 Heart and Pericardium..................................................... 217 Arteries and Veins ............................................................ 264 Lymph Nodes.................................................................. 555 Mediastinum ................................................................... 558
Diaphragm...................................................................... 562 Esophagus....................................................................... 566 Abdomen ........................................................................ 613 Thyroid Gland ................................................................. 618 Parathyroid ..................................................................... 619 Nervous System .............................................................. 622 Medicine ......................................................................... 629 Appendix ........................................................................ 690 Evaluation and Management........................................... 743 Index............................................................................... 765
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Coding Companion for Cardiology/Cardiothoracic/Vascular Surgery
Contents
33413
33413 Replacement, aortic valve; by translocation of autologous pulmonary valve with allograft replacement of pulmonary valve (Ross procedure)
Coding Tips Report 33530 in addition to the code for the primary procedure for reoperation on aortic valve more than one month after the original procedure. When more than one valve (aortic, mitral, tricuspid, pulmonary) is being repaired or replaced, report each procedure separately and append modifier 51 to the secondary valve procedures. For valvuloplasty of aortic valve, see 33400–33403. For construction of apical aortic conduit, see 33404.
ICD-9-CM Procedural 35.21 Replacement of aortic valve with tissue graft 35.25 Replacement of pulmonary valve with tissue graft 35.33 Annuloplasty 39.61 Extracorporeal circulation auxiliary to open heart surgery
Anesthesia 33413 00561, 00562, 00563
Heart and Pericardium
ICD-9-CM Diagnostic 395.0 Rheumatic aortic stenosis 395.1 Rheumatic aortic insufficiency
Explanation Cardiopulmonary bypass is initiated. The aorta and pulmonary artery are separated and the main pulmonary trunk is completely cleaned off. After the heart is stopped, the pulmonary trunk is detached from the branching point of the left and right pulmonary arteries. It is taken off the heart with a small lip of heart muscle. Care is taken when the muscle of interventricular septum is cut. It is possible to damage a large branch of the left anterior descending coronary artery when this muscle is cut. The aorta is then opened above the valve. The coronary arteries are detached from the aorta with a surrounding "button" of aortic wall. Next, the aortic valve and its annulus are removed from the heart. A length of the ascending aorta is also removed. The pulmonary artery is sewn to the heart in the aortic position. The commissures and cusps of the pulmonary valve are lined up to be in the same positions as their aortic counterparts were before the aortic valve was removed. The open end of the pulmonary artery is then sewn to the ascending aorta. The coronary arteries are re-implanted on the pulmonary artery in positions similar to their positions on the aorta. The pulmonary valve and artery from an organ donor are then sewn into the pulmonary position.
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158 — Heart and Pericardium
395.2 Rheumatic aortic stenosis with insufficiency 395.9 Other and unspecified rheumatic aortic diseases 396.1 Mitral valve stenosis and aortic valve insufficiency 396.2 Mitral valve insufficiency and aortic valve stenosis 396.3 Mitral valve insufficiency and aortic valve insufficiency 396.8 Multiple involvement of mitral and aortic valves 424.1 Aortic valve disorders
code to identify complication: 338.18-338.19, 338.28-338.29)
Terms To Know allograft. Graft from one individual to another of the same species. atresia. Congenital closure or absence of a tubular organ or an opening to the body surface. cardiopulmonary bypass. Venous blood is diverted to a heart-lung machine, which mechanically pumps and oxygenates the blood temporarily so the heart can be bypassed while an open procedure on the heart or coronary arteries is performed. During bypass, the lungs are deflated and immobile. stenosis. Narrowing or constriction of a passage.
CCI Version 14.3
20680, 32100, 32422, 32551, 33140, 33210-33211, 33254-33256, 33310-33315, 36000, 36410, 37202, 39010, 51701-51703, 62318-62319, 64415-64417, 64420-64421, 64450, 64470, 64475, 69990, 90760, 90765, 90772, 90774, 90775, 92986 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above.
Medicare Edits Fac Non-Fac RVU RVU FUD 88.35 88.35 90 33413 Medicare References: None
Assist d
424.90 Endocarditis, valve unspecified, unspecified cause 746.3 Congenital stenosis of aortic valve 747.22 Congenital atresia and stenosis of aorta 862.9 Injury to multiple and unspecified intrathoracic organs with open wound into cavity 996.02 Mechanical complication due to heart valve prosthesis 996.61 Infection and inflammatory reaction due to cardiac device, implant, and graft — (Use additional code to identify specified infections) 996.71 Other complications due to heart valve prosthesis — (Use additional
CPT only © 2008 American Medical Association. All Rights Reserved.
Coding Companion for Cardiology/Cardiothoracic Surgery/Vascular Surgery
36870
36870 Thrombectomy, percutaneous, arteriovenous fistula, autogenous or nonautogenous graft (includes mechanical thrombus extraction and intra-graft thrombolysis)
not reported separately. However, anesthesia services (00100-01999) may be billed separately when performed by a physician (or other qualified provider) other than the physician performing the procedure. Supplies used when providing this procedure may be reported with C1757. Check with the specific payer to determine coverage.
V45.11 Renal dialysis status V45.12 Noncompliance with renal dialysis
ICD-9-CM Procedural
chronic. Persistent, continuing, or recurring.
39.49 Other revision of vascular procedure
fistula. Abnormal tube-like passage between two body cavities or organs or from an organ to the outside surface.
Anesthesia 36870 01844
ICD-9-CM Diagnostic
Explanation
Coding Tips Do not report declotting by a thrombolytic agent (36593) separately when performed in conjunction with percutaneous thrombectomy. For catheterization of an arteriovenous fistula, see 36145. For radiological supervision of an arteriovenous fistula angiography, see 75790. For open thrombectomy, arteriovenous fistula, see 36831. For open revision of an arteriovenous fistula without thrombectomy, see 36832; with thrombectomy, see 36833. Moderate sedation performed with 36870 is considered to be an integral part of the procedure and is
catheter. Flexible tube inserted into an area of the body for introducing or withdrawing fluid.
renal failure. Inability of a kidney to eliminate metabolites and retain electrolytes at a normal level. revision. Reordering or rearrangement of tissue to suit a particular need or function. thrombus. Stationary blood clot inside a blood vessel.
CCI Version 14.3
01844, 01924-01926, 34001v, 34101-34111v, 34201-34203v, 34421-34451v, 34490v, 35201-35206, 35226, 35236, 35256-35266, 35286-35305v, 35321v, 35355v, 35371v, 35800, 35860, 35875-35876v, 36000, 36002-36005, 36011-36012, 36140, 36410, 36593, 36800-36810, 36819v, 36821-36830v, 36834-36835v, 36860-36861, 37186v, 37188v, 37201-37202, 51701-51703, 62318-62319, 64415-64417, 64450, 64470, 64475, 69990, 76000-76001, 76942, 77002, 90760, 90765, 90772, 90774, 90775, 93000-93010, 93040-93042, 94770, 99143-99144, 99148-99149, J1644 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above.
Medicare Edits Fac Non-Fac RVU RVU FUD Assist 8.4 49.08 90 36870 N/A Medicare References: 100-2,15,260; 100-4,12,30; 100-4,12,90.3; 100-4,14,10
996.73 Other complications due to renal dialysis device, implant, and graft — (Use additional code to identify complication: 338.18-338.19, 338.28-338.29)
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Coding Companion for Cardiology/Cardiothoracic Surgery/Vascular Surgery
© 2008 Ingenix
Arteries and Veins — 513
Arteries and Veins
Under separately reportable radiologic guidance, a percutaneously placed catheter is advanced to the site of a thrombus or clot that has formed in a previously created connection between an artery and a vein, (arteriovenous fistula). The catheter is inserted into the clot and the clot is fragmented. Injection of urokinase may be required to dissolve the clot or percutaneous pharmacomechanical thrombolysis may be performed. Pharmacomechanical thrombolysis involves both injection of urokinase and mechanical fragmentation of the clot. Suction is applied and the clot fragments are removed through the catheter. The catheter is removed and pressure is applied at the insertion site.
403.91 Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease — (Use additional code to identify the stage of chronic kidney disease: 585.5, 585.6) 585.4 Chronic kidney disease, Stage IV (severe) — (Use additional code to identify kidney transplant status, if applicable: V42.0. Use additional code to identify manifestation: 357.4, 420.0. Code first hypertensive chronic kidney disease, if applicable: 403.00-403.91, 404.00-404.93) 585.5 Chronic kidney disease, Stage V — (Use additional code to identify kidney transplant status, if applicable: V42.0. Use additional code to identify manifestation: 357.4, 420.0. Code first hypertensive chronic kidney disease, if applicable: 403.00-403.91, 404.00-404.93) 585.6 End stage renal disease — (Use additional code to identify kidney transplant status, if applicable: V42.0. Use additional code to identify manifestation: 357.4, 420.0. Code first hypertensive chronic kidney disease, if applicable: 403.00-403.91, 404.00-404.93) 585.9 Chronic kidney disease, unspecified — (Use additional code to identify kidney transplant status, if applicable: V42.0. Use additional code to identify manifestation: 357.4, 420.0. Code first hypertensive chronic kidney disease, if applicable: 403.00-403.91, 404.00-404.93) 586 Unspecified renal failure
Terms To Know
04 A TCR EM .fm Page 743 Friday,N ovem ber14,2008 2:16 PM
This section provides an overview of evaluation and management (E/M) services, tables that identify the documentation elements associated with each code, and the federal documentation guidelines with emphasis on the 1997 exam guidelines. This set of guidelines represent the most complete discussion of the elements of the currently accepted versions. The 1997 version identifies both general multi-system physical examinations and single-system examinations, but providers may also use the original 1995 version of the E/M guidelines; both are currently supported by the Centers for Medicare and Medicaid Services (CMS) for audit purposes. Although some of the most commonly used codes by physicians of all specialties, the E/M service codes are among the least understood. These codes, introduced in the 1992 CPT® manual, were designed to increase accuracy and consistency of use in the reporting of levels of non-procedural encounters. This was accomplished by defining the E/M codes based on the degree that certain common elements are addressed or performed and reflected in the medical documentation. The Office of the Inspector General (OIG) Work Plan for physicians consistently lists these codes as an area of continued investigative review. This is primarily because Medicare payments for these services total approximately $29 billion per year and are responsible for close to half of Medicare payments for physician services. The levels of E/M services define the wide variations in skill, effort, and time and are required for preventing and/or diagnosing and treating illness or injury, and promoting optimal health. These codes are intended to represent physician work, and because much of this work involves the amount of training, experience, expertise, and knowledge that a provider may bring to bear on a given patient presentation, the true indications of the level of this work may be difficult to recognize without some explanation. At first glance, selecting an E/M code may appear to be difficult, but the system of coding clinical visits may be mastered once the requirements for code selection are learned and used.
Types of E/M Services When approaching E/M, the first choice that a provider must make is what type of code to use. The following tables outline the E/M codes for different levels of care for: • Office or other outpatient services—new patient • Office or other outpatient services—established patient • Hospital observation services • Hospital inpatient services—initial care
CPT only © 2008 American Medical Association. All Rights Reserved.
Coding Companion for Cardiology/Cardiothoracic/Vascular Surgery
Evaluation and Management
Evaluation and Management • Hospital inpatient services—subsequent care • Observation or inpatient care (including admission and discharge services) • Consultations—office or other outpatient • Consultations—inpatient The specifics of the code components that determine code selection are listed in the table and discussed in the next section. Before a level of service is decided upon, the correct type of service is identified. Office or other outpatient services are E/M services provided in the physician’s office, the outpatient area, or other ambulatory facility. Until the patient is admitted to a health care facility, he/she is considered to be an outpatient. A new patient is a patient who has not received any face-to-face professional services from the physician within the past three years. An established patient is a patient who has received face-to-face professional services from the physician within the past three years. In the case of group practices, if a physician of the same specialty has seen the patient within three years, the patient is considered established. If a physician is on call for or covering for another physician, the patient’s encounter is classified as it would have been by the physician who is not available. Thus, a locum tenens physician who sees a patient on behalf of the patient’s attending physician may not bill a new patient code unless the attending physician has not seen the patient for any problem within three years. Hospital observation services are E/M services provided to patients who are designated or admitted as “observation status” in a hospital. Codes 99218-99220 are used to indicate initial observation care. These codes include the initiation of the observation status, supervision of patient care including writing orders, and the performance of periodic reassessments. These codes are used only by the physician “admitting” the patient for observation. Codes 99234-99236 are used to indicate evaluation and management services to a patient who is admitted to and discharged from observation status or hospital inpatient on the same day. If the patient is admitted as an inpatient from observation on the same day, use the appropriate level of Initial Hospital Care (99221-99223). Code 99217 indicates discharge from observation status. It includes the final physical examination of the patient and instructions and © 2008 Ingenix
Evaluation and Management — 743
