 By Brenda Ray, CCS, CCS-P, COC, AHIMA-Approved Trainer It is imperative that proper documentation and coding are utilized to document cardiac conditions accurately and streamline the cardiology billing process appropriately. In the following, our industry expert, Brenda Ray, delves deeper into some pertinent coding updates and guidelines around cardiac conditions. Among the changes for 2023, new guidelines for Shunting Procedures have been added to clarify further the intent and correct reporting of existing codes 33741, 33745, and 33746.  The Shunting Procedures subsection guidelines have been revised to clarify when it is appropriate to report selective pulmonary arterial, and venous angiography described with new codes 93569 – 93575 with code 33741 or 33745. There are numerous guideline changes throughout this section, including guidelines related to reporting injection procedures for diagnostic angiography as well as reporting diagnostic right and left heart catheterization in conjunction with 33741 or 33745. You should refer to the CPT Manual to review all the 2023 changes for the Cardiovascular System > Shunting Procedures guidelines. Cardiovascular System Changes New Shunting Procedure Guidelines Codes 33741, 33745 are typically used to report creation of effective intracardiac blood flow in the setting of congenital heart defects. Code 33741 (transcatheter atrial septostomy) involves the percutaneous creation of improved atrial blood flow (e.g., balloon/blade method), typically in infants ≤4 kg with congenital heart disease. Code 33745 is typically used for intracardiac shunt creation by stent placement to establish improved intracardiac blood flow (e.g., atrial septum, Fontan fenestration, right ventricular outflow tract, Mustard/Senning/Warden baffles). Code 33746 is used to describe each additional intracardiac shunt creation by stent placement at a separate location during the same session as the primary intervention (33745). New Codes: Percutaneous Pulmonary Artery Revascularization Five new codes, 33900 – 33904, have been added for reporting percutaneous pulmonary artery revascularization procedures performed using both normal native and abnormal connections. These codes describe the endovascular repair of pulmonary artery stenosis by stent placement. Percutaneous Pulmonary Artery Revascularization – New Guidelines Guidelines for the new codes provide information regarding all of the services included as part of the procedures such as vascular access/catheterization, guidewire manipulation, imaging to guide intervention, post-diagnostic road-mapping, post-implant evaluations, stenting, balloon inflation, and radiologic supervision and interpretation needed for the intervention. Angiography at the same session, as part of a diagnostic cardiac catheterization, may be reported with the appropriate angiographic codes from the Radiology or Medicine/Cardiovascular/Cardiac Catheterization/Injection Procedures sections. Please refer to the 2023 CPT Manual for additional guidelines regarding when it is and is not appropriate to code Diagnostic cardiac catheterization and angiography codes in conjunction with pulmonary artery revascularization codes. Additional guidelines included for the new codes indicate how to report balloon angioplasty within the same target lesion as stent placement in the pulmonary artery as well as how to report balloon angioplasty performed at the same session for a distinct lesion or a different artery. New Parenthetical Note for Venous Reconstruction In accordance with the creation of Category III code 0744T, cross-reference parenetical notes have been added following codes 34501 and 34510 to reflect this change. Category III code 0744T was added to report the insertion of a bioprosthetic valve in the femoral vein via an open approach. It includes imaging guidance using duplex ultrasound. The valve is single-use and meant to be permanently implanted to support blood flow from the lower extremities despite the absence of native deep venous valvular function. It may be used to treat conditions such as chronic deep vein insufficiency and reflux in the deep venous system or leg ulcers. New codes 36836 and 36837, new introductory guidelines, and new and revised parenthetical notes have been added within the Surgery/Cardiovascular System and Radiology subsections to identify the appropriate reporting for percutaneous arteriovenous fistula creation via single access of both the peripheral artery and peripheral vein (36836) and via separate access sites of the peripheral artery and peripheral vein (36837). Fistula maturation procedures such as coil embolization of extra venous outflow channels may be used to increase flow through the fistula. Balloon dilation of the connection may be used to increase the size of the communication to increase blood flow. New Codes: Percutaneous AV Fistula Creation Previously there were only codes for AV fistula creation via an open approach. These codes are for the upper extremity only; use an unlisted code for the lower extremity. Several parenthetical notes have been added following these codes to provide further guidance regarding the intended use of these new codes. The first parenthetical note you see excludes reporting of these services in conjunction with several procedures throughout the CPT Manual. The second and third parenthetical notes have been added to direct users to the appropriate reporting for arteriovenous fistula creation via an open approach and reporting unlisted code 37799 for percutaneous arteriovenous fistula creation in any location other than the upper extremity. Numerous parenthetical notes in the Surgery and Radiology subsections have been added or revised to further clarify the appropriate reporting of these codes. As always, please refer to the CPT Manual to review all guidelines and parentheticals related to the new codes.  This information is provided as an overview, it is intended as informational only, and should not be considered as official guidance. Axea Solutions recommends readers inquire directly with the CPT Manual to review all the changes for the Cardiovascular System.
If you are in need of coding support or team training to better understand new guidelines, Axea advisors can assist your coding team with targeted training in needed areas, supported by Axea's online interactive learning platform, Axea Academy®.
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