Use These Cardiology Category I Codes in Place of ‘T’ Codes in 2016

Posted on 30 Oct, 2015 |comments_icon 2|By Chris Boucher
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Keep an eye on Medicare, other payers for reimbursement news.

If your cardiology practice has been hoping for a better chance at payment for a couple of currently “experimental” procedures, CPT® has good news.

The skinny: The 2016 CPT® manual deletes 0262T (Implantation of catheter-delivered prosthetic pulmonary valve, endovascular approach) and 0311T (Non-invasive calculation and analysis of central arterial pressure waveforms with interpretation and report) and replaces them with a pair of category I codes.

Read on for a rundown of the reasons these code changes are such good news.

Category I Bump-Up Increases Reimbursement Chances

In 2016, report 33477 (Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed) instead of 0262T. The new code number places the service in with other pulmonary valve surgical procedures.

Also, report 93050 (Arterial pressure waveform analysis for assessment of central arterial pressures, includes obtaining waveform[s], digitization and application of nonlinear mathematical transformations to determine central arterial pressures and augmentation index, with interpretation and report, upper extremity artery, non-invasive) in place of 0311T. Experts expected this code change, as waveform analysis not only indicates central systolic and diastolic pressure, it also determines the influence of pulse wave reflection on the central pressure waveform. It can serve as a useful adjunct to brachial blood pressure measurements in initiating and monitoring hypertensive treatment and other factors.

Benefit: Whenever CPT® moves a code from category III to category I, it’s a big deal in the coding world. Category III codes represent procedures that CPT® deems “experimental;” thusly, cardiology practices have a tough time getting paid for category III codes. If the code is “upped” to category I status, however, the procedure is no longer considered experimental.

As Advance Healthcare Network reports on its Website, category I codes are for “procedures that are consistent with contemporary medical practice and are widely performed,” while category III codes represent “temporary codes for emerging technology, services and procedures.”

Payment for these procedures might still be spotty, especially in 2016. The change is great news, however, as it means CPT® is trying to get 33477 and 93050 into the procedural mainstream — which can only help payment possibilities.

Author

Chris Boucher


Chris Boucher has nearly 10 years of experience writing various newsletters and other products for The Coding Institute. His blog will cover several areas of coding and compliance, including CPT® coding, modifiers, HIPAA compliance and ICD-10 coding.

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