Changes to cardiology coding were kept to a minimum for 2015. Next year will see Current Procedural Terminology (CPT®) codes for newer technology and procedures. Make certain to review the many revisions for CPT codes and introductory language. Each year the American Medical Association (AMA) publishes a new CPT book with all the new, deleted and/or revised codes. Often, the introductory language gets overlooked but this language contains updated coding guidelines that are of great importance.

Pacemaker and Implantable Defibrillator

Four new codes were developed for subcutaneous implantable defibrillators. These devices differ from transvenous implantable pacing cardioverter-defibrillators in that subcutaneous defibrillators do not provide antitachycardia pacing or chronic pacing.

New CPT Code	Descriptor	AMA RUC Recommended Work RVU	CY 2015 Interim Final Work RVU
33270	Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed	9.10	9.10
33271	Insertion of subcutaneous implantable defibrillator electrode	7.50	7.50
33272	Removal of subcutaneous implantable defibrillator electrode	5.42	5.42
33273	Repositioning of previously implantable defibrillator electrode	6.50	6.50

Revisions were made to CPT codes 33215 – 33220, 33223 – 33225, 33240 – 33264, 33243 – 33249 (# - Resequenced) regarding the phrase "pacing cardioverter-defibrillator". The new language is "implantable defibrillator". Review the new introductory language of the CPT book for pacemakers and implantable defibrillators.  Examples of new language:

• 2014 – 33243 – Removal of single or dual chamber pacing cardioverter-defibrillator electrode(s); by thoracotomy
• 2015 – 33243 – Removal of single or dual chamber implantable defibrillator electrode(s); by thoracotomy

Transcatheter Mitral Valve Repair

New CPT codes 33418 and 33419 are used to report transcatheter mitral valve repair (TMVR). Code 33419 should only be reported once per session. These codes include the work, when performed, of percutaneous access, placing the access sheath, transseptal puncture, advancing the repair device delivery system into position, repositioning the device as needed, and deploying the device(s).  Angiography, radiological supervision, and interpretation performed to guide TMVR are included in these codes.  For more coding and billing information see the introductory language in your CPT book.

New CPT Code	Descriptor	AMA RUC Recommended Work RVU	CY 2015 Interim Final Work RVU
33418	Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis	32.25	32.25
+33419	Additional prosthesis(es) during same session (List separately in addition to code for primary procedure)	7.93	7.93

Transcatheter Placement of Intravascular Stent

New CPT Code	Descriptor	AMA RUC Recommended Work RVU	CY 2015 Interim Final Work RVU
37218	Transcatheter placement of intravascular stent(s),intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation	15.00	15.00

It was identified that the cervical carotid stent codes 37215 and 37216 do not follow the standard endovascular intervention convention of allowing for either open or percutaneous vascular access so for 2015 there is an editorial change to add the phrase "open or percutaneous".

• 37215 - Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection
• 37216 - Without distal embolic protection

Implantable and Wearable Cardiac Device Evaluations

Changes have been added to the introductory language for implantable and wearable device evaluations. These changes were added to replace implantable cardioverter-defibrillator with implantable defibrillator and language to accommodate the two new codes for subcutaneous defibrillator into the coding guidelines.

New CPT Code	Descriptor	AMA RUC Recommended Work RVU	CY 2015 Interim Final Work RVU
93260	Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; implantable subcutaneous lead defibrillator system	0.85	0.85
93261	Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable subcutaneous lead defibrillator	0.74	0.74

Advanced Care Planning

These codes are used to report the face-to-face service between a physician or other qualified health care professional and a patient, family member, or surrogate in counseling and discussing advance directives, with or without completing relevant legal forms.  When using these codes, no active management of the problem(s) is undertaken during the time period reported.

New CPT Code	Descriptor	AMA RUC Recommended Work RVU	CY 2015 Interim Final Work RVU
99497	Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate	1.50	N/A
99498	Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (list separately in addition to code for primary procedure)	1.40	N/A

The Final Rule states "For CY 2015, we are assigning a PFS status indicator of 'I' (Not valid for Medicare purposes. Medicare uses another code for the reporting and payment of these services.) to CPT codes 99497 and 99498 for CY 2015. However, we will consider whether to pay for CPT codes 99497 and 99498 after we have had the opportunity to go through notice and comment rulemaking."

Extracorporeal Membrane Oxygenation

For 2015 the extracorporeal membrane oxygenation (ECMO) codes 33960, 33960, and 36822 were deleted and replaced with 25 new codes.  New codes 33946 – 33989 deal with:

• Initiation
• Daily Management
• Cannulation (Further defined by age)
• Insertion
• Repositioning
• Removal
• Age of patient

Coding Resources

For all the new codes for cardiology including evaluation and management (E/M) codes, review the ACC's free Cardiovascular CPT Coding Update for 2015 webinar.

CPT codes for 2015 can be found in the AMA's CPT book for 2015. The ACC and AMA have partnered to publish the 2015 CPT Reference Guide for Cardiovascular Coding. Stay ahead of coding changes. Order your copy today.

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