Coding Corner: Overview of 2024 Coding Changes Impacting Cardiology

Cardiovascular clinicians will see a number of coding changes starting Jan. 1, 2024. The ACC Advocacy team has prepared the following overview outlining the 23 new CPT® codes, new HCPCS codes, and the deletion of HCPCS code G2066 that are important to cardiovascular clinicians. Additionally, the 2024 CPT/HCPCS book, which contains new introductory language, parentheticals and additional information pertaining to these new codes, is an important resource.

Phrenic Nerve Stimulator System Codes For Central Sleep Apnea: A total of 12 CPT codes were developed for the phrenic nerve stimulator system to treat central sleep apnea. Eight CPT codes (33277-33288) were developed for the insertion, removal, and removal and replacement of the phrenic nerve stimulator. These codes include vessel catheterization, all imaging guidance, and interrogation and programming, when performed. One new code was created for therapy activation of the implanted phrenic nerve stimulator system (93150) to be performed on another day. Two new codes were developed for the interrogation and programming of an implanted phrenic nerve stimulator (93151 and 93152) and one new code for interrogation without programming (93153).

Coronary Computed Tomography Fractional Flow Reserve: One new code (75880) was established for the noninvasive estimate of coronary fractional flow reserve derived from a coronary computed tomography angiography with interpretation and report. This code can be billed globally or with a technical component (TC)/professional component (PC) split. Previously, this service was reported using one or several of the four Category III codes (0501T-0504T), which will be deleted in 2024.

Intraoperative Epicardial Cardiac Ultrasound: Three CPT codes were established specifically for diagnostic intraoperative epicardial cardiac ultrasound. The global code is for placement and manipulation of transducer, image acquisition, and interpretation and report (76987). There are also component codes for placement, manipulation of transducer and image acquisition only (76988) and for interpretation and report only (76989). Separate from this family of codes is a CPT code for intraoperative ultrasound for thoracic aorta (76984).

Percutaneous Transluminal Coronary Lithotripsy: The American Medical Association developed an add-on CPT code (+92972) for intravascular coronary lithotripsy, which can be applied to eight PCI procedures (92920, 92924, 92928, 92933, 92937, 92941, 92943, 92975).

Deletion of HCPCS Code G2066: The Centers for Medicare and Medicaid Services (CMS) deleted G2066 and added refinement of existing CPT code 93297 and 93298 for interrogation device evaluations. CMS had created G2066 to report the TC of insertable cardiac monitor and implantable loop recorder remote interrogation in 2020 after 93299 was deleted. The 2024 Medicare Physician Fee Schedule (PFS) final rule now assigns TC to 93297 and 93298. Both 93297 and 93298 can be billed without modifiers to report the global service when a clinician/office performs both the professional and technical portion of remote interrogation. These codes can also be billed with the 26 modifier for the professional service only when the technical component is provided by another entity. In cases where another entity provides the technical component, the TC modifier will be billed for the technical portion only of the remote interrogation services.

Venography Codes For Congenital Heart Defect(s): Five new add-on codes were created for performing venography for congenital heart defect(s). First is a code for venography for anomalous or persistent superior vena cava when it exists as a second contralateral superior vena cava with native drainage to heart (93584). Other codes are for azygos/hemi-azygos venous system (93585), coronary sinus (93586), venovenous collaterals originating at or above the heart (93586) and venovenous collaterals originating below the heart (93588). All codes include catheter placement and radiological supervision and interpretation.

Ongoing Care Evaluation and Management (E/M) New Code G2211: In the 2024 Medicare PFS final rule, CMS implemented an HCPCS add-on code for "visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient' single, serious condition or a complex condition"(G2211). This code can be applied to the following office/outpatient (O/O) services: 99202-99215. G2211 would not be payable when the O/O E/M visit is reported with modifier 25 (Significant Separately Identifiable E/M visit). CMS created this code to reflect the time, intensity and practice expense resources involved when practitioners furnish O/O E/M visits that enable them to build long-lasting relationships with their patients and address the majority of a patient's health care needs with consistency and continuity over longer periods of time. CMS has indicated that the relationship between the patient and the practitioner is the determining factor of when the add-on code should be billed. This relationship should be clearly defined in documentation. Since this is a new coding concept, CMS will consider developing additional educational materials as needed. This code will be reported by specialties and clinicians who rely on O/O E/M visits to report ongoing E/M services. Update: CMS issued additional instructions for reporting G2211 on Jan. 18, 2024. Learn more.

Office or Other Outpatient Services and Other E/M Changes: Several revisions were made in the E/M section of the CPT book for office/outpatient visits codes 99202-99215. Time ranges have been removed from office/outpatient E/M codes and replaced with a minimum of time spent with patients. For example, 99203 used to say "30-44 minutes of total time is spent on the date of the encounter" and now the code states "30 minutes must be met or exceeded". The office/outpatient services E/M codes now mimic the inpatient codes, articulating that medical decision making can determine the level of your E/M visit when performed with a medically appropriate history and/or examination. Clinicians can code their visits based on time or medical decision making. There are also new guidelines regarding time and consultations to review in the combined hospital inpatient and observation codes (99234-99239).

Split (or Shared) Visits: CMS finalized a policy for E/M visits furnished in a facility setting to allow payment to a physician for a split (or shared) visit (including prolonged visits), where a physician and advanced practice provider in the same group practice provide the service together (not necessarily concurrently), and the billing physician personally performs a "substantive portion" of the visit. CMS will now define a substantive portion of a split/shared visit to align with the new CPT guidelines for spilt or shared visits. CPT guidelines state: "The split or shared visits guidelines are applied to determine which professional may report the service. If the physician or other QHP performs a substantive portion of the encounter, the physician or other QHP may report the service. If code selection is based on total time on the date of the encounter, the service is reported by the professional who spent the majority of the face-to-face or non-face-to-face time performing the service." This CMS policy allows the billing provider to continue to be determined by either total time or medical decision-making (MDM) performed with the exception of critical care visits, which do not use MDM, only time.

Clinical Topics: Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and Imaging, Computed Tomography, Nuclear Imaging

Keywords: ACC Advocacy, Current Procedural Terminology, Centers for Medicare and Medicaid Services, U.S., Fractional Flow Reserve, Myocardial, Outpatients, Inpatients, Phrenic Nerve, Coronary Sinus, Healthcare Common Procedure Coding System, American Medical Association, Computed Tomography, Computed Tomography Angiography, Percutaneous Coronary Intervention, Medicare, Catheterization, Referral and Consultation, Delivery of Health Care, Fee Schedules, Group Practice, Lithotripsy, Critical Care, Hospitals

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