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2008 CPT changes: Understand cardiovascular system changes


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Editor's note: This is the fifth article in an ongoing series about the 2008 CPT code changes. To read a summary of the anesthesia services, integumentary system, respiratory system, nervous system, and eye and auditory code changes, click here. To read a summary of the digestive code changes, click here. To read a summary of the urinary, genital, obstetric, and pathology and laboratory changes, click here. For information on of the musculoskeletal system changes, click here.

The American Medical Association (AMA) didn't make many major changes to the cardiovascular section of the 2008 CPT Manual. Instead, the cardiovascular changes take the form of new codes added to aid primary procedures.

Get acquainted with the new codes for 2008

The AMA added nine new cardiovascular system codes. Three of the new codes now report atria tissue ablation and reconstruction procedures when done concurrently with other cardiac procedures. List the following codes in addition to a primary maze procedure code:

  • 33257-Limited (e.g., modified maze procedure)
  • 33258-Extensive (e.g., maze procedure), without cardiopulmonary bypass
  • 33259-Extensive (e.g., maze procedure), without cardiopulmonary bypass

Use new code 33864 to report an ascending aorta graft with a cardiopulmonary bypass for valve suspension, which includes coronary reconstruction and valve-sparing aortic annulus remodeling (e.g., Tirone David or Yacoub procedure).

Cindy Basham, MHA, BSN, CCS, CPC, senior regulatory specialist for HCPro, Inc., in Maryville, TN, says the change to code 33864 reflects the number of people who no longer require total aortic valve replacement due to technological advancements.

"The code reports root reconstruction procedures in which the aortic valve is preserved and the aortic annulus is remodeled," Basham says.

Another new CPT code is 34806, which reports the transcatheter placement of a wireless physiologic sensor in the aneurysmal sac during an endovascular repair. It replaces category III code 0153T, which the AMA deleted. A parenthetical note indicates not to report this code in conjunction with subsequent moderating code 93982.

"That subsequent moderating code is typically performed after discharge at, usually, yearly or half-year intervals," Basham says. "So you will not see these two codes reported together."

The AMA added code 35523 to capture bypass grafts in the arm that terminate on the brachial-radial or radial artery to reroute blood around occluded, upper-extremity arteries. A parenthetical note indicates not to report this code in conjunction with codes 35206 (upper extremity blood vessel repair), 35500 (harvest of one upper extremity vein segment), 35525 (brachial-brachial bypass graft), or 36838 (steal syndrome). A second parenthetical indicates coders should use code 37799 for bypass grafts performed with a synthetic conduit.

The AMA replaced deleted CPT codes 36540 and 36550 with three blood collection codes. These codes fall under a new subcategory heading, "other central venous access procedures." The codes are:

  • 36591-Collection of blood specimen from a completely implantable venous device. A parenthetical note indicates coders should not report this code in conjunction with any other service.
  • 36592-Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified. A parenthetical note indicates coders should not to report this code in conjunction with any other service.
  • 36593-Declotting by thrombolytic agent of implanted vascular access device or catheter.

Modifier -51 list revisions

The modifier -51 list is now nine codes shorter. The AMA revised the following nine codes into "add-on" codes:

  • 33517- Coronary artery bypass, using venous graft(s) and arterial grafts; single vein graft
  • 33518-Coronary artery bypass, using venous graft(s) and arterial grafts; two venous grafts
  • 33519-Coronary artery bypass, using venous graft(s) and arterial grafts; three venous grafts
  • 33521-Coronary artery bypass, using venous graft(s) and arterial grafts; four venous grafts
  • 33522-Coronary artery bypass, using venous graft(s) and arterial grafts; five venous grafts
  • 33523-Coronary artery bypass, using venous graft(s) and arterial grafts; six or more venous grafts
  • 35600-Harvest of upper extremity artery
  • 36660-Catherization, umbilical artery, newborn for diagnosis or therapy
  • 38792-Injection procedure; lymphangiography for identification of sentinel node

"Designating these codes as add-on codes for 2008 makes sense," Basham says. "This really does support the definition of add-on codes always performed with a defined base code . . . Modifier -51 exempt [codes] are not always adjunctive, which means that because these are the venous portion of the venous arterial bypass grafting combined procedure, we would not use these by themselves."

Test your knowledge with these coding scenarios

A 55-year-old female patient has hypertension and hyperlipidemia. She is examined because of unstable angina, and to rule out myocardial infarction. The patient is diagnosed with three-vessel coronary disease and moderate right ventricular dysfunction. She has had numerous atrial fibrillation episodes but now has sinus rhythm and is taking antiarrhythmic medications. An echocardiography shows that she has a slightly enlarged right atrium. At the time of her cardiac procedure, the physician performs a limited operative tissue ablation and reconstruction of the atria (e.g., modified maze procedure).

Click here for answer.

A 75-year-old male has heart failure, severe mitral regurgitation, and a 10-year history of atrial fibrillation requiring anticoagulation. An echocardiogram shows biventricular and biatrial enlargement. A physician performs a cardiopulmonary bypass and an extensive operative tissue ablation and reconstruction of atria (e.g., maze procedure) at the time of his cardiac procedure.

Click here for answer.

A 71-year-old female is diagnosed with a 7.2 cm abdominal aortic aneurysm. She elects to have an endovascular repair to treat it. The physician places an implantable, wireless pressure sensor during the endovascular repair procedure.

Click here for answer.

Editor's note: Contact Cindy Basham, MHA, BSN, CCS, CPC, at cbasham@hcpro.com.

To learn more about the 2008 CPT changes, purchase HCPro's November 28, 2007, audioconference,"2008 CPT: Overview of major coding additions, changes, and deletions" here.