What Is The Cpt Code For Repair Pulmonary Artery Aneurysm

Pat Maccariella‑Hafey
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Instruction
AHIMA‑Canonical ICD‑10‑CM/PCS Trainer and Ambassador

This is Part 3 of a five function series on the new 2020 CPT codes. In this series we will explore the CPT changes for FY2019 and include examples to help the coder understand the new codes. There are eleven new cardiovascular CPT codes added with 8 deletions and ii revisions.

Pericardiocentesis

4 new codes were developed for pericardiocentesis by historic period and whether patient has congenital cardiac bibelot or not.

• 33016 Pericardiocentesis, including imaging guidance, when performed
• 33017 Pericardial drainage with insertion of indwelling catheter, percutaneous, including fluoroscopy and/or ultrasound guidance, when performed, 6 years and older without congenital cardiac bibelot  (Usually for CHF.)
• 33018, birth through five years OR any age WITH built cardiac anomaly.   (code to this code if postop within 90 days of repairing the built cardiac defect)  See notes in CPT volume after code.

The catheter needs to remain in place subsequently the procedure.

• 33019 Pericardial drainage with insertion of indwelling catheter, percutaneous, including CT guidance

Coders should non written report 33016-33018 with 93303-93325 when echocardiography is performed solely for the purpose of pericardiocentesis guidance.

(Do non report 33017-33019 with 75989, 76942, 77002, 77012, 77021)

Older codes 33010, 33011 were deleted. (They had been initial and subsequent)

The codes include imaging as many other codes at present do.  Coders must be aware if the patient has or had a congenital bibelot repaired within 90 days.

Ascending Aorta Graft

Iii new codes were developed for ascending aorta graft and transverse aorta graft:

• 33858 Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed; for aortic autopsy
• 33859 for aortic disease other than dissection (eg, aneurysm)

Deleted 33860 Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed

The new codes differentiate this process past what information technology is performed for. The basic process is the aforementioned as 2019, just the reason was added.

Deleted 33870 Transverse arch graft, with cardiopulmonary bypass

• 33871 Transverse aortic curvation graft, with cardiopulmonary bypass, with profound hypothermia, total circulatory arrest and isolated cerebral perfusion with reimplantation of arch vessel(s) (eg, isle pedicle or private arch vessel reimplantation)
  The new codes now differentiate betwixt an ascending aortic graft done for aortic dissection vs one done for diseases other than dissection such as an aneurysms.

Endovascular Repair of Iliac Artery

Two new codes for IBE or iliac branched endograft. Ane is an add-0n code for repair at time of aorto-iliac endograft and one done at some other fourth dimension on its own.  This is an endograft that has BRANCHES, 1 for internal iliac and one for external iliac co-operative. Please see this website for photos and example:https://evtoday.com/articles/2017-aug-supplement/techniques-of-endovascular-aortoiliac-repair-using-an-iliac-branch-endoprosthesis

• +34717 Endovascular repair of iliac avenue at the time of aorto-iliac artery endograft placement by deployment of an iliac branched endograft including pre-procedure sizing and device pick, all ipsilateral selective iliac artery catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation and distally in the internal iliac, external iliac, and mutual femoral artery(ies), and treatment zone angioplasty/stenting, when performed, for rupture or other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation, penetrating ulcer, traumatic disruption), unilateral (List separately in addition to code for primary procedure) (IBE)
• 34718 Endovascular repair of iliac artery, non associated with placement of an aorto-iliac artery endograft at the aforementioned session, by deployment of an iliac branched endograft, including pre-process sizing and device selection, all ipsilateral selective iliac artery catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(due south) proximally to the aortic bifurcation and distally in the internal iliac, external iliac, and common femoral avenue(ies), and handling zone angioplasty/stenting, when performed, for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation, penetrating ulcer), unilateral  (IBE)

Exploration of Avenue

One revised code and two new codes describe exploration of avenue without any other surgical repair.  They are categorized past arteries of cervix, of upper extremity and lower extremity.  This is much easier than trying to create codes for each specific artery.  Older codes were deleted.

▲ 35701 Exploration (not followed by surgical repair,), with or without lysis of artery; cervix (e.g., carotid artery, subclavian)

• 35702 Exploration (not followed by surgical repair,), artery; upper extremity (eg, axillary, brachial, radial, ulnar)
• 35703 Exploration (not followed by surgical repair,), artery; lower extremity (eg, mutual femoral, deep femoral, superficial femoral, popliteal, tibial, peroneal)

Deleted:

35721 Exploration (not followed past surgical repair), with or without lysis of artery; femoral artery

35741 Exploration (not followed by surgical repair), with or without lysis of artery; popliteal artery

35761 Exploration (not followed past surgical repair), with or without lysis of artery; other vessels

Center Valve Repairs

There are several new codes for dissimilar methods of different valve repairs:

• 0543T Transapical mitral valve repair, including transthoracic echocardiography, when performed, with placement of bogus chordae tendineae. This website helps the coder sympathise the repair: https://www.semanticscholar.org/paper/Transapical-chirapsia-heart-chordae-implantation-in-a-Lancellotti-Radermecker/17289628020b757c742e2d2bc0410902c5840d16
• 0544T Transcatheter mitral valve annulus reconstruction with  implantation of adjustable annulus reconstruction device, percutaneous arroyo including transseptal puncture. This website helps the coder empathise the repair:  https://www.edwards.com/gb/devices/transcatheter-valve-repair/cardiobandmitralsystem
• 0545T Transcatheter TRICUSPID valve annulus reconstruction with  implantation of adaptable annulus reconstruction device, percutaneous approach
• +0569T Transcatheter tricuspid valve repair, percutaneous approach, initial prosthesis
• +0570T each additional prosthesis during the aforementioned session (code in addition to +0569T) These websites will assist coders with tricuspid valve repairs. https://www.cathlabdigest.com/commodity/Percutaneous-Valve-Innovations-Tricuspid-Valve-Intervention   https://world wide web.icrjournal.com/manufactures/Transcatheter-Tricuspid-Regurgitation-Handling

(Do non written report with 93451 thru 93461, 93566 for diagnostic left and correct center catheterization procedures intrinsic to the valve repair procedure.  Do not written report with 93454, 93563, 93564 for coronary angiography procedures intrinsic to the valve repair procedure.)

Prior to 2020, only Open tricuspid valve repair procedures were available.  We now have codes for percutaneous tricuspid valve repair.

Cardioverter Defibrillator with Substernal Electrode

Annotation that at that place are now Three different types of cardioverter-defibrillators:

Transvenous implantable  (ICD)

Subcutaneous implantable (Southward-ICD)

Substernal implantable (new in 2020)

Substernal defibrillator has the atomic number 82 subcutaneously tunneled and placed in the substernal anterior mediastinum, without entering the pericardial cavity. The generator is placed subcutaneously in the chest surface area as other defibrillator generators are.   Coders must make certain they are coding the appropriate blazon and method of device and must read the operative note carefully.  The new range of codes are Category III codes get-go with 0571T for insertion of this system through 0580T for removal of substernal pulse generator just. There are 10 new codes for insertions, removal, repositioning, programing, interrogation, etc.  Coders must become familiar with all of these codes.  This website will assist the coder in substernal electrode placement:  https://www.dicardiology.com/article/future-cardiac-rhythm-management-device-technology

Iliac Arteriovenous Anastomosis Implant

• +0553T Percutaneous transcatheter placement of iliac arteriovenous anastomosis implant, inclusive of all radiological S&I, intraprocedural roadmapping, and imaging guidance necessary to complete intervention is a new lawmaking.  This is a transcatheter creation of an iliac AV anastomosis via an implant.  It is different from other process since this procedure creates an anastomosis in the iliac vein and artery using an implanted device.  This is used to treat patients with resistant hypertension.  The AV coupler device leads to decreased full vascular resistance and improved arterial compliance.  Do non report with 36005, 36011, 36012, 36140, 36245, 36246, 37220, 37221, 37224, 37226, 37238, 37248, 75710, or 75820.  This website will help coders sympathise this new device: https://www.researchgate.cyberspace/figure/A-Arteriovenous-coupler-and-introducer-The-ROX-coupler-is-a-self-expanding-nitinol_fig1_306048039

In Function 4 of this serial, we will discuss the remaining new surgical CPT codes for 2020.

Happy Coding!

The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they tin modify rapidly.

Source: https://www.hiacode.com/education/new-2020-cpt-codes-cardiovascular-system/

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