In case you haven’t heard, they’re here: Yes, the 2019 Current Procedural Terminology CPT® codes have been released, with 335 code changes for 2019. Though they don’t take effect until Jan. 1, 2019 (and there could be more changes before then), it’s wise to begin upgrading your knowledge—or risk losing reimbursement due to lack of preparation.
One area of focus for 2019 cardiology coding deals with cardiac cath CPT® codes, says educator Terry Fletcher in her upcoming ProfEdOnDemand webinar on catheter and percutaneous coronary intervention (PCI) coding. As part of her four-part series in the 2019 Coding Updates Virtual Boot Camp, this session will prepare coders and billers with all you need to know about catheter codes, PV bonus coding, and everything related.
Catheterizations: Know the Access Points
Even if you think you’ve got cath coding down, it’s still worth taking a second – or third or fourth! – look to make sure you understand everything. Knowing right from left catheterization is a no brainer, but have you got all the access points memorized? And could you pick out which is which in the documentation?
Here’s a quick breakdown of main cath access points:
- Femoral artery: Still the most common and the traditional entry point, this artery is found in the groin area.
- Radial artery: A less invasive entry point at the wrist, this approach offers fewer complications, less risk of pain (since there are no major nerves in the wrist) or bleeding, and faster recovery time. This entry point is growing in use, although certain patients still require the femoral artery approach if they do not have good blood flow to both hands.
- Brachial artery: This entry point is in the arm. More complications than radial entry; disadvantages to this approach include the obstacles of the medial nerve and biceps brachial tendon.
Sharp Eyes: To pick out the entry point for each, search the documentation for mention of a specific artery or mention of groin, wrist, or arm. Such attention to detail will also help you in deciding to code for a catheterization or angiography—as well as for right heart catheterization (RHC) or a Swanz-Ganz catheterization.
RHC or Swanz Ganz? Look at the Purpose
If cardiology procedures have you befuddled, you’re not alone. There are catheterizations—and there angiographies using catheters. These two procedures are often confused. Know that an angiography is one of the procedures that can be done during a catheterization, using contrasting agents to view blood vessels.
More: To confuse matters further, there are diagnostic RHCs and Swanz-Ganz catheterizations, which typically measure blood flow through the right side of the heart. If both deal with basically the same area of the heart, what’s the difference?
Basically, the difference between RHCs and Swanz-Ganz is the why of the procedure. If the procedure was purely diagnostic—that is, to see where there are blockages in the blood vessels leading to the heart—you would code for an RHC. If, however, the procedure was done just to monitor and measure blood pressure, Swanz-Ganz is more accurate. Swanz-Ganz is often performed for patients with heart failure, pulmonary artery hypertension, pulmonary edema, and other conditions, as well as after a myocardial infarction (MI) or open heart surgery.
PCI: Which Vessel Affected?
A third catheter-related procedure that very well may have you confused is a PCI, which is a non-surgical procedure that places a stent in veins that have been narrowed by plaque. There were several PCI CPT® codes as of Jan. 1, 2018, so be sure to check if any of them have changed. As with any cath procedure, also look to see which payers are – and aren’t – reimbursing for PCI.
Time’s Ticking: Training Can Help
Take the stress out of the coming cardiology code changes by checking out Fletcher’s webinar and getting your most burning questions answered at the live Q&A. Your practice (and its coffers) will be grateful for your time and extra dedication to your work!
