Cardiology coding is undergoing massive changes in 2018. There are 34 new, 12 revised and 28 deleted codes for CPT®, and these 74 code changes will have a major impact on your 2018 reimbursement. The 2018 ICD-10-CM codes that used for discharges occurring from October 1, 2017 through September 30, 2018, and for patient encounters occurring from October 1, 2017 through September 30, 2018 are also here. Get up to speed quickly with the changes to ensure your claims are paid!
Coding expert Terry A. Fletcher recently explained the CPT®, ICD-10-CM and Medicare updates for cardiology in 2018 in an audio conference for ProfEdOnDemand, detailing what you need to do to update your physicians and coders for 2018.
New Hypertension Codes in 2018
As per Fletcher, ICD-10-CM 2018 brings six new codes for pulmonary hypertension, which affects the arteries of the lungs and the heart, as follows:
- 20 (Pulmonary hypertension, unspecified)
- 21 (Secondary pulmonary arterial hypertension)
- 22 (Pulmonary hypertension due to left heart disease)
- 23 (Pulmonary hypertension due to lung diseases and hypoxia)
- 24 (Chronic thromboembolic pulmonary hypertension)
- 29 (Other secondary pulmonary hypertension)
You may see these codes more often with right heart catheter coding and possible valve replacement coding, noted Fletcher.
New Specialty Codes Added
CMS has added three specialty designations starting October 1, 2017 for 2018. Three new specialties will appear under the provider enrollment chain and ownership system (PECOS), which may open up billing opportunities for your provider staff.
These specialty codes pertain to cardiology, medical toxicology and cell transplantation providers, and include:
- C7- Advanced heart failure and transplant cardiology
- C8- Medical toxicology
- C9- Hematorpoietic cell transplantation and cellular therapy
Some specialty groups consider this a big win in preventing some of the denials that come from local Medicare carriers for duplicate billing. For example, when a cardiologist and a specialist, say for heart failure, from the same practice have billed E/M services on the same date, denials are bound to happen, but according to Fletcher, with the new designations, CMS will allow separate services when appropriate.
2018 E/M and Telehealth Services Coding Updates
E/M codes have also undergone several changes, including a new “star” symbol added to CPT® to designate possible “Synchronous Telemedicine Health” code inclusions, and several revised code descriptor sections. Coders should pay specific attention to modifier -95 and -GT, according to Fletcher.
You must submit your Medicare and Medicaid claims for telehealth services using the appropriate CPT® or HCPCS code for the telehealth service along with the modifier GT (via interactive audio and video telecommunications systems)—for example, 99202-GT, according to Fletcher.
- Using the GT modifier with a covered telehealth procedure code certifies that the beneficiary was present at an eligible originating site when your physician or qualified approved practitioner furnishes the telehealth service.
- Using the GT modifier with the covered ESRD-related service telehealth code certifies that your provider furnishes one “hands on” visit per month to examine the vascular access site.
- For federal telemedicine demonstration programs in Alaska or Hawaii, submit claims with the appropriate CPT® or HCPCS code for the professional service along with the GQ modifier, to certify an asynchronous telecommunications system was used.
CPT® Additions, Revisions and Deletions
- New CAT III codes have been added, including for absolute quantitation, valve repair and others.
- New CAT I codes replace total heart system CAT III codes 0051T-0053T.
- Codes now combine the endovascular repair/prosthesis of abdominal aortic/iliac aneurysm (etc), and replace deleted codes.
- New codes for delivery to the endograft and delivery of endovascular prosthesis have been added.
- Revisions include add-on codes for endovascular or open aortic/iliac aneurysm repairs.
- Revisions to the E/M observation codes will add “outpatient hospital” to their descriptors.
- Additions also include new anticoagulant codes to the cardio section, which replace E/M 99363 and 99364.
Apart from these, moderate sedation CPT® codes have undergone major changes. E/M codes with modifier -25 may face drastic pay reductions for some practices, and there are proposed modifiers in the works for the 2018 physician fee schedule, noted Fletcher.
