This is Part 2 of a 5 part series on the new 2022 CPT codes. In this series we will explore the CPT changes for FY2022 and include some examples to help the coder understand the new codes. There are significant additions, deletions and changes for the cardiovascular system this year. In this part, I will discuss both the cardiovascular surgery sub-section changes, the Medicine section cardiovascular changes and the Category III cardiovascular code changes since they all involve the cardiovascular system. I will cover each under separate title below. Sorry for the length!
Cardiovascular System Surgery Sub-Section
We start this with codes added for 2 OPEN and 1 THORACOSCOPIC exclusion of left atrial appendage (LAA):
- 33267 Exclusion of left atrial appendage, open, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip)
- ✚33268 Exclusion of left atrial appendage, open, performed at the time of other sternotomy or thoracotomy procedure(s), any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip) (List separately in addition to code for primary procedure)
- 33269 Exclusion of left atrial appendage, thoracoscopic, any method
(eg, excision, isolation via stapling, oversewing, ligation, plication, clip)
Be aware of the notations for these codes in the CPT book. +33268 is obviously an add-on code. And 33259 is THORACOSCOPIC so coders will need to be aware of the approach used. These procedures are usually done to treat atrial fibrillation or to mitigate postoperative thromboembolic complications.
- +33370 Transcatheter placement and subsequent removal of cerebral embolic protection device(s), including arterial access, catheterization, imaging and radiological supervision and interpretation, percutaneous (List separately in addition to code for primary procedure) (Use +33370 in conjunction with 33361-33366). The cerebral embolic protection device is used with the TAVR/TAVI codes and protects the supra-aortic vessels from embolic debris such as calcification fragments.
The “harvest of artery ENDOSCOPIC” and existing codes have been revised as follows:
- 33509 Harvest of upper extremity artery, 1 segment, for coronary artery bypass procedure, endoscopic (use -50 for bilateral)
- Use existing code 33508 for endoscopic harvesting of VEIN
▲35600 Harvest of upper extremity artery, 1 segment, for coronary artery bypass procedure, open(List separately in addition to code for primary procedure) No longer an add-on code. Use 35600 in conjunction with 33533–33536.
New codes for endovascular stent repair of coarctation of ascending, transverse or descending thoracic aorta based on if it is across major side branches or not. This site gives a good photo: https://childrenheartcare.com/interventions/stenting-of-coarctation-of-aorta-coa/
- 33894 Endovascular stent repair of coarctation of the ascending, transverse, or descending thoracic or abdominal aorta, involving stent placement; across major side branches
- 33895 not crossing major side branches
Major side branches are brachiocephalic, carotid, subclavian for thoracic aorta and celiac, superior mesenteric, inferior mesenteric and renal arteries for abd aorta.
Coder must be sure to ascertain if the stent is crossing or not cross major side branches listed above and read the “do not report with codes” in the tabular.
- 33897 Percutaneous transluminal angioplasty of native or recurrent coarctation of the aorta. Note that this is addressing coarctation but by ANGIOPLASTY and not a stent.
Cardiovascular Medicine Section Codes
There is a new code for 3D echocardiographic imaging for congenital cardiac anomalies. It is in real time and acquisition of pyramidal datasets without the need for offline reconstruction.
- +93319 3D echocardiographic imaging and postprocessing during transesophageal echocardiography, or during transthoracic echocardiography for congenital cardiac anomalies, for the assessment of cardiac structure(s) (eg, cardiac chambers and valves, left atrial appendage, interatrial septum, interventricular septum) and function, when performed (List separately in addition to code for echocardiographic imaging)
New codes were create for congenital heart catheterizations! The old codes 93530-93539 were deleted. The new codes are based on normal vs abnormal native connections. Coders must read the extensive notes in this subsection. There are notes that state what to do in different situations. Coders must SEE TABLE 771-773 in the CPT book for help.
- Normal native connections: blood flows along the expected course through the right and left heart chambers and the great vessels. For example, acyanotic defects like coarctation, VSD, ASD. PDA and PS are NORMAL connections.
- Abnormal native connections: alternative connections for the pathway of blood flow through the heart and great vessels, typically patients with cyanotic defects.
- Typically found in patients with abnormal cardiac anatomy (eg, Tetralogy of Fallot, hypoplastic left or right heart, transposition of great vessels, s/p Fontan, tricuspid atresia, atrial switch conduits, etc.) More examples in CPT book.
- 93593 Right heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone; normal native connections (includes ventricle subpulmonic position)
- 93594 abnormal native connections
- 93595 Left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone, normal or abnormal native connections (includes rt ventricle subaortic)
- 93596 Right and left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone(s); normal native connections
- 93597 abnormal native connections
- +93598 Cardiac output measurement(s), thermodilution or other indicator dilution method, performed during cardiac catheterization for the evaluation of congenital heart defects (List separately in addition to code for primary procedure)
Cardiovascular Category III Section Codes
It is easier to discuss the cat III CV codes here since they are similar, just not yet Section I codes.
The first codes are for laparoscopic placement of synchronized diaphragmatic stimulation device to improve cardiac output. This is done to address congestive heart failure where other methods may have failed. Achieved by synchronizing movement of the diaphragm with the movement or beating of the heart, thereby reducing the effort necessary for the heart to pump blood throughout the body. VisOne by VisCardia is one example. There are several codes depending on what is inserted or removed. Coders will have to be sure they are assigning the correct code for what is being done as there are several codes:
- 0674T Laparoscopic insertion of new or replacement of permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, including an implantable pulse generator and diaphragmatic lead(s)
- 0675T Laparoscopic insertion of new or replacement of diaphragmatic lead(s), permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, including connection to an existing pulse generator; first lead
- ✚0676T each additional lead (List separately in addition to code for primary procedure)
- 0677T Laparoscopic repositioning of diaphragmatic lead(s), permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, including connection to an existing pulse generator; first repositioned lead
- ✚0678T each additional repositioned lead (List separately in addition to code for primary procedure)
- 0679T Laparoscopic removal of diaphragmatic lead(s), permanent implantable
synchronized diaphragmatic stimulation system for augmentation of cardiac function ►(Use 0679T only once regardless of the number of leads removed)◄
- 0680T Insertion or replacement of pulse generator only, permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, with connection to existing lead(s)
- 0681T Relocation of pulse generator only, permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, with connection to existing dual leads
- 0682T Removal of pulse generator only, permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function
- 0683T Programming device evaluation (in-person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional, permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function
- 0684T Peri-procedural device evaluation (in-person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review, and report by a physician or other qualified health care professional, permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function
- 0685T Interrogation device evaluation (in-person) with analysis, review and report by a physician or other qualified health care professional, including connection, recording and disconnection per patient encounter, permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function
Body surface–activation mapping is a technology used to determine optimal placement of a cardiac resynchronization device, such as a pacemaker or cardioverter-defibrillator, to treat cardiac dys-synchrony
- 0695T Body surface–activation mapping (BSAM) of pacemaker or pacing cardioverter-defibrillator lead(s) to optimize electrical synchrony, cardiac resynchronization therapy device, including connection, recording, disconnection, review, and report; at time of implant or replacement
►(Use 0695T in conjunction with 33224, 33225, 33226)◄
- 0696T at time of follow-up interrogation or programming device evaluation
►(Use 0696T in conjunction with 93281, 93284, 93286, 93287, 93288, 93289)◄
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In Part 3 we will discuss the digestive, urinary, and reproductive system CPT code changes.
The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.