This is Part 3 of a five part series on the new 2021 CPT codes. In this series we will explore the cardiovascular system CPT changes. There are 5 new cardiovascular CPT codes added with 0 deletions and 4 revisions.
Three new codes were developed for shunting procedures:
- 33741 Transcatheter arterial septostomy (TAS) for congenital cardiac anomalies to create effective atrial flow, including all imaging guidance by the proceduralist, when performed, any method (eg, Rashkind, Sang-Park, balloon, cutting balloon, blade) (Use 93462 for transseptal puncture)
- 33745 Transcatheter intracardiac shunt (TIS) creation by stent placement for congenital cardiac anomalies to establish effective intracardiac flow, including all imaging guidance by proceduralist, when performed, left and right heart diagnostic catheterization for congenital cardiac anomalies, and target zone angioplasty, when performed, (eg, atrial septum, Fontan fenestration, right ventricular outflow tract, Mustard/Senning/Warden baffles); initial intracardiac shunt (Extensive notes at Shunting Procedures section!)
- +33746 each additional intracardiac shunt location (list separately)
Coders must review the method used to create the shunt to assign the correct code. Also, these procedures are for patients with congenital heart problems such as transposition of great vessels or hypoplastic left heart syndrome. There are extensive notes for these codes so be sure to read them. For example, all catheterization, US imaging, fluoro and diagnostic cardiac catheterization is included in 33745. A diagnostic cath usually is not done during 33741 but if it is, the coder CAN report it. The coder can’t report it with 33745 as that code includes it.
Also, if multiple stents are used in 33745, only report the code once regardless of how many stents.
Percutaneous Ventricular Assist Device (VAD)
One new code and several revisions to existing codes were made for percutaneous ventricular assist device. The coder must be careful to identify what side of heart is involved as can be seen below.
- 33995 Insertion of ventricular assist device, percutaneous, including radiological S&I;
- right heart, venous access only
▲ 33990 left heart, arterial access only
▲ 33991 left heart, both arterial and venous access, with transeptal puncture
▲ 33992 Removal of percutaneous left heart ventricular assist device, arterial or arterial and venous cannula(s), at separate and distinct session from insertion. (Includes removal of cannulas)
- 33997 Removal of percutaneous right heart ventricular assist device, venous cannula, at separate and distinct session from insertion
▲ 33993 Repositioning of percutaneous right or left heart ventricular assist device with imaging guidance at separate and distinct session from insertion.
The VAD provides hemodynamic support to the right heart, left heart or both. The approach can be open or percutaneous. There are extensive notes. For example, repositioning of the VAD at time of insertion is not separately reportable.
Interatrial Septal Shunt Device
There is a new code for this type of shunt, also called or known as an “IASD”
- 0613T Percutaneous transcatheter implantation of interatrial septal shunt device, including right and left heat catheterization, intracardiac echocardiography, and imaging guidance by the proceduralist, when performed. Coders must be sure to read the extensive exclusion notes.
An interatrial shunt device reduces left atrial pressure, improves hemodynamics and prevents adverse remodeling in an ovine heart failure model. … A modified technique of stent fenestration of the interatrial septum improves patients with pulmonary hypertension.
Replacement of Substernal Defibrillator Generator
There was no code previously for just the removal and replacement of substernal generator alone. 0580T is for removal WITHOUT replacement. The AMA created this new code:
- 0614T Removal and replacement of substernal implantable defibrillator pulse generator
(Do note report 0614T with 33262, 0571T, 0572T, 0575T, 0576T, 0577T, 0580T) These are the other codes are for insertion of device with electrodes, programming, repositioning, etc.
Automated Quantification of Plaque
There are several new codes for automated quantification of plaque:
- 0623T Automated quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, using data from coronary computed tomographic angiography; data preparation and transmission, computerized analysis of data, with review of computerized analysis output to reconcile discordant data, interpretation and report
- 0624T data preparation and transmission
- 0625T computerized analysis of data from coronary computed tomographic angiography
- 0626T review of computerized analysis output to reconcile discordant data, interpretation and report
This is a web-based service instead of an in person service in which CTA data are analyzed using computerized algorithms to assess the extent and severity of coronary artery disease.
Endovascular Venous Arterialization
A new category III code was created for tibial or peroneal venous arterialization. This is for a patient that has chronic total occlusion. It is a connection from artery to vein is performed using various methods. A covered stent introduced into vessel to connect the two.
- 0620T Endovascular venous arterialization tibial, or peroneal vein, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed, all catheterization(s) and intraprocedural roadmapping and imaging guidance necessary to complete the intervention, all associated S&I when performed
Transcatheter Ultrasound Ablation of Nerves of Pulmonary Arteries
- 0632T Percutaneous transcatheter ultrasound ablation of nerves innervating the pulmonary arteries, including right heart catheterization, pulmonary angiography, and all imaging guidance
We have seen this done to other nerve areas such as the knee. This is just a code for a new site.
In Part 4 of this series, we will discuss the remaining new surgical CPT codes in the surgery section for 2021.
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 can change rapidly.