There were several 2013 coding changes to the Cardiovascular System. Codebusters only addresses those codes most likely performed in the outpatient setting, of which there were very few. In the Cardiovascular section, a new line was added to the table on pacemaker and cardioverter-defibrillator procedures to cover conversion of an existing system to biventricular. The code for left ventricular lead insertion (33225) was revised and a note added to clarify the reporting of pocket revision. A new section and guidelines were added for “Heart (Including Valves) and Great Vessels.” New codes were established for transcatheter aortic valve replacement (33361-33369) and percutaneous ventricular assist device procedures (33990-33993), both of which were previously reported with Category III codes.
New codes were established for head and neck arteriograms (36221-36228) that include both the catheter placement and the imaging. New comprehensive codes were also established for transcatheter thrombolysis (37211-37214) and transcatheter foreign body retrieval (37197). Finally, the revascularization guidelines have been revised to clarify the reporting hierarchy.
CARDIOVASCULAR SYSTEM – VASCULAR INJECTION PXS – DIAGNOSTIC STUDIES AND THERAPEUTIC INTERVENTIONS OF AV DIALYSIS SHUNTS
|36010||Introduction of catheter, superior or inferior vena cava|
|36140||Introduction of needle or intracatheter, extremity|
For the purpose of coding interventional procedures, diagnostic or therapeutic, on renal dialysis patients with AV shunts or grafts, these codes were revised. Injection of medication, repositioning a catheter in an AV shunt/graft patient and introduction of radiopaque contrast (diagnostic) may be performed as needed. Common access veins include the brachial and cephalic veins. Regardless of whether the targeted vein is the superior or inferior vena cava or an extremity artery (brachial or cephalic), the goal is to deliver medications or contrast material.
A 59-year-old woman with ESRD, status post AV graft for renal dialysis is seen by her physician who wants to check the position of her catheter by injecting a contrast material. The subclavian vein is punctured with a large needle and a guidewire is passed into the punctured vein and is threaded into the superior vena cava, after which a radiopaque substance is introduced. Fluoroscopy is used to check the catheter position…………36010