Cardiology Coding Alert: +92973 Debate Goes Up Around Aspiration Catheters

New information lays emphasis on a 'mechanical' necessity for the thrombectomy code.

In case you've been using coronary thrombectomy code +92973 for reporting a range of methods, pay attention. Thrombectomy by means of aspiration catheter is included in the intervention, as per the American Medical Association (AMA) as well as American College of Cardiology (ACC). Read this article and get an expert cardiology coding insight for accurate claims and maximized ethical reimbursement.

Take a Closer Look at +92973

The code being discussed is +92973 (Percutaneous transluminal coronary thrombectomy [List independently other than code for primary procedure]).

For years, a lot of resources have based their coding recommendations on the simple face of the definition of +92973. If you go through the descriptor, you'll find that it does not specify anything but 'Percutaneous transluminal coronary thrombectomy.

Accordingly, a general recommendation has been that you may give +92973 for a range of methods used to eliminate thrombus, including both fragmentation and aspiration catheters.

Consider the Aspiration Catheter Question

The issue: The 2011 CPT® Reference Guide meant for Cardiovascular Coding (co-published by the AMA and ACC) mentions that +92973 is correct only when the physician uses a mechanical device that fragments the thrombus and removes the clots.

What's new: A number of firms required clarification from the AMA about correct coding for +92973. The firms have lately reported independently that the AMA's response has been to back the information in the ACC/AMA publication: +92973 is not suitable for thrombectomy by aspiration catheter.

The reported AMA responses also point out that non-mechanical coronary thrombectomy is included in any other intervention carried out (for instance coronary angioplasty or stent placement). Under that interpretation, "thrombectomies performed along with aspiration devices such as Pronto and Fetch are incorporated in the intervention and not independently reportable, Thus you would require to see proof that the physician fragmented (broke up) the thrombus versus aspirated (suctioned) it to report +92973.

Confusion remains: A lot of coders maintain that they want to see a more clear guidance in the CPT® manual for +92973 and published guidance from CMS to settle the issue since it could involve changing practice policy on coding these services. Some industry experts have recommended that until CMS issues written guidance, practices should code the service consistently across the board. In other words, the recommendation is that in the absence of written guidance, you shouldn't code differently for different payers.

Bonus: Additional Tips Aid +92973 Correctness

When your documentation does support reporting +92973, keep in mind that you must not report it as an individual code. It is an add-on code and should go with either 92980 (Transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel) or 92982 (Percutaneous transluminal coronary balloon angioplasty; single vessel).

Want to have more expert tips like this and latest cardiology billing and coding updates? Click here to read the entire article and to get access to our monthly Cardiology Coding Alert: Your practical adviser for ethically optimizing cardiology billing and coding, payment and efficiency in cardiology practices. With Cardiology Coding Alert, you get the updated cardiology -specific coding and Medical billing information delivered to you every month

784.0 or 723.8? Headache Choice Depends on Provider Notes

Know the best diagnosis and injection codes.

In case your neurologist or pain specialist administers greater occipital nerve blocks, don't allow coding turn into a headache. Confirm specifics about the patient's headache as well as the service your provider provided to pin down the accurate diagnosis and procedure codes each time. Read this neurology billing and coding expert insight and know what neurology CPT codes apply in such a scenario.

Location of the Occipital Nerve

The greater occipital nerve (GON) starts from the subsequent medial branch of the C2 spinal nerve and supplies sensory innervations to the posterior area of the scalp going to the top of the head. Physicians normally inject the GON at the point of the superior nuchal line which exists just above the bottom of the skull for occipital headaches or neck pain.

Tip: Some physician practices have a little illustration in the chart that the physician can mark with a range of injection sites. Counting this type of tool helps your physician unmistakably document the injection location, which further helps you select the correct nerve injection neurology CPT code as well as submit more accurate claims.

Kind of Headache

Your physician's documentation may have notes covering "occipital headache" to "occipital neuralgia" to "cervicogenic headache." Your job is to make certain that you interpret the notes and then assign the most precise diagnosis.

Occipital headache: ICD-9's alphabetic index does not contain a definite listing meant for occipital headache. Owing to this, you should report the general code 784.0 (Headache), which involves "Pain in head NOS." Further details in your provider's notes may result in diagnoses like 307.81 (Tension headache), 339.00 (Cluster headaches), 339.1x (Tension type headache), or 346.xx (Migraine).

Occipital neuralgia: You have certainly a more definite diagnosis to code when your provider documents occipital neuralgia. Greater occipital neuralgia lead to an aching, burning, or hammering pain or sensation a tingling or numbness all along the back of the head. You'll, in such a case, report diagnosis 723.8 (Other syndromes affecting cervical region).

Cervicogenic headache: The alphabetic index doesn't involve a listing requiring coders to reassess a definite ICD-9 code . A lot of coders report 784.0 (Headache) because of lack of a better option.

Handling Bilateral Injections

Once your provider administers bilateral GON injections, confirm the patient's insurance company prior to completing your claim.

Reason: A lot of Medicare contractors need you to report bilateral procedures as simply a single line item along with a single unit of service as well as modifier 50 (Bilateral procedure) appended. Private payers, though, regularly need two lines for bilateral claims:

Line 1 including the neurology procedure code, modifier RT (Right side), as well as one unit of service

Line 2 including the neurology procedure code, modifier LT (Left side), as well as one unit of service.

Want to have more neurology Medical billing and coding expert tips and know everything about neurology CPT codes ? Click here to read the entire article and to get access to our monthly Neurology and Pain Management Coding Alert: Your practical adviser for ethically optimizing neurology billing and coding, payment, and efficiency in neurology and pain management practice

About the Editor: Leigh DeLozier, BS, CPC, moved from the world of hospital public relations to writing Specialty Alerts in the year 1999. She launched the Anesthesia Coding Specialty Alert and is presently the editor for three other publications including Neurology and Pain Management Coding Alert, Family Practice Coding Alert, and Anesthesia Coding Alert. She has written for pain management, pulmonology, oncology, and other specialties along the way. Leigh re-launched newsletters for podiatry and dermatology in 2009.
She became a Certified Professional Coder® (CPC®) through the American Academy of Professional Coders (AAPC) in 2002.

Pin down Common Acronyms to Code More Precisely

Make out how well you understand these abbreviations.

In case the charts you code occasionally seem like alphabet soup owing to specialized acronyms or abbreviations your providers use, it's time to re-acquaint yourself with some common terms to help improve your coding. Read on this expert anesthesia billing service insight and for perfect anesthesia claims and maximized reimbursements.

Here's why: When the physician documents a chart, he doesn't at all times have time to elucidate phrases like "past history" (PH) and "present illness" (PI), however knowing which is which can make a remarkable difference in the correctness of your charts. In case you code a chart thinking that the patient presently suffers from every condition listed as "PH," you'll be certainly coding the wrong diagnoses for the present illness.

Does 'TKA' Mean Visualizing or Replacing?

The physician documents "TKA" in the patient' chart, which could mean "total knee arthroplasty" or "total knee arthroscopy." In arthroplasty, the surgeon repairs or replaces a joint. Through arthroscopy, on the other hand, the surgeon utilizes minimally invasive techniques to look inside the patient's joint to better diagnose problems and probably provide some treatment.

Possibility 1: The right CPT® surgical code meant for total knee arthroplasty is 27447 (Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing [total knee arthroplasty]). Code 27447 crosses to anesthesia CPT code 01402 (Anesthesia for open or surgical arthroscopic procedures on knee joint; total knee arthroplasty), which has a base value of 7 units.

Possibility 2: CPT® covers a variety of codes meant for total knee arthroscopy, resting on the detailed procedure. Each choice crosses to anesthesia CPT code 01400 (Anesthesia for open or surgical arthroscopic procedures on knee joint; not otherwise specified), which is valued at 4 base units.

Does 'I&D' Point to Clean Up or Incision?

Assume the doctor documents "I and D" on the chart that means he has documented this for both 'irrigation and debridement' as well as 'incision and drainage, This is a different example of two dissimilar types of procedures with two seperate surgical codes, so make certain that you know what your provider means.

Possibility 1: You code irrigation and debridement along with the suitable selection from a huge range of codes, dependent on which level of skin the surgeon reaches. A number of of the options meant for surgical codes cross to either 00300 (Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified) with 5 base units or 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified) with 3 base unit value. Though, other options send coders to more detailed anatomical codes, so ensure that you do understand which code selection is suitable.

Possibility 2: You code incision and drainage, though, with a choice from 10060-10180. The code descriptors differ in accordance with what the surgeon incised as well sd the level of complexity. Each code crosses to anesthesia CPT codes 00300 or 00400, as the irrigation and debridement procedures.

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