Medical Billing Blog

New PCI Codes for 2013--Fun With Percutaneous Cardiac Intervention!

Posted by Loriann Code, CPC, CCC, CMA on Tue, Mar, 26, 2013 @ 12:03 PM

Road Closed Heart Detour resized 600The new PCI codes introduced into the CPT Code Set in 2013 may seem confusing, but it’s worth wading through the information available, since their use can more than make up for revenue lost to fee schedule cuts and previously non-reimbursable procedures and decision making.  In fact, creation of these new PCI codes represents a positive response to requests from providers for revision of the codes to allow payment for actual services performed.

It used to be that physicians could not bill for intervention in a bypass graft, but the 2013 added codes now allow providers to be paid for percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), or for any combination of intracoronary stent, atherectomy, and angioplasty, including distal protection.

This means the regulatory bodies have now made it permissible for providers to submit claims for work on all five major arteries, as if the anatomy had not always been there! Providers are now allowed to get paid not only for work on the Ramus intermedius and left main artery, but also for work on up to two branches extending from three of these coronary arteries.

For the first time, these new codes allow providers to seek reimbursement for procedures that take into account multiple criteria not considered relevant prior to the start of this year:  Consideration is given for anatomy, timing, number of vessels, and level of occlusion.

In order to use these codes appropriately and to the maximum benefit, the new code set also indicates a need for greater communication between doctor and biller.  For the first time, it has become important for billers to understand what is going on in the case before the provider performs an intervention, so prudent providers should ensure they account for pre-intervention case history and timing when recording dictation.  Notes should include information about status, timing and severity in order to provide their billers and coders with fully-compliant notes:  Is the patient having an acute Myocardial Infarction?  How long has the patient been in the hospital?  How occluded is the vessel?  Proper dictation, in this case, also means the doctor earns higher RVUs for these interventions.

Now more than ever, it’s important for providers to be familiar with coding changes and to communicate openly with their revenue cycle managers to maximize reimbursement for all of their work.  And they’re being granted consideration for timely performance and decision making on a level previously nonexistent.  Of course, providers have to be aware of—and comply with—guidelines for using these new codes, but these changes represent a very positive step for the CPT set, and providers should welcome both the learning curve, and the remuneration that go with it.