Important CCI Policy Manual Change Thanks to 2013’s New PCI Codes

Mon, Jan 21, 2013 --

Coding Updates

One of the CCI revisions that got you thinking covers guidelines for the new percutaneous coronary intervention (PCI) codes. Check out the highlights of this new policy:

  • For Same-Vessel Services Code is All you Require: The just-out CCI policy manual entry starts by explaining the services included under the term PCI. It also explains that the new codes may cover multiple PCIs in a single code.

CCI Excerpt 1: “Percutaneous coronary artery interventions (PCI) include stent placement, atherectomy, and balloon angioplasty. There are CPT codes describing various combinations of these PCI procedures.”

The “combinations” concept is an important one for proper use of the new codes. For instance, if you compare the two codes below, you’ll see that CPT® clearly defines which PCI procedures are included in the codes (bold added):

·      92924, Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed

·         92933, Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed

As the code definitions show, a single code is sufficient to report multiple PCI services.

  • Add LM and RI to Your Coronary Modifier Arsenal: The subsequent sentence in the CCI policy addresses a significant development for PCI coding. This year, CMS recognizes five major coronary arteries. In 2012, it recognized only three for coding and payment purposes.

CCI Excerpt 2: “There are five major coronary arteries (left main, left anterior descending, left circumflex, right, and ramus intermedius).”

  • Graft Services Merit Separate Code:  The next excerpt from the CCI manual addresses reporting PCI on a second vessel segment through a graft.

CCI Excerpt 3: “Only one PCI code may be reported for all PCIs of a major coronary artery through the native circulation. However, PCI treatment of a different second segment of a major coronary artery through a bypass graft may also be reported with a different PCI code for revascularization treatment through a coronary artery bypass.”

Excerpt 3 repeats the point made in Excerpt 1 that you need only one code to represent multiple PCI services in a major coronary artery. But Excerpt 3 goes further and explains that you may report a second code if additional PCI is carried out in the same vessel through a bypass graft.

CPT® 2013 guidelines offer more guidance: “If one segment of a major coronary artery and its recognized branches is treated through the native circulation, and treatment of another segment of the same vessel requires access through a coronary artery bypass graft, an additional base code is reported to describe the intervention performed through the bypass graft.”

 

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