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Cardiology Coding Alert

HCPCS:

Focus on Arteriovenous Fistula Creation HCPCS Level II Updates

 Remember: Pay attention to effective dates for COVID-19 HCPCS Level II codes.

The Centers for Medicare & Medicaid Services (CMS) has released the July 2020 quarterly updates to the HCPCS Level II file. You’ll see several cardiology-specific changes, including arteriovenous fistula creation additions and deletions, new endovascular revascularization codes, and cardiac magnetic resonance imaging additions.

Editor’s note: The effective date for these codes is July 1, 2020 unless otherwise specified.

Read on to learn how to report the new HCPCS Level II codes in your cardiology practice.

Catch New Arteriovenous Fistula Creation Codes

You will see several changes to the arteriovenous fistula creation HCPCS Level II codes.

First, the following codes will be added:

  • G2170 (Percutaneous arteriovenous fistula creation (AVF), direct, any site, by tissue approximation using thermal resistance energy, and secondary procedures to redirect blood flow (e.g., transluminal balloon angioplasty, coil embolization) when performed, and includes all imaging and radiologic guidance, supervision and interpretation, when performed)
  • G2171 (Percutaneous arteriovenous fistula creation (AVF), direct, any site, using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, veinography, and/or ultrasound, with radiologic supervision and interpretation, when performed)

 Don’t miss: As you can see, you will report either G2170 or G2171 for direct percutaneous arteriovenous fistula creation. However, your code selection will depend upon the method used. So, you must carefully check the medical documentation when your cardiologist performs these procedures to ensure that you choose the correct code.

With code G2170, “tissue approximation using thermal resistance energy and secondary procedures to redirect blood flow,” should be used. And with code G2171 “magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures” should be used.

“These HCPCS Level II codes were created to replace deleted codes C9754 and C9755 and were assigned to the same APC and status indicators,” says Robin Peterson, CPC, CPMA, Manager of Professional Coding, Pinnacle Integrated Coding Solutions, LLC.

Deletions: CMS will delete the following two arteriovenous fistula creation codes on July 1:

  • C9754 (Creation of arteriovenous fistula, percutaneous; direct, any site, including all imaging and radiologic supervision and interpretation, when performed and secondary procedures to redirect blood flow (e.g., transluminal balloon angioplasty, coil embolization, when performed))
  • C9755 (Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed))

“According to CMS Claims Processing Manual Transmittal 10166, “CMS established C9754 for the Ellipsys® Vascular Access System, which is now reported as G2170 and C9755 for the WavelinQ™ (formerly EverlinQ) endoAVF system, which will now be reported with G2171, ” Peterson says.

Identify 4 New Revascularization Codes

This quarterly update will also add the following new revascularization HCPCS Level II codes:

  • C9764 (Revascularization, endovascular, open or percutaneous, any vessel(s); with intravascular lithotripsy, includes angioplasty within the same vessel(s), when performed)
  • C9765 (… with intravascular lithotripsy, and transluminal stent placement(s), includes angioplasty within the same vessel(s), when performed)
  • C9766 (… with intravascular lithotripsy and atherectomy, includes angioplasty within the same vessel(s), when performed)
  • C9767 (… with intravascular lithotripsy and transluminal stent placement(s), and atherectomy, includes angioplasty within the same vessel(s), when performed)

Don’t Miss These Miscellaneous Additions

You will gain two new codes for cardiac magnetic resonance imaging on July 1:

  • C9762 (Cardiac magnetic resonance imaging for morphology and function, quantification of segmental dysfunction; with strain imaging)
  • C9763 (… with stress imaging)

You will also gain the two new following codes for transcatheter procedures:

  • C9759 (Transcatheter intraoperative blood vessel microinfusion(s) (e.g., intraluminal, vascular wall and/or perivascular) therapy, any vessel, including radiological supervision and interpretation, when performed)
  • C9760 (Non-randomized, non-blinded procedure for NYHA class II, III, IV heart failure; transcatheter implantation of interatrial shunt or placebo control, including right and left heart catheterization, transeptal puncture, trans-esophageal echocardiography (TEE)/intracardiac echocardiography (ICE), and all imaging with or without guidance (e.g., ultrasound, fluoroscopy), performed in an approved investigational device exemption (IDE) study)).

Pay Attention to Effective Date for These COVID-19 HCPCS Level II Codes

The COVID-19 public health emergency (PHE) warranted the addition of numerous new HCPCS Level II codes. Although the effective date for the codes U0003, U0004, C9803 is before July 1, 2020, you will find these codes in the latest HCPC Level II code Excel file of updates.

Codes U0003 and U0004: CMS created codes U0003 (Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R). and U0004 (2019-nCoV Coronavirus, sars-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R) “to capture clinical diagnostic laboratory tests (CDLTs) that utilize high throughput technologies,” per AHA Coding Clinic® HCPCS Vol. 20, No. 2.

Code U0003 is similar to code 87635 (Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique), but you should report U0003 if the high throughput technologies were used, according to AHA Coding Clinic®. And code U0004 is similar to code U0002 (2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc), but you should report U0004 if the high throughput technologies are used.

Caution: You should never report U0003 or U0004 for COVID-19 antibody detection tests.

Code C9803: C9803 (Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), any specimen source). Code C9803 should be reported for specimen collection billed by hospital outpatient departments. This code is effective for dates of service on or after March 1, 2020.