Cardiovascular Coding in the ASC
Cardiovascular procedures are becoming more prevalent in the ASC setting. Below are some of the most common procedures and their coding guidelines.
Pacemakers and Defibrillators
When inserting or replacing a pacemaker or defibrillator system, document the equipment used, including the make and model numbers of the implants. This allows the coder to properly capture HCPCS for these implants.
Insurance companies have specific coverage requirements for pacemakers. Documentation should include all cardiovascular diagnoses and conditions to their highest specificity. If the patient has an atrioventricular block, be sure to specify the degree (1st, 2nd, 3rd) of the block. If the patient has cardiomyopathy, be sure to specify the type of cardiomyopathy (e.g., ischemic, dilated). If the patient has congestive heart failure, be sure to specify critical details, such as acute vs. chronic and systolic vs. diastolic.
Document any complications that would necessitate the revision, replacement, or removal of equipment. This will help support the medical necessity of all procedures. For example, CPT 33222 (Relocation of skin pocket for pacemaker) and CPT 33223 (Relocation of skin pocket for implantable defibrillator) cannot be coded for a revision of an existing pocket without creation of a new one. A new pocket must be created, then any revisions and closure of the existing pocket are included in the relocation code 33222 or 33223.
ICD-10-CM codes for varicose veins are categorized by symptoms and complications associated with the varices. If the patient suffers from pain, inflammation, or other conditions, include this in your documentation to support the highest specified code.
Phlebectomy procedures are coded based on the number of incisions performed on each leg. Accurate documentation of the exact number of incisions performed will stand up best if audited and allow for accurate coding. If fewer than 10 incisions are performed on an extremity, then the procedure is unlisted and not reimbursable in the ASC.
Revascularization procedures are categorized by the arteries that are treated. Clearly document which artery or branch is treated to capture the correct code.
If treatment is performed on an artery, then all image and contrast studies of the entire extremity are included in the treatment code and not separately reportable. For example, if an ASC performs an angiogram with unilateral runoff on the right leg, selective catheterization and study of the right leg popliteal artery, selective catheterization and study of the right leg tibial artery, and angioplasty of the right leg tibial artery, then all those procedures should be included in the code for the angioplasty of the tibial artery.