Conquering Coronary Lithotripsy Coding for Cardiology Success in 2024

Cardiology is a complex area full of challenges that can drive confusion for coders across the nation. Even more, cardiology services are only expected to grow in the coming years, meaning increased reimbursement dollars will be on the line. February is American Heart Month, bringing special attention to the area of cardiology. With changes on the line for 2024, let’s explore the nuances of coronary intravascular lithotripsy, one area our experts have targeted for review.

Decoding Service Details

Coronary Intravascular Lithotripsy (Coronary IVL) employs a lithotripter device aimed at calcified coronary lesions, fracturing them through sonic pressure wave generation. Derived from kidney stone treatment lithotripsy, this procedure utilizes the Shockwave Coronary IVL catheter by Shockwave Medical, the current market offering. Additionally, other coronary IVL catheters are under development by Fastwave Medical and Cardiovascular Systems Incorporated, awaiting market release.

+92972            Percutaneous transluminal coronary lithotripsy (List separately in addition to

                          code for primary procedure)

To code correctly it is important to understand the complete service nuances. The Shockwave Coronary Intravascular Lithotripsy (IVL) catheter utilizes a balloon mechanism to deliver pressurized saline in a circular motion to the diseased coronary vessel’s inner lumen walls. An electrode catheter within the balloon generates electrical impulses, creating vaporizing bubbles that transmit sonic pressure waves through the saline. These pressure waves are then transmitted to the surface of the interior lumen of the vessel walls. The waves fracture the calcium, pressing the material into the interstitial layers of the coronary wall, making the lesion more pliable and reducing the degree of stenosis. This is typically followed with the application of stenting to the area, which is a separately reported service.

Tackling Essential Tips for Coding Success:

• According to CPT®, use 92972 in conjunction with base codes 92920, 92924, 92928, 92933, 92941, 92943, and 92975. The CMS add-on code file for facility outpatient hospital services also includes C9600, C9602, C9604, C9606, and C9607 as additional base codes.
• Understand that this is an add-on code. It should be reported in addition to the primary base services listed above. It may be reported for both professional and facility coding.
• Note that Catheter placement is not reported separately with this code.
• Separately report the use of diagnostic heart catheterization and coronary angiogram, the use of IVUS or FFR, and the performance of other separate coronary interventions.
• Report the performance of this procedure one time per coronary territory for all lesion(s) treated. The MUE for this code is 3 with an MAI of 3.
• Per precedent set with the previous category III code +0715T for this service, the AHA Coding Clinic, Volume 23, Number 2, Second Quarter 2023 establishes that this add-on code service may be reported by facilities with base services described by HCPCS Level II Code range C9600–C9608, when applicable.
• Utilization of intravascular lithotripsy outside of the coronary arteries would be reported with the application of the appropriate unlisted procedure code per the body area or system involved, except for utilization in the lower extremities. Facility coding for the use of intravascular lithotripsy in the lower extremities is captured with HCPCS Level II code range C9764–C9767 and C9772–C9776. Currently, professional fee coding should capture the utilization of intravascular lithotripsy in the lower extremities with code range CPT 37220– 37235 and consider IVL a method of angioplasty in that context.

These are NOT all the tips and tricks necessary for cardiology coding.
As service volumes rebound and every dollar of reimbursement counts more than ever in the face of payment cuts, it’s imperative to make sure your CPT® coding is correct and compliant. Master more cardiology coding topics and break down the complexity with our cardiology resources. We have an exclusive offer just for you. Use code HEART24 on ANY of our cardiology resources by 2/23/24 for 20% off your purchase. Find the right resource tailored to your needs today before the offer expires!