2022 Removal Intracardiac Vegetation Coding Knowledge

New category III codes that could impact your cardiology coding services and now effective as of January 1, 2022. With these codes now active, cardiology coders, providers, compliance professionals, and stakeholders should be aware of the scope of changes in place for the new year. New code 0644T mentioned in our IR insights blog is also performed in cardiology and includes a significant amount of detail for correct coding and comprehension. By knowing the rationale, staff and coders can prepare for a successful year while safeguarding compliance.

Cracking 0644T Coding

Category III code 0644T is reported for the suction of intracardiac thrombus or vegetations (endocarditis). This code may be performed more often in a cardiology lab, but we should note that many interventional radiology physicians are also performing this procedure. Code 0644T represents a comprehensive code that includes access, sheath, and device introduction, manipulation and positioning of wires and catheters, dilation, embolic protection, and closure. This code also includes the following components:

• the work of percutaneous access
• all associated sheath device introduction
• manipulation and positioning of guidewires and selective and non-selective catheterizations (e.g., 36140, 36200, 36215, 36216, 36217, 36218, 36245, 36246, 36247, 36248)
• blood vessel dilation
• embolic protection if used
• percutaneous venous thrombectomy (e.g., 37187, 37188)
• and closure of the blood vessel by pressure or application of an access vessel arterial closure device.

Guidance is also included as is introduction of cannula and initiation of an extracorporeal circuit. If prolonged extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) is required after the suction thrombectomy procedure is completed, that may be reported separately. Do not report 0644T with 37187 or 37188.b

Understand that if an axillary, femoral, or iliac conduit is required to facilitate access of the catheter, 34714, 34716, or 34833 may be reported in addition to 0644T. Extensive repair or replacement of a blood vessel (e.g., 35206, 35226, 35231, 35236, 35256, 35266, 35286, 35302, 35371) may be reported separately. When it comes to fluoroscopic and ultrasound guidance used in conjunction with percutaneous intracardiac mass removal is not separately reported. However, transesophageal echocardiography guidance may be reported separately, when provided by a separate provider.

Reporting with Other Services Continued

The insertion and removal of arterial and/or venous cannula(e) (e.g., 33951, 33952, 33953, 33954, 33955, 33956, 33965, 33966, 33969, 33984, 33985, 33986) and initiation (e.g., 33946, 33947) of the extracorporeal circuit (veno-arterial or veno-venous) for intraoperative reinfusion of aspirated blood is included in the procedure. If prolonged extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) is required at the conclusion of the procedure, then the appropriate ECMO cannula(e) insertion code (e.g., 33951, 33952, 33953, 33954, 33955, 33956), removal code (33965, 33966, 33969, 33984, 33985, 33986), and initiation code (e.g., 33946, 33947) may be reported in addition to 0644T.

Note that other interventional procedures performed at the time of percutaneous intracardiac mass removal may be reported separately (e.g., removal of infected pacemaker leads, removal of tunneled catheters, placement of dialysis catheters, valve repair, or replacement).

Understand that when transcatheter ventricular support is required in conjunction with percutaneous intracardiac mass removal, 0644T may be reported with the appropriate ventricular assist device (VAD) procedure code (33975, 33976, 33990, 33991, 33992, 33993, 33995, 33997, 33999) or balloon pump insertion code (33967, 33970, 33973). When cardiopulmonary bypass is performed in conjunction with percutaneous intracardiac mass removal, 0644T may be reported with the appropriate add-on code for percutaneous peripheral bypass (33367), open peripheral bypass (33368), or central bypass (33369).

These are not all the coding updates impacting cardiology. Explore more coding knowledge and additional pressing topics to master compliance and coding with our 2022 Cardiology Coding Update on-demand webcast. No matter the challenges to your revenue and compliance, you’ll take away workable solutions from this annual webcast. In addition, you’ll get in-depth guidance with all 2022 code changes — clear definitions and actionable steps to ensure correct coding. Take control of the chronically challenging issues and changes that may put your facility at risk for claim denials, underpayment, and auditor action.