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Coding Update: Transcatheter Aortic Valve Replacement

By Sarah Serling, CPC, CPC-H, CPC-I, CCS-P, CCS, ICD-10-CM/PCS Trainer
January 17, 2013

Aortic valve replacement is a common treatment for symptomatic aortic stenosis. Aortic stenosis is a narrowing of the aortic valve that obstructs blood flow from the left ventricle into the ascending aorta. Transcatheter aortic valve replacement (TAVR)—also known as transcatheter aortic valve implantation or TAVI—is a new technology used to treat aortic stenosis. Transcatheter replacement of a stenotic aortic heart valve with a prosthetic valve delivered using a catheter is an alternative to open heart aortic valve replacement.

The Centers for Medicare & Medicaid Services (CMS) issued a National Coverage Determination (NCD) in May 2012, covering TAVR procedures for severe symptomatic aortic valve stenosis. TAVR claims from May-December 2012 were reported with temporary Category III CPT codes 0256T, 0257T, 0258T, and 0259T. Effective January 1, 2013, TAVR services are reported with new, permanent CPT codes (33361, 33362, 33363, 33364, and 33365) and one temporary category III code (0318T). CPT 2013 also includes new guidelines and parenthetical notes to instruct users on the appropriate reporting of the TAVR codes. 

The TAVR procedure is performed in an operating room or a cardiac catheterization lab with the ability to accommodate cases that may require conversion to an open surgical procedure. The interventional cardiologist and cardiothoracic surgeon jointly perform the intra-operative technical aspects of TAVR with one performing the cardiovascular access procedure and the other performing the delivery/implantation procedures. Because TAVR procedures require two physicians, codes 33361-33365, 0318T are reported with modifier 62 appended indicating Two Surgeons.

TAVR codes 33361-33365, 0318T codes include the percutaneous access, open arterial or cardiac approach, placing the access sheath, balloon aortic valvuloplasty, advancing the valve delivery system into position, repositioning the valve as needed, deploying the valve, temporary pacemaker insertion for rapid pacing, and closure of the arteriotomy. Angiography, contrast injections, roadmapping, aorta/left ventricular outflow tract measurement, fluoroscopic guidance, and radiological supervision and interpretation performed to guide TAVR/TAVI are also included in these codes. When cardiopulmonary bypass is performed in conjunction with a TAVR procedure, the appropriate add-on code for percutaneous peripheral bypass (33367), open peripheral bypass (33368), or central bypass (33369) is reported with codes 33361-33365, 0318T.

Codes for diagnostic left heart catheterization (93452, 93453, 93458-93461) and supravalvular aortography (93567) should not be reported with the TAVR the codes. However, diagnostic coronary angiography performed at a separate session from an interventional procedure may be separately reported. For diagnostic coronary angiography services performed at same session or on the same day, report the appropriate diagnostic cardiac catheterization code(s) appended with modifier 59 to indicate a separate and distinct procedural service from TAVR. Other cardiac catheterization services are separately reportable when performed for diagnostic purposes not intrinsic to TAVR/TAVI.
 

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