So, I'm talking a little bit about coarctation codes, I have no relevant disclosures. So we're going to talk about coarctation and the main issues come in here between crossing a major side branch and not crossing a major side branch. So the 33894 is a stent repair of coarctation and that's ascending transverse or descending thoracic or abdominal aorta with a stent crossing a major side branch, I'll give you some examples, versus 95 which is the same areas of the arch but not crossing a major side branch. And then angioplasty of native or recurrent coarctation of the aorta is the 33897. So 33894 is for crossing a major side branch and so this picture here shows the stent completely covering the left subclavian. This is from a different case, both images supplied to me by members of the team here because I couldn't find one of mine that showed it quite so nicely. But you can see here the balloon going through the stent into the left subclavian, so this is accounting for the extra work you have to do doing this. Now, this would be in contrast to the stent that is just below the left subclavian or that kind of goes into the left subclavian a little bit or flares its edges into the left subclavian. Those would not count as crossing major side branches. So if you look at the codes, you have the 33894 and 95, here's the RVUs that are associated with them. What is included in these, a stent inside a stent is not something that can be separately billed for. Pacing is bundled if done, although that is not commonly done. Aortic angiography is included. The ultrasound for vascular access is included and all three are bundled with the diagnostic left heart cap. If you angioplasty before or after the stent placement, you cannot separately bill for the angioplasty. So if you put in a stent and then re-dilate it, you can't bill angioplasty afterwards. Now, it's very important, the pacing, if you use venous access only for a pacing catheter, you cannot bill for that. If you perform, however, a right heart catheterization, you can use either the 9-3 or 9-4 codes that are reportable based on connections, but you must document that you did the right heart cath, obviously, and an LV angiogram is not considered part of the left heart cath for the coarctation procedure. So this is one of the questions that is from a previous meeting. Does stent placement for coarct need to be completely crossed, major side branches, or partial crossing? And so for coarct, the intent at CPT was that it was supposed to cross the side branch. So lesser or amount, you can't really say. And most of the images that were presented are of a type where the vessel is completely crossed. And we, as a group, thought that if it's completely crossing vessels, it's quite clearly crossing, and if it's the type where it's flaring into, that would not count. If it was a type of stent that was crossing in such a way that you need to go through the cells and re-dilate and do work into the branch or stent the branch, that that would count as crossing the branch. And then we have, this was another question that I'm answering from a prior thing, was asking about whether the 741 to 746 codes can be used for non-congenital conditions. And the answer is no, they can only be used for congenital conditions. So if these are performed for adults or for non-congenital reasons, they need to be used a non, an unlisted code. And if it becomes something that comes up in the future, they would have to get their own application for non-congenital use of any of these codes that we use. And that was my last slide, thank you.

coarctation codes

stent repair

aorta

billing considerations

coding guidelines