Vascular surgeons perform a comprehensive range of procedures and the adoption of new endovascular techniques has led to reduced hospital stays. Under Medicare’s value-based program, health care providers are rewarded with incentive payments for the quality of care rather than the quantum of services provided. Outsourcing medical coding to a company that has certified coders with expertise in CPT, HCPCS and ICD-10 coding, and are knowledgeable about individual payer policies is the best way to ensure appropriate reimbursement for coronary and endovascular procedures.
Comprehensive Ambulatory Payment Classifications (C-APCs) are package payments for services and supplies rather than separate and multiple payments for each individual service. Under the policy, CMS assigns a HCPCS code as a primary service allotted to a C-APC and reimburses providers for all other items and services reported on the claim as being integral, ancillary, supportive, depending, and adjunct to the primary service.
In calendar year (CY) 2017, CMS continues with the C-APC policies established in CY 2015, but has added 25 new C-APCs. The new C-APCs include diagnostic catheterization and angiographies, leading to the creation of a new level and re-leveling of existing procedures within family of endovascular procedures.
Vascular Clinical Family (VASCX) — Changes for 2017
– The number of clinical families has been increased from 14 to 21
– Diagnostic catheters and angiographies are newly classified as a c-APC, expanding the PCI vascular family from three C-APC levels to four. Note, the c-APC changes for 2017 are listed in the table below, and reflect the CY2017 vascular clinical family (VASCX) c-APCs
The vascular clinical family (VASCX) c-APCs changes for 2017 are as follows:
| 2017 C-APC | Primary procedure description | HCPCS Codes for Primary Procedure |
| 5191 (formerly 5188) | Level 1 Endovascular Procedure | 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93530, 93531, 93532, 93533 |
| 5192 (formerly 5191) | Level 2 Endovascular Procedures | 0338T, 0339T, 36902, 36904, 37183, 37220, 37224, 37246, 37248, 92920, 92986 |
| 5193 (formerly 5192) | Level 3 Endovascular Procedures | 0234T, 0236T, 0237T, 36903, 36905, 37221, 37225, 37226, 37228, 37236, 37238, 37241, 37242, 37243, 37244, 61623, 61626, 92924, 92928, 92937, 92941, 92943, 92987, 92990, 92997, C6900, C6904 |
| 5194 (formerly 5193) | Level 4 Endovascular Procedures | 0238T, 0387T, 36906, 37227, 37229, 37230, 37231, 92933, 93580, 93581, 93582, 93590, 93591, C9602, C9606, C6907 |
HCPCS/CPT codes assigned to the 4 primary procedure C-APCs in the VASCX Family
- C-APC 5191 Level 1 HCPCS/CPT codes93451 Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed93451 Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed93452 Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed93453 Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed93454 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation
93455 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography
93460 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed
93530 Right heart catheterization, for congenital cardiac anomalies
93531 Combined right heart catheterization and retrograde left heart catheterization, for congenital cardiac anomalies
93532 Combined right heart catheterization and transseptal left heart catheterization through intact septum with or without retrograde left heart catheterization, for congenital cardiac anomalies
93533 Combined right heart catheterization and transseptal left heart catheterization through existing septal opening, with or without retrograde left heart catheterization, for congenital cardiac anomalies
- C-APC 5192 Level 2 HCPCS/CPT codes0338T Transcatheter renal sympathetic denervation, percutaneous approach including arterial puncture, selective catheter placement(s) renal artery(ies), fluoroscopy, contrast injection(s), intraprocedural roadmapping and radiological supervision and interpretation, including pressure gradient measurements, flush aortogram and diagnostic renal angiography when performed; unilateral0339T Transcatheter renal sympathetic denervation, percutaneous approach including arterial puncture, selective catheter placement(s) renal artery(ies), fluoroscopy, contrast injection(s), intraprocedural roadmapping and radiological supervision and interpretation, including pressure gradient measurements, flush aortogram and diagnostic renal angiography when performed; bilateral36902 Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report; with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty36904 Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s);37183 Revision of transvenous intrahepatic portosystemic shunt(s) (TIPS) (includes venous access, hepatic and portal vein catheterization, portography with hemodynamic evaluation, intrahepatic tract recanulization/dilatation, stent placement and all associated imaging guidance and documentation) 37220 Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty
37224 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty
37246 Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery
37248 Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein
92920 Percutaneous transluminal coronary angioplasty; single major coronary artery or branch
92986 Percutaneous balloon valvuloplasty; aortic valve
- APC 5193 Level 3 HCPCS/CPT codes0234T Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; renal artery 0236T Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; abdominal aorta0237T Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; brachiocephalic trunk and branches, each vessel92986 Revision of aortic valve36903 Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report; with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment36905 Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s); with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty
37221 Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
37225 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed
37226 Fem/popl revasc w/stentRevascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed 37228 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty
37236 Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery
92941 Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel
92943 Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel 92987 Percutaneous balloon valvuloplasty; mitral valve
92990 Percutaneous balloon valvuloplasty; pulmonary valve
92997 Percutaneous transluminal pulmonary artery balloon angioplasty; single vessel
C9600 Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch
C9604 Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel
- APC 5194 Level 4 HCPCS/CPT codes0238T Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; iliac artery, each vessel0387T Transcatheter insertion or replacement of permanent leadless pacemaker, ventricular36906 Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s); with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis circuit37227 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed37229 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed
37230 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
37231 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
92933 Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch
93580 Percutaneous transcatheter closure of congenital interatrial communication (ie, Fontan fenestration, atrial septal defect) with implant
93581 Percutaneous transcatheter closure of a congenital ventricular septal defect with implant 93582 Percutaneous transcatheter closure of patent ductus arteriosus
93590 Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, mitral valve
93591 Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, aortic valve
C9602 Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch
C9606 Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel
C9607 Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel
With most coronary and endovascular procedures qualifying for Comprehensive APC (C-APC) payments, it’s important to have an expert medical coding service provider to handle vascular medical coding. Moreover, surgeons need to adhere to the guidelines and coverage policies that individual payers may have regarding certain services. An experienced medical coding company can provide accurate vascular medical coding and patient billing solutions to meet CMS and private payer norms and ensure optimal reimbursement.
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