This month “Spotlight on CPT” looks at coding of pulmonary artery revascularization procedures. In 2023 a new series of CPT codes, 33900-33904, was created to code stent placement for repair of pulmonary artery stenosis.
33900 Percutaneous
pulmonary artery revascularization by
stent placement, initial; normal native
connections,
unilateral
33901 normal native connections, bilateral
33902 abnormal connections, unilateral
33903 abnormal connections, bilateral
+33904 Percutaneous pulmonary artery
revascularization by stent placement, each additional
vessel or separate lesion,
normal or abnormal connections
These codes include vascular access, catheter & guidewire manipulation, fluoroscopy, post-diagnostic angiography for roadmapping, post-implant evaluation, stent positioning and balloon inflation for stent delivery. They also include the radiologic S&I.
Angioplasty, before or after stent deployment, for the same target lesion as the stent is not separately reportable. However, if there is a distinct lesion or a lesion in a different vessel then an additional angioplasty code may be assigned. This is a code series with many notes associated with it, so coding professionals should be sure to carefully read the notes before assigning code(s).
Let’s take a moment to explore what is meant by normal native or abnormal connections. In the first picture below, you can see the catheter accessing the heart through the inferior vena cava (if it was the superior vena cava, that is also a normal native connection), then to the right atrium, the right ventricle, and finally, the pulmonary artery(ies). Abnormal connections are when the stent is placed within the pulmonary artery(ies), ductus arteriosus, or within a surgical shunt, by way of abnormal connections or through post-surgical shunts. These shunts could be Blalock-Taussig, Sano, or post Glenn or Fontan procedures. Examples can be seen in the second picture below.
It is worth pointing out that the add-on code of 33904 is for each vessel or separate lesion and can be assigned whether the stent is placed via native normal connections or abnormal connections.
Now, light has been shed on coding pulmonary artery revascularization procedures.
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About the Author
Dianna Foley, RHIA, CCS, CHPS, CDIP, is
OHIMA's Education Coordinator. Dianna has been an HIM
professional for over 20 years. She progressed through the ranks of coder,
department supervisor, and department director, to her current role as a
coding consultant. She previously served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati and holds RHIA, CHPS, CDIP and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and is a presenter on coding topics at the national, state, and regional levels. Dianna mentors new AHIMA members and also provides monthly educational lectures to coders and clinical documentation specialists.
