A definition change may add 12 cardiac catheterization procedures to CMS' ASC covered list

CMS proposed changing the definition of surgery to account for "surgery-like" procedures in the 2019 proposed payment rule for ASCs and hospital outpatient departments, which could add cardiac catheterization procedures to the ASC covered list.

According to a Q&A with ASCA CEO William Prentice, the revised definition of "surgery" would add procedures that are currently assigned codes outside of the CPT surgical range. "This change allows them to propose adding 12 cardiac catheterization procedures to the ASC covered procedures list," he said.

Over the past few years, cardiovascular surgery centers have begun to open across the country. In July, Manhattan (Kan.) Specialist Center, a physician-owned cardiovascular ASC, opened offering most cardiovascular procedures including stenting and pacemakers.

Franklin Surgical Center in Basking Ridge, N.J., affiliated with Surgical Care Affiliates, launched a peripheral vascular procedure program at the end of 2016 and has experienced success.

The codes CMS proposed for the ASC covered list include CPT codes:

1. 93451: Right heart catheterization including measurements of oxygen saturation and cardiac output, when performed

2. 93452: Left heart catheterization including intraprocedural injections for left ventriculogrpahy, imaging supervision and interpretation, when performed

3. 93453: Combined right and left heart categorization including intraporcedural injections for left ventriculography, imaging supervision and interpretation, when performed

4. 92454: Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation

5. 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

6. 93456: Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization

7. 93457: 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 and right heart catheterization

8. 93458: Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed

9. 93459: Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography

10. 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

11. 93461: 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, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography

12. 93462: Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (list separately in addition to code for primary procedure)

CMS has asked for comments on adding these procedures to the ASC covered list.

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