394.x-398.x and 424.x: Clarify the Role of ‘Rheumatic’

Use this cheat sheet to aid your non-congenital valve disorder coding

 

Code Descriptor Role of ‘Rheumatic’

 

MITRAL VALVE ONLY

 

394.0 Mitral stenosis Use if specified as rheumatic or unspecified. If specified as non-rheumatic, use 424.0.
394.1 Rheumatic mitral insufficiency Specific to rheumatic cases. For others, use 424.0.
394.2 Mitral stenosis with insufficiency Use if specified as rheumatic or unspecified. If specified as non-rheumatic, use 424.0.
394.9 Other and unspecified mitral valve disease Use if specified as rheumatic or unspecified. If specified as non-rheumatic, use 424.0.
424.0 Mitral valve disorders Use if specified as non-rheumatic. Also use for mitral insufficiency of unspecified cause.
AORTIC VALVE ONLY
395.0 Rheumatic aortic stenosis Specific to rheumatic cases. For others, use 424.1.
395.1 Rheumatic aortic insufficiency Specific to rheumatic cases. For others, use 424.1.
395.2 Rheumatic aortic stenosis with insufficiency Specific to rheumatic cases. For others, use 424.1.
395.9 Other and unspecified rheumatic aortic diseases Specific to rheumatic cases. For others, use 424.1.
424.1 Aortic valve disorders Use if specified as non-rheumatic or unspecified. If specified as rheumatic, see 395.x.
BOTH MITRAL AND AORTIC VALVES

 

396.0 Mitral valve

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4 Common Interventional PM Procedures You Can’t Afford To Miss

Get the lowdown on when to code separately for fluoroscopy.

If your physician performs interventional pain management (IPM) services, you’ll need to be up to speed on four top IPM procedures to make sure you’re earning full deserved reimbursement for your claims.

Difference: Pain management specialists are physicians who study pain and perform less invasive injections (soft tissue, peripheral nerve, and joint injections) and medication management to help relieve patients’ pain. One common pain management procedure is trigger point injection (20552, Injection[s]; single or multiple trigger point[s], 1 or 2 muscle[s]) or 20553, single or multiple trigger point[s], 3 or more muscle[s]). An interventional pain management specialist’s scope includes spinal diagnostic and therapeutic procedures and other invasive techniques like nerve stimulator or opioid pump insertion, says Scott Groudine, MD, an anesthesiologist in Albany, N.Y. When submitting claims, you’ll use specialty designation 72 for pain management or 09 for interventional pain management.

Learn the Most Common Injections

All injections are not created equal – and they’re not coded the same. Here’s your guide to four types of treatments that commonly fall under the IPM umbrella.

Facet injections: CPT® includes a range of codes describing the various sites and levels associated with paravertebral facet joint and facet joint nerve injections. You’ll find these in code family 64490-64495 (Injection(s), diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT]). If your physician uses ultrasound guidance during the injection procedure, turn to the Category III code section of CPT® instead. There you’ll find codes 0216T-0218T (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with ultrasound guidance). You’ll choose the appropriate code based on the anatomic injection site...

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