Effective October 1, 2008, new codes have been created to identify fractional flow reserve (FFR) in coronary vessels and intravascular pressure measurement of intra-aneurysm sac and noncoronary vessels. Prior to this change, intracoronary pressure measurement was assigned to code 89.69, Monitoring of coronary blood flow. The inclusion term listed under code 89.69, "Coronary blood flow monitoring by coincidence counting technique," did not fully capture the use of FFR. Additionally, this code did not capture the use of intravascular pressure measurement outside of the heart. In the past, intravascular pressure measurement might have been viewed as adjunct to other procedures (e.g., angiography) and might not have been coded at all.
FFR is a technique designed to assess the severity of coronary artery stenosis that might otherwise not be accurately measured by conventional angiography. This technique involves using a pressure sensitive catheter to compare the intravascular pressure to the main aortic pressure in order to develop a ratio between the two. This information can be used to assess the functional severity of the lesion in terms of limitation of blood flow. FFR also allows physicians to better diagnose more complex diseases such as serial stenosis, diffuse diseases and patients with multi-vessel disease.
Coronary blood flow monitoring is performed by another method known as coincidence counting technique. Coincidence counting relies on measurements of radioactive tracers to estimate blood flow, whereas FFR assesses blood flow using comparative pressure measurements.
New code 00.58 Insertion of intra-aneurysm sac pressure monitoring device (intraoperative) Insertion of pressure sensor during endovascular repair of abdominal or thoracic aortic Aneurysm(s) New code 00.59 Intravascular pressure measurement of coronary arteries Includes: fractional flow reserve (FFR) Code also any synchronous diagnostic or therapeutic procedures Excludes: intravascular pressure measurement of intrathoracic arteries (00.67) New code 00.67 Intravascular pressure measurement of intrathoracic arteries Assessment of: aorta and aortic arch carotid Code also any synchronous diagnostic or therapeutic procedures New code 00.68 Intravascular pressure measurement of peripheral arteries Assessment of: other peripheral vessels vessels of arm(s) vessels of leg(s) Code also any synchronous diagnostic or therapeutic procedures New code 00.69 Intravascular pressure measurement, other specified and unspecified vessels Assessment of: liac vessels intra-abdominal vessels mesenteric vessels renal vessels Code also any synchronous diagnostic or therapeutic procedures Excludes: intravascular pressure measurement of: coronary arteries (00.59) intrathoracic arteries (00.67) peripheral arteries (00.68)
What is the correct code for the insertion of an EndoSureÂ® wireless AAA pressure measurement system? This is an implantable pressure sensor that combines wireless and microelectromechanical system (MEMS) technology. It is used to measure pressure in an abdominal aortic aneurysm (AAA). Patients with AAA may require lifetime monitoring and this device can help monitor the AAA pressure.
Assign code 00.58, Insertion of intra-aneurysm sac pressure monitoring device (intraoperative), for the insertion of the EndoSureÂ® wireless AAA pressure measurement system.