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CCI Edit: 93454-93461 Note These Column Changes For Correct Cardiology Coding

Correct Coding Initiative version 17.1 brings 11,831 new edit pairs, effective April 1 for physicians. That’s the word from a March 17 announcement by Frank Cohen, principal and senior analyst for the Frank Cohen Group. Here’s a look at the major pointers you need to keep in mind to comply with the new cardiology-related edits, including cardiac catheterization, radiological supervision and interpretation, cardiac rehabilitation, and more.

1. Prevent Denials by Remembering 93454-93461 Are Diagnostic

New edits will prevent you from reporting heart catheter/angiography codes 93454- 93461 (column 2) with the following cardiovascular therapeutic services and procedures (column 1):

  • 92975 — Thrombolysis coronary; by intracoronary infusion, including selective coronary angiography
  • 92980 — Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel
  • 92982 — Percutaneous transluminal coronary balloon angioplasty; single vessel
  • 92995 — Percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty; single vessel.

The 929xx codes in column 1 describe coronary therapies. The 934xx codes in column 2 are diagnostic procedures. You should never use the 934xx diagnostic codes in column 2 to report catheter placement and coronary angiography performed as an integral part of the therapeutic column 1 services.

Opportunity: The edits have a modifier indicator of 1, so you may override them with an appropriate modifier when the procedures are distinct. If you report both codes in the edit pair and don’t append a modifier to the column 2 code, Medicare (and payers applying Medicare rules) will reimburse you for only the column 1 code.

The AMA, via CPT Assistant (April 2005), indicates that you may report a true diagnostic catheterization in addition to the therapeutic procedures described by 92980 and 92982: “These two distinct procedures (diagnostic catheterization and therapeutic procedures), therefore, should…

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MACs Differ on Response to CMS’s Cardiology Payment Adjustments

Don’t look for a raise just yet, in most cases.

CMS may talk, but MACs don’t always listen — at least not quickly.

As we told you in last week’s Insider, CMS recently corrected several “technical errors” published in the 2010 Fee Schedule, and thanks to these corrections, Medicare will increase payment for several cardiology-related testing codes, including codes 75571-75574 (Heart CT) and 78451-78454 (Heart muscle SPECT imaging).

Although many practices are eager to see the payment boosts in their next Medicare payments, that may be an overly ambitious goal at this point.

“I inquired with a few MAC carriers such as Trailblazer, Noridian, and Palmetto, and was told different things by different Medicare payers,” says Terry Fletcher, BS, CPC, CCS-P, CCS, CMSCS, CCC, CEMS, CMS, CEO of Terry Fletcher Consulting Inc.

“One did not even know there was a change,” she says. “Next, Noridian said that they will be making the adjustments when they get the directive from CMS. And Palmetto said they would need the provider to contact them and then batch retroactive to January the myocardial perfusion imaging claims and send a letter to request the increase,” she says.

Bottom line: Until CMS provides a clear answer to the MACs regarding when they must implement the changes, you may not see your pay increases, but keep an eye on your carrier’s Web site for information on when it intends to reprocess claims using the new rates.

Part B Insider. Editor: Torrey Kim, CPC

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Check 33208 Global to Prevent E&M Snafu

When an EM service occurs during a postop global period for reasons unrelated to the original procedure, use this modifier.

Question: If the cardiologist performs a pacemaker insertion in the hospital and later visits the patient in observation, should I

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93000-93010: Hone Your ECG Coding Skills With 3 Essential Pointers

Grasping 93010’s effect on new vs. established patient status could bring a $58 reward.

Whether you call them ECGs or EKGs, chances are you see a lot of electrocardiograms in your practice. That means that even the tiniest coding errors…

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CPT 2010: Add New AV Shunt Codes to Your Toolbox

Initial vs. additional access matters in 2010.
Love them or hate them, the trend toward guidance-inclusive codes doesn’t seem to be slowing.
Case in point: CPT 2010 ousts 36145 (Introduction of needle or intracatheter; arteriovenous shunt created for dialysis [cannula, fistula, or graft]) and 75790 (Angiography, arteriovenous shunt [e.g., dialysis patient], radiological supervision and interpretation) and instead […]

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2 New 2010 CPT Codes for High-Tech Cardiology Services

Steer clear of Cat. I codes for intravascular spectroscopy — here’s where to look instead.
The CPT update season is fast approaching. Warm up for the changes coming your way with a look at new-for-2010 Category III codes aimed at diagnosing coronary artery disease.
Match 0206T to MCG
One of the new Category III codes with a Jan. 1 […]

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OIG Auditors to Cardiologist: You’re Billing Medicare Properly

Report reveals what he and his billing staff did right. Does your practice have the right stuff?
Turns out the old saying is true: If you haven’t done anything wrong, an OIG audit is nothing to worry about.
A New York cardiologist who collected over $1.3 million over a three-year period for 5,061 claims caught the OIG’s […]

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