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 be reported separately when performed at the same session or on the same day at a different session.”
When the cardiologist does perform a distinct 93454-93461 diagnostic service on the same date as a cardiovascular therapeutic service, you should append modifier 59 (Distinct procedural service) to the diagnostic code, advises Christina Neighbors, MA, CPC, CCC, ACS-CA, charge capture reconciliation specialist and coder at St. Joseph Heart & Vascular Center in Tacoma, Wash. You also may need to append modifier 51 (Multiple procedures).
Modifier 59 identifies the procedure as being a distinct procedural service. Modifier 51 identifies multiple procedures were performed during the same session. Although CPT identifies many codes as modifier 51 exempt, 93454-93461 aren’t currently exempt. However, Medicare and other payers may tell you not to use modifier 51 because they will apply the multiple procedure rule themselves.
You also should remember to append modifier 26 (Professional component) to 93454-93461 when you need to indicate you’re reporting only the professional component of the service, Neighbors says. The Medicare physician fee schedule shows separate professional and technical components for these codes.
2. Follow S&I Instructions to Stay Compliant
Like many existing edits, a large number of the new cardiology-related edits help keep your coding in line with CPT guidelines for using radiology codes with procedure codes.
Example 1: Code 0236T (Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; abdominal aorta) includes radiological supervision and interpretation (S&I) in its definition. So you shouldn’t be surprised to learn that the latest CCI version bundles radiology codes 75600-75630 (Aortography … radiological supervision and interpretation) into 0236T.
Example 2: CCI now bundles 75600-75774 and 75810-75891 into 37205 (Transcatheter placement of an intravascular stent[s] [except coronary, carotid, vertebral, iliac, and lower extremity arteries], percutaneous; initial vessel). But this shouldn’t restrict your coding because a CPT instruction with 37205 tells you that the appropriate code for S&I related to 37205 is 75960 (Transcatheter introduction of intravascular stent[s] [except coronary, carotid, vertebral, iliac, and lower extremity artery], percutaneous and/or open, radiological supervision and interpretation, each vessel).
To prevent denials, check code definitions, CPT guidelines, and CCI edits before reporting an S&I code with a procedure code — both to be sure you report the appropriate S&I code for the procedure and to be sure you comply with CCI edits.
3. Watch for Blood Draw, Pulmonary Services, EEG and More
In the latest edits, CCI bundles many of the same column 2 codes into the following column 1 codes:
93660 — Evaluation of cardiovascular function with tilt table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention
93724 — Electronic analysis of antitachycardia pacemaker system (includes electrocardiographic recording, programming of device, induction and termination of tachycardia via implanted pacemaker, and interpretation of recordings)
93797-93798 — Physician services for outpatient cardiac rehabilitation …
While the column 2 codes in the edits aren’t entirely identical for each of the column 1 codes above, there is a definite pattern. Below is a sampling of the column 2 codes:
364xx — Venipuncture and transfusion
366xx — Arterial puncture blood draw and arterial catheterization for infusion
37202 — Transcatheter therapy, infusion other than for thrombolysis, any type (e.g., spasmolytic, vasoconstrictive)
43752 — Naso- or oro-gastric tube placement, requiring physician’s skill and fluoroscopic guidance (includes fluoroscopy, image documentation and report)
94xxx — Pulmonary services
958xx — Routine electroencephalography (EEG)
95955 — Electroencephalogram (EEG) during nonintracranial surgery (e.g., carotid surgery).
Before you report a tilt table exam, an antitachycardia-pacemaker analysis, or outpatient cardiac rehab code, check the CCI edits to verify that you haven’t included one of the many bundled codes on your claim.
You can download the CCI edits from www.cms.gov/NationalCorrectCodInitEd/.
