Cardiology Coding Alert

Overlooking modifier indicators is a big mistake

When you're coding selective arterial catheter placements as well as atherectomies, you may need to consult the Correct Coding Initiative (CCI) before you submit your claim.

Although you don't have many CCI edits to learn this time around, you're still expected to apply the following edits to your coding practice by July 1. Our experts break down what you need to know.

Attack This Solitary Atherectomy, Catheter Edit

You've got one addition that promises to have you scratching your head in confusion.

CCI bundles catheterization code 36247 (Selective catheter placement, arterial system; initial third-order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family) into atherectomy code 35485 (Transluminal peripheral atherectomy, open; tibioperoneal trunk and branches).

In other words, if your cardiologist performs both the selective arterial catheter placement (36247) as well as an atherectomy (35485), then you'll report only 35485.

Why: "The logic, I presume, is that the 35485 is an open procedure and that coders would not typically bill for percutaneous third-order selective catheter placement with an open intervention," says Jim Collins, CPC, ACS-CA, ChCC, president of The Cardiology Coalition in Matthews, N.C.

Here's the strange part: CCI 13.2 does not impact the other open atherectomy procedures in this section (35480-35485) with other catheter placement codes (36245-36247). "There does not appear to be much logic in having one edit and not a whole slew of them," Collins says.

Good news: This edit has a modifier indicator of "1," which means you may use a modifier to override the edit if the procedures are distinct from one another (for instance, if they occur in separate anatomic locations). You can append modifier 59 (Distinct procedural service) to the lesser code (in this case, 36247) to indicate to the payer that the billed procedures are distinct and separately identifiable, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, director of outreach programs for the American Academy of Professional Coders, the coding organization based in Salt Lake City. But don't forget to back up your claim with documentation.

For instance, your cardiologist performs a percu-taneous diagnostic lower extremity study. You report this with 36247 and 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation). The study's findings trigger an immediate open atherectomy procedure during the same operative session. In this case, you can report both procedures, Collins says. Apply modifier 59 to 36247. Don't forget: Your cardiologist's documentation should demonstrate how these were two distinct procedural services.

Endovascular 'T' Codes Don't Escape Unscathed

You've got a mix of edits that involve endovascular aortic aneurysm repair codes 0153T (Transcatheter placement of wireless physiologic sensor in aneurysmal sac during endovascular repair, including radiological supervision and interpretation and instrument calibration [List separately in addition to code for primary procedure]) and 0154T (Noninvasive physiologic study of implanted wireless pressure sensor in aneurysmal sac following endovascular repair, complete study including recording, analysis of pressure and waveform tracings, interpretation and report).

No big surprise: If you look at the parenthetical note under 00153T, you'll see "Use in addition to 34800, 34802, 34803, 34804, 34805, and 34900," according to CPT. Therefore, "these edits probably just addressed some commonly reported services that coders shouldn't be billing with these codes," Collins says.

Note: CMS considers the code listed in column 2 as the lesser service, which is included as a component of the more extensive column 1 procedure.

The following table shows which codes now include the work represented by 0153T and 00154T:

Red flag: For all of these edits, you'll find a modifier indicator of "0." This means you cannot override the edit pair under any circumstances. Effectively, you cannot get paid for these two services when the cardiologist performs them for the same patient on the same day.