Cardiology Coding Alert

The Correct Coding Initiative (CCI) piles on more than 18,000 new edit pairs in version 15.3, but you don't want to miss the catheter placement, electrophysiology study, and imaging edit needles in this haystack. Here are the four areas to keep your eye on.

CCI offers a few deletions this round, removing edits bundling electrophysiology (EP) studies with ablation codes. But don't start adding EP studies to your claims willy-nilly, experts warn. CPT guidelines indicate you should report only "diagnostic" EP studies alongside ablation.

Deletion details: Effective Oct. 1, 93600 (Bundle of His recording) is no longer bundled into 93650 (Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement).

Similarly, CCI no longer bundles the following codes with 93651 (Intracardiac catheter ablation of arrhythmogenic focus; for treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathways, accessory atrioventricular connections or other atrial foci, singly or in combination):

• 93600

• 93602 -- Intra-atrial recording

• 93603 -- Right ventricular recording

• 93618 -- Induction of arrhythmia by electrical pacing.

Edit deletions generally are welcome, says Jim Collins, CCC, CPC, ACS-CA, CHCC, president of CardiologyCoder.Com in Saratoga Springs, N.Y. But these edits had a certain logic behind them, he says. They fell in line with the following CCI guideline:

"If the diagnostic procedure precedes the surgical procedure and is the basis on which the decision to perform the surgical procedure is made, the two procedures may be reported with modifier 59 [Distinct procedural service] under appropriate circum-stances. However, if the diagnostic procedure is an inherent component of the surgical procedure, it cannot be reported separately" (National Correct Coding Initiative Coding Policy Manual, Chapter 1, Section E.1.d, www.cms.hhs.gov/NationalCorrectCodInitEd/).

In fact, CPT's guidelines for "Intracardiac Electrophysiological Procedures/Studies" similarly specify that you may report EP studies, mapping, and ablation on the same date when "a diagnostic electrophysiologic study is performed, induced tachycardia(s) are mapped, and on the basis of the diagnostic and mapping information, the tissue is ablated" (emphasis added).

Bottom line: Even though CCI deletes these edits, the CPT guidelines indicate that you should continue to verify the study is diagnostic before you code it. If the cardiologist has diagnosed the problem on a previous date and uses the EP study simply for localization during ablation, reporting the study would be inappropriate. For instance, in many cases, "doctors know that they are starting the procedure to ablate the AV node, so there should not be any diagnostic testing codes listed on the same claim," says Collins.

Example: A cardiologist performs His bundle recording to localize the AV node for ablation (93650). You would report the ablation (93650, $601.95 Medicare national rate) and not the His bundle recording (93600, $119.38 Medicare national rate).

If you incorrectly reported the His recording, you'd be overcoding by $119, which would be subject to payback requests.

2. Keep 'Second Physician' in Mind for 99148-99150

You can sum up the bulk of this round of CCI bundles in seven words: Check the edits before reporting moderate sedation.

Roughly 80 percent of the new bundles relate to moderate sedation codes 99148-99150 (Moderate sedation services [other than those services described by codes 00100-01999], provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports ...), according to the Sept. 11 "NCCI 15.3 Update" news release by Frank Cohen, MPA, senior analyst with MIT Solutions Inc. in Clearwater, Fla. These edits carry a modifier indicator of "0," which means you can't override the edit with a modifier.

Whether it's transluminal balloon angioplasty (35470-35476), EP studies (93600-93603), or almost any other service you can think of, CCI edits bundle in various moderate sedation codes. But don't start counting the dollars you'll be losing if the bundled codes are 99148-99150. As the descriptors indicate, these codes describe sedation by a second physician -- not by the physician performing the diagnostic or therapeutic service. So those edits shouldn't change how you code your claims for procedures.

Although not as overwhelming as the moderate sedation edits, CCI also created a number of edits to keep you from reporting catheter introduction and placement with pacemaker, pacing cardioverter-defibrillator, and EP study codes (see the chart below). All of these edits have a modifier indicator of "1," which means you may override the edit with a modifier when appropriate (such as when the patient has an EP study in the morning and later in the day has another procedure with reportable cath placement).

Impact: These edits should help keep your coding on the straight and narrow rather than changing your day-today practices if you've been coding correctly all along. For instance, you wouldn't report catheter placement in addition to 93620 (Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia ...) because CPT guidelines state "arrhythmia induction occurs via the same catheter(s) inserted for the electrophysiologic study(ies), [so] catheter insertion and temporary pacemaker codes are not additionally reported."

CCI also bundles 76380 (Computed tomography, limited or localized follow-up study) into a number of imaging codes, including cardiac CT codes 0144T-0150T. These edits also have a modifier indicator of "1."

Example: A cardiologist performs calcium scoring and a related follow-up CT. You should report only 0144T (Computed tomography, heart, without contrast material, including image postprocessing and quantitative evaluation of coronary calcium). You do not add 76380 to that claim, according to the new edits.