Cardiology Coding Alert

Hint: Don't report hospital observation codes 99217-99220 together with 93793.

As you're getting into the swing of things with the new 2018 CPT^® codes, don't forget to learn the recently released Correct Coding Initiative (CCI) 24.0 edits associated with these codes. When you comb through the edits, you'll see a variety of cardiology-specific edits to become familiar with.

Check out these anticoagulant, category III, and observation edits to see what you're dealing with.

Observe These Total Replacement Heart System Edits

In CPT^® 2018, new permanent codes 33927 (Implantation of a total replacement heart system (artificial heart) with recipient cardiectomy), 33928 (Removal and replacement of total replacement heart system (artificial heart), and +33929 (Removal of a total replacement heart system (artificial heart) for heart transplantation ...) take the place of several category III total replacement heart system codes. Take a look at the following edits surrounding these new codes:

Some of the codes bundled into 33928 with a modifier indicator of 0 include: +33929; operating microscope code +69990; and irrigation of implanted venous access device code 96523. These edits cannot be broken under any circumstances because they have a modifier indicator of "0."

Some of the codes bundled into 33928 with a modifier indicator of 1 include: injection codes 0213T, 0216T, 0228T; and debridement codes 11004-11006 and 11042-+11047. These edits have a modifier indicator of "1," which means the edits can be overcome, if appropriate, with the use of a modifier

Code 33928 is bundled into many codes including the following: insertion of extracorporeal ventricular assist device codes 33975 and 33976 and replacement of ventricular assist device codes 33981-33983. These edits have a modifier indicator of "0."

Catch These New 93792 and 93793 Edits

You have a bunch of edits to learn surrounding new anticoagulant codes 93792 (Patient/caregiver training for initiation of home international normalized ratio (INR) monitoring under the direction of a physician or other qualified health care professional ...) and 93793 (Anticoagulant management for a patient taking warfarin, must include review and interpretation of a new home, office, or lab international normalized ratio (INR) test result, patient instructions, dosage adjustment (as needed), and scheduling of additional test(s), when performed).

Code 93792 is bundled into several codes with a modifier indicator of "1" including: telephone assessment and management service codes 98966-98968; new patient evaluation and management (E/M) codes 99201-99203; hospital observation codes 99217-99220; and subsequent hospital care code 99462.

Code 93793 is bundled into these codes with a modifier indicator of "0": hospital observation codes 99217- 99220; hospital discharge code 99239; and subsequent nursing facility care codes 99307 and 99308.

Reminder: Only report 93793 once per day, regardless of the number of tests reviewed, says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC's Certified Cardiology Coder steering committee.

Important: As per the above examples, notice that while you may be able to use a modifier to override the edits for 99217-99220 and 93792, this is not the case with 93793. You know this is true when you see that the 99217-99220 and 93792 edits carry a modifier indicator of "1," but the 99217- 99220 and 93793 edits carry a modifier indicator of "0."

Apply CCI Edits to New Category III Codes

As you may recall, CPT^® 2018 brought you several new Category III options:

• +0482T (Absolute quantitation of myocardial blood flow, positron emission tomography (PET), rest and stress [List separately in addition to code for primary procedure])
• 0483T and 0484T (Transcatheter mitral valve implan­tation/replacement (TMVI) with prosthetic valve...)
•  0497T and 0498T (External patient-activated, physician- or other qualified health care professional-prescribed, electrocardiographic rhythm derived event recorder without 24 hour attended monitoring ...)
• 0501T through 0504T (Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary computed tomography angiography data using computation fluid dynamics physiologic simulation software analysis of functional data to assess the severity of coronary artery disease...).

As an example of the new edits you'll contend with surrounding these category III codes, check these out:

Codes bundled into 0482T with a modifier indicator of "1" include: injection codes 96372 and 96374-+96376; and hydration intravenous infusion code 96360.

Codes bundled into 0482T with a modifier indicator of "0" include: non-cardiac vascular flow imaging code 78445; irrigation of implanted venous access device code 96523; and HCPCS codes A4641, A9540, and A9558.

Remember: Category III codes (also known as "T-codes") are temporary codes for emerging services. Using the Category III code allows for the collection of specific data about use, efficacy, and outcomes. From a billing standpoint, Category III codes often apply to services that payers consider investigational/experimental.

Editor's note: These edits are just a sample of what you should be aware of surrounding the 2018 anticoagulant, category III, and observation code updates, not an exhaustive list. Visit www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Version_Update_Changes.html for the complete list of CCI 24.0 edits.