Cardiology Coding Alert

Make sure you know what the different modifier indicators mean.

You’ve learned all about the 2021 CPT^® congenital transcatheter, ventricular assist device, and electrocardiographic (ECG) recording additions, changes, and revisions in recent issues of Cardiology Coding Alert. Now, with the release of the Correct Coding Initiative (CCI) 27.0 procedure-to-procedure (PTP) edits, you should also see how these edits will impact your cardiology practice’s reimbursement this year.

As is typical of the first round of bundlings for a new year, many of the 27.0 edits focus on the new 2021 CPT^® codes.

Check Out These Congenital Transcatheter Edits

You’ll see many edits involving new code 33741 (Transcatheter atrial septostomy (TAS) for congenital cardiac anomalies to create effective atrial flow, including all imaging guidance by the proceduralist, when performed, any method (eg, Rashkind, Sang-Park, balloon, cutting balloon, blade)).

Codes bundled into 33741: For example, codes bundled into 33741 with a modifier indicator of “1” include the following:

• Debridement codes 11000-11006, 11042-+11047
• Simple repair codes 12001-12021
• Intermediate repair codes 12031-12057
• Complex repair codes 13100-+13153
• Blood vessel repair codes 35201-35266
• Introduction of needle or intracatheter code 36000
• Venipuncture codes 36400-36410; transfusion code 36430
• Push transfusion code 36440
• Venous catheterization code 36500

Remember: A modifier indicator of “1” lets you know that an edit can be overcome, if appropriate, with the use of a modifier, such as modifier 59 or modifiers XE (Separate encounter…), XS (Separate structure…), XP (Separate practitioner…), or XU (Unusual non-overlapping service…). However, you should never use modifier 59 and other CCI-associated modifiers to bypass a CCI edit unless you meet the proper criteria for the use of the modifier. The documentation in the medical record must satisfy the criteria required by any CCI-associated modifier that you use.

On the other hand: For example, codes bundled into 33741 with a modifier indicator of “0” include: pacemaker codes 33210 and 33211; collection of blood specimen codes 36591 and 36592; and injection codes 62320-62327

These edits cannot be broken under any circumstances because they have a modifier indicator of “0.”

You also see some edits involving codes 33745 (Transcatheter intracardiac shunt (TIS) creation by stent placement for congenital cardiac anomalies to establish effective intracardiac flow, including all imaging guidance by the proceduralist, when performed, left and right heart diagnostic cardiac catherization for congenital cardiac anomalies, and target zone angioplasty, when performed (eg, atrial septum, Fontan fenestration, right ventricular outflow tract, Mustard/Senning/Warden baffles); initial intracardiac shunt) and +33746 (… each additional intracardiac shunt location (List separately in addition to code for primary procedure)).

Codes bundled into 33745 and +33746: For example, codes bundled into 33745 and +33746 with a modifier indicator of “1” include: arterial puncture code 36600; arterial catheterization code 36640; naso- or oro-gastric tube placement code 43752; fluoroscopy code 76000; ultrasonic guidance code 76942; cardioversion code 92961; ECG codes 93000-93010; catheter placement in coronary artery codes 93454 and 93455; and EEG codes 95812-95819.