Cardiology Coding Alert

CCI 28.1:

Pay Attention to New Coarctation of Aorta Repair Edits to Submit Clean Claims

Hint: A modifier indicator of “0” means you cannot break an edit.

You’ve learned about the 2022 CPT® left atrial appendage (LAA) exclusion, coarctation of aorta repair and congenital heart catheter additions, changes, and revisions in recent issues of Cardiology Coding Alert. Now, with the release of the National Correct Coding Initiative (NCCI) 28.1 procedure-to-procedure (PTP) edits, you should also review 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 28.1 edits focus on the new 2022 CPT® codes.

Look at These New LAA Exclusion Edits

You’ll see many edits involving the new LAA exclusion codes 33267 (Exclusion of left atrial appendage, open, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip)) through 33269 (Exclusion of left atrial appendage, thoracoscopic, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip)).

Codes bundled into 33267-33269: For example, codes bundled into 33267-33269 with a modifier indicator of “1” include the following:

  • Debridement codes 11000-11006 and 11042-+11047
  • Simple repair codes 12001-12021, intermediate repair codes 12031-12057, and complex repair codes 13100-+13153
  • Pleural drainage codes 32556 and 32557
  • Blood vessel repair codes 35201-35207
  • Venipuncture codes 36410, 36420, and 36425
  • Transfusion codes 36430 and 36440
  • Arterial cath code 36640
  • Mediastinotomy codes 39000 and 39010
  • Naso- or orogastric tube placement code 43752
  • Bladder cath insertion codes 51701-51703
  • Ultrasonic guidance codes 76942 and 76998
  • Electrocardiogram codes 93000-93010
  • Rhythm ECG codes 93040-93042
  • Echocardiography transesophageal (TEE) code 93318
  • Electroencephalogram (EEG) codes 95812-95819
  • Evaluation and management (E/M) codes 99211-99223, 99231-99236, 99241-99245, 99251-99255, and 99304-99310

Remember: A modifier indicator of “1” lets you know that you can override an edit, if appropriate, using 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 NCCI-associated modifiers to bypass an NCCI edit unless you meet the proper criteria for using the modifier. The documentation in the medical record must satisfy the criteria required by any NCCI-associated modifier that you use.

On the other hand: For example, codes bundled into 33267-33269 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, 64400-64425, 64479-+64484, 64486-+64495, and 64505-64530. These edits cannot be broken under any circumstances because they have a modifier indicator of “0.”

Don’t miss: “One category of NCCI edits is known as Column 1/Column 2 edits or procedure-to- procedure (PTP). These list procedures that may be part of a more extensive surgery,” says Robin Peterson, CPC, CPMA, manager of professional coding, Pinnacle Integrated Coding Solutions, LLC. “The second category of NCCI edits is the medically unlikely edits or MUEs. MUEs give a maximum number of units of service for a single beneficiary on a single calendar day.”

Discover New Coarctation of Aorta Repair Edits

You will also see some edits involving the new codes for transcatheter interventions for revascularization or repair of the coarctation of the aorta: 33894 (Endovascular stent repair of coarctation of the ascending, transverse, or descending thoracic or abdominal aorta, involving stent placement; across major side branches), 33895 (… not crossing major side branches), and 33897 (Percutaneous transluminal angioplasty of native or recurrent coarctation of the aorta).

Codes bundled into 33894, 33895, and 33897: For example, codes bundled into 33894 and 33895 with a modifier indicator of “1” include the following:

  • Blood vessel repair codes 35201-35286
  • Arterial puncture code 36600
  • Transcath stent placement codes 37236 and +37237
  • Transluminal balloon angioplasty code +37247
  • Ophthalmological services codes 92012 and 92014
  • Ventilation assist and management code 94002
  • Maximum breathing capacity code 94200
  • Oxygen uptake codes 94680-94690
  • Electrocorticogram code 95829
  • EEG code 95955
  • Intravenous infusion codes 96360 and +96361 and 96365-+96368
  • E/M codes 99211-99223, 99231-99236, 99241-99245, 99251-99255, and 99347-99350

Additionally: Codes bundled into 33894, 33895, and 33897 with a modifier indicator of “0” include endovascular repair codes 34701-34706; introduction of catheter code 36200; injection codes 64400-64425, 64479-+64484, 64486-+64495, and 64505-64530; aortography codes 75600 and 75625; and moderate sedation codes 99155-+99157.

Focus on Congenital Heart Cath Edits

You will also see edits with new congenital heart cath codes 93593 (Right heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone; normal native connections)-+93598 (Cardiac output measurement(s), thermodilution or other indicator dilution method, performed during cardiac catheterization for the evaluation of congenital heart defects (List separately in addition to code for primary procedure)).

Codes bundled into 93593-+93598: For example, codes bundled into 93593-+93598 with a modifier indicator of “1” include the following:

  • Injection code 36005
  • Venous sampling code 75893
  • Fluoroscopy code 76000
  • Ultrasound guidance code +76937
  • Ophthalmological services codes 92012 and 92014
  • Electrocardiogram codes 93000-93010
  • EEG codes 95812 and 95813 and 95816-95829
  • Injection codes 96372-96377
  • E/M codes 99231-99239, 99241-99245, 99251-99255, 99304-99310, 99374- 99378, and 99495-99496

Don’t miss: Codes bundled into 93593-+93598 with a modifier indicator of “0” include collection of blood specimen codes 36591 and 36592, paravertebral bloc (PVB) codes 64461-64463, transversus abdominus plane (TAP) block codes 64486-64489, and moderate sedation codes 99155-+99157.