Cardiology Coding Alert

Version 8.1 of the national Correct Coding Initiative (CCI) (effective April 1, 2002-June 30, 2002) deletes an inappropriate edit that defeated the purpose of a CPT revision for two electrophysiology (EP) codes.

In version 8.0 (effective Jan. 1-March 31, 2002), CCI bundled a primary code (93620, Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia) into its add-on components, +93621 ( with left atrial pacing and recording from coronary sinus or left atrium [list separately in addition to code for primary procedure]) and +93622 ( with left ventricular pacing and recording [list separately in addition to code for primary procedure]).

As of Jan. 1, 2002, CPT revised these three codes. Code 93620 is no longer an extension of 93619 (... without induction or attempted induction of arrhythmia) and now stands alone. More significant, +93621 and +93622 were changed to add-on codes that may be reported in addition to 93620. Previously, +93621 and +93622 were comprehensive codes that incorporated all the elements of 93620 as well as left atrial or left ventricular study.

The CPT change resolved a long-standing issue about how EP studies that also involve the left atrium and/or the left ventricle should be coded. Although CCI bundled 93620 with +93621 and +93622, some EP physicians argued that, given the tiny increase in fees for performing the left-side study, both right-side (93620) and left-side (+93621 and/or +93622) studies should be separately reported.

"By changing +93621 and +93622 to add-on codes, the issue was supposed to go away," says Belinda Inabinet, CPC, technical support and coding manager at South Carolina Heart Center, a 21-physician practice in Columbia, S.C. "But CCI wasn't notified in time to correct the problem for the first-quarter edits, so they were not removed, and some Medicare and other carriers continued to deny the main procedure." Other carriers, she adds, allowed the claim to go through on appeal.

After they were designated as add-on codes, CMS revised their value. In 2001, before the change, +93621-26 ( Professional component) was assigned 21.20 relative value units (RVUs), whereas +93622-26 was valued at 21.32 RVUs. As add-on codes, the values have been drastically reduced (+93621, 3.13 RVUs; +93622, 5.07 RVUs).

The failure to remove the edit in 8.0 results in the denial of 93620-26 and its 17.01 RVUs, leaving the EP physician with payment only for 93621-26 and/or 93622-26, a fraction of the appropriate amount for performing the left- and right-side EP studies.

The edits no longer appear in version 8.1 and do not apply as of April 1, says Linda Dietz, RHIA, CCS, CCS-P, coding specialist for the CCI, which is compiled by AdminaStar Federal in Indianapolis.

"As of April 1, cardiology practices should refile denied claims made between Jan. 1 and March 31," Dietz says. As add-on codes, +93621 and +93622 may not be reported without 93620. When the additional studies are performed, multiple-procedure guidelines do not apply, and the amount billed for the additional procedures does not have to be reduced by 50 percent (or at all) because the fees of add-on services are already reduced.

Code 93025 (Microvolt T-wave alternans for assessment of ventricular arrhythmias) now includes cardiovascular stress testing. Comprehensive code 93015, as well as component codes 93016 and 93017, should not be billed with 93025.

Microwave T-wave alternans is a provocative diagnostic test that identifies patients at risk for sudden cardiac death and involves gradually elevating the patient's heart rate to 110 on a treadmill (or, in some cases, pharmacologically or by atrial pacing). Despite the similarities, 93025 is not a true stress test, and the two services would likely not be performed together.

Most of the other edits affecting cardiologists involve three codes 36000* (Introduction of needle or intracatheter, vein), 34812 (Open femoral artery exposure for delivery of aortic endovascular prosthesis, by groin incision, unilateral) and +34813 (Placement of femoral-femoral prosthetic graft during endovascular aortic aneurysm repair [list separately in addition to code for primary procedure]). The latter two are part of a series of codes for endovascular repair of abdominal aortic aneurysm introduced in 2001.

As of April 1, all three codes became components of other vascular and coronary procedures. Notably, 36000, 34812 and 34813 have been bundled with most left heart cath codes, including 93510 (Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous), 93511 ( by cutdown) and 93526 (Combined right heart catheterization and retrograde left heart catheterization). In addition, 34812 and 34813 are included in the three coronary interventions: PTCA (92982), stents (92980) and atherectomy (92995).

Note: To obtain additional edit information, a subscription to the CCI with quarterly updates should be purchased. Contact NTIS at its Web site: www.ntis.gov.