Cardiology Coding Alert

Alert your team to watch for 37236-+37239 changes coming down the pike.

You can expect two Correct Coding Initiative (CCI) edits affecting your stent claims to be deleted in April. Here are the details and tips for dealing with claims until the deletions become effective.

Double Check 37236/+37237 Claims for Denials

National Government Services, the Part B MAC for Jurisdictions K and 6, posted news that CMS plans to delete a handful of CCI edits in the April 2014 version. All of the edits were originally implemented in the January 2014 version. The deletions will be retroactive to Jan. 1, 2014, so it will be as if the edits never existed.

The first cardiology-related deletion will affect new-for-2014 codes for stent placement in certain arteries. The edit places “additional artery” code +37237 in Column 1 and “initial artery” code 37236 in Column 2:

• 37236, Transcatheter placement of an intravascular stent(s) (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery
  
• +37237, … each additional artery (List separately in addition to code for primary procedure)
  

Problem: Code 37236 is the only appropriate primary code for add-on code +37237, so an edit that prevents payment of 37236 when reported with +37237 doesn’t make sense. “The edit may have just been a mistake,” says Marchelle Cagle, CPC, CPC-I, PCS, of Cagle Medical Consulting. “Modifiers are not needed in addition to add-on codes with a primary procedure.”

The reason CCI originally gave for the edit was “sequential procedure.” But 37236/+37237 does not meet CCI’s definition of sequential procedure: “If a provider attempts several procedures in direct succession at a patient encounter to accomplish the same end, only the procedure that successfully accomplishes the expected result is reported” (NCCI correspondence language manual, www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Downloads/ncci_correspondence_language_manual.pdf).

Clearly, that sequential procedure policy does not apply to services performed on an initial artery (37236) and an additional artery (+37237).

Add 37238/+37239 to Your Watch List, Too

The second cardiology-related edit that will be deleted is another primary/add-on stenting code pair introduced in 2014. The edit places “additional vein” code +37239 in Column 1 and “initial vein” code 37238 in Column 2:

• 37238, Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; initial vein
  
• +37239, … each additional vein (List separately in addition to code for primary procedure).
  

The situation for 37238/+37239 is identical to the 37236/+37237 edit. CCI gave the same reason, “sequential procedure,” for the edit’s creation. Code 37238 is the only appropriate primary code for add-on code +37239, so again it makes sense to delete an edit that prevents payment of 37238 when reported with +37239.

Decide How to Handle Claims Until Deletion

CCI will delete the edits in the CCI version implemented on April 1, 2014. The deletions are expected to be retroactive to Jan. 1, 2014. Until the deletion occurs, coding experts recommend either overriding the edit by appending a modifier (the edits have a modifier indicator of 1) or holding the claims, keeping in mind any timely filing requirements.

Posting: To locate the National Government Services article, head to www.ngsmedicare.com/ngs/portal/ngsmedicare/news. Choose a Part B jurisdiction, and when the new page opens, re-enter the Web address above. In the Articles Search box, enter this phrase: Six NCCI Procedure to Procedure Edits. When the results appear, click the link for the article beginning with that same phrase.

Final tip: Codes 37236-+37239 still have more than 1,000 edits between them, so be sure to continue to check the edits before submitting claims for these codes.