Cardiology Coding Alert

Stent placement and fluoroscopy updates could affect your claims.

“Swap” is the name of the game for cardiology edits in Correct Coding Initiative 20.2, effective July 1, 2014. In a few edits, codes swap columns, and in some other edits, you’ll see modifier indicators flip. Here are the details.

Don’t Stop at the Deletions for 37236-+37239

The first set of affected codes involves transcatheter intravascular stent placement codes 37236-37239:

• 37236, Transcatheter placement of an intravascular stent(s) (except lower extremity arteries for occlusive disease, 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)
• 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 above codes had the following edits in version 20.1, and became effective back in January at the same time that the codes became effective:

Version 20.2 deletes all of the above edits retroactive to Jan. 1, 2014, according to the analysis by Frank Cohen of the healthcare analytics firm The Frank Cohen Group. 

But there’s a catch. Version 20.2 adds back two new edits for these codes:

Bottom line: The modifier indicator of 1 means that you may override the edit with a modifier when appropriate. Specifically, to report additional vein code +37239 on the same date as initial artery code 37236, you’ll need to append a modifier to +37239. You’ll also need to report initial vein code 37238 as the primary code for +37239.

Similarly, to report additional artery code +37237 on the same date as initial vein code 37238, you’ll need to append a modifier to +37237. You’ll also need to report initial artery code 37236 as the primary code for +37237.

Tie to the past: As explained in Cardiology Coding Alert, vol. 17, no. 3, the above changes aren’t the only ones CCI has made to edits for these codes. Version 20.1 retroactively deleted edits preventing you from reporting 37236 with +37237 and 37238 with +37239.

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 is illogical. The same reasoning applies to the 37238/+37239 edit. As Marchelle Cagle, CPC, CPC-I, PCS, of Cagle Medical Consulting, explained, you should not need a modifier to report an add-on code with its primary code, so deleting these edits made sense.

Don’t Abuse Fluoro Modifier Indicator Switch

Another swap you’ll see in version 20.2 is the modifier indicator for many edits with column 2 code 76000 (Fluoroscopy [separate procedure], up to 1 hour physician or other qualified health care professional time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]).

The modifier indicator switches from 0 to 1, meaning that you will now be able to report 76000 with a modifier on the same date as the column 1 procedure, but only if the fluoroscopy is a distinct service.

The relevant column 1 codes you should note are as follows:

• 0293T-0294T, Insertion of left atrial hemodynamic monitor …
• 33967, Insertion of intra-aortic balloon assist device, percutaneous
• 93451-93453, right and/or left heart catheterization
• 93456-93461, coronary angiography
• 93505, Endomyocardial biopsy
• +93563-+93567, Injection procedure during cardiac catheterization …

Bottom line: Just because CCI allows you to override an edit, that doesn’t mean you should override the edit. Only override the edit when documentation clearly shows the use of fluoroscopy was truly distinct from the column 1 procedure.