Cardiology Coding Alert

Plus: 93602 and 93610 are no longer bundled with 92961.

In the latest version of the Correct Coding Initiative (CCI), it's the deleted edit pairs -- rather than the added ones -- that may be of most interest to you. Check out these vascular and electrophysiology (EP) changes, effective Oct. 1, 2011, for physicians.

Don't Assume Old 36xxx Edits Still Apply

This version of CCI deletes 835 edit pairs, notes Frank Cohen, principal and senior analyst for The Frank Cohen Group, LLC, in his NCCI 17.3 Update (available at www.frankcohen.com/html/access.html).

More than 600 of those deletions eliminate edits that had 36xxx (vascular introduction and injection procedure) codes in the column 1 position. While the deletions mean you shouldn't assume the old bundles are in place when considering a 36xxx code, finding cases in which reporting both codes is appropriate may still be rare.

For example: CCI 17.3 deletes the edit bundling 36000 (Introduction of needle or intracatheter, vein) into 36010 (Introduction of catheter, superior or inferior vena cava). This edit had a modifier indicator of 1, so when the edit was in place, you were able to override it with a modifier when the needle introduction (36000) was performed in a different vein than the 36010 service. As of October 1, you should be able to report both codes (when appropriate) without the modifier. (See "Master the Meaning of CCI Modifier Indicators" on page 76 for more detail on overriding edits.)

93602 and 93610 Break Free of 92961

Additional edit deletions affect EP procedures. The following bundles are no longer active under CCI 17.3:

Before you report these codes together on a claim, you still want to be sure documentation supports reporting the codes. Here's a look at the services the codes describe.

92961: When 92961 was a new code, CPT® Assistant (November 2000) explained that physicians typically use elective internal cardioversion when external cardioversion doesn't work in treating atrial fibrillation and flutter.

The procedure involves percutaneously placing an electrode catheter in a vein and advancing the catheter to the right atrium. The physician places a second electrode in the coronary sinus or pulmonary artery. She connects the electrodes to an external cardioverter defibrillator, and then uses electrical shock to try to restore the heart's rhythm.

Code 92961's definition includes the key phrase "separate procedure." CPT® adds this phrase to code definitions to indicate the physician normally performs it as an integral part of another, more extensive procedure. Therefore, the only time you should report the "separate procedure" code is when the service is unrelated to or distinct from other services performed at the same time.

The 2000 CPT® Assistant article offered some additional clues: "Internal elective cardioversion is not separately reported when performed as an integral component of another procedure/service as in an electrophysiological study or cardiac catheterization."

93602 and 93610: These EP codes describe single-catheter services. Typical EP studies use two or more electrode catheters. The single-cath codes usually apply when the physician wants "specific diagnostic information from a specific intracardiac site," states CPT® Assistant (April 2004).

"A combination of single catheter recording and pacing studies of a specific intracardiac site is commonly performed in arrhythmia termination," the 2004 article states.

For 93602, the physician advances an electrode catheter attached to a recording device into the right atrium (left atrial recordings are also possible).

Code 93610 also involves using an electrode catheter. For this service, the physician attaches the catheter to a pacing device to send pacing impulses to the chosen atrium.

Resource: You can download the current physician edits from www.cms.gov/NationalCorrectCodInitEd/NCCIEP/list.asp.