Cardiology Coding Alert

CCI Update:

Don't Miss 64-Lead ECG Edits Among 304,000 New Bundles

Weve sorted through the massive release to find the edits that affect you.

Bring order to the chaos of the hundreds of thousands of new edits Correct Coding Initiative (CCI) version 15.1 put into effect April 1 by breaking it down into a few digestible chunks.

Put your mind at ease with this analysis of CCIs newest bundle pairs.

A Short List of Codes Bears the Brunt

CCI takes aim at a relatively small group of codes this round, with only 524 unique codes listed in column 2 of the new column 1/column 2 edit list, according to Frank Cohen, MPA, senior analyst with MIT Solutions Inc. in Clearwater, Fla., in his March 25, 2009, webinar NCCI Version 15.1 Update.

For example: CCI bundles many of the codes it focuses on into interventional procedures, such as 93508 (Catheter placement in coronary artery[s], arterial coronary conduit[s], and/or venous coronary bypass graft[s] for coronary angiography without concomitant left heart catheterization).

Some of the edits have a modifier indicator of 1, which means you may override the edit with a modifier when appropriate (such as when the services are at different anatomic sites or at separate encounters).

The following column 2 codes are among those bundled into 93508 with a 1 indicator:

" Venipuncture: 36400-36406, 36420-36425

" Transfusion: 36430-36440

" Arterial puncture/catheterization: 36600, 36640

" Naso- or oro-gastric tube placement: 43752

" Anesthetic agent injection: 64505-64530

" Surface neurostimulator application: 64550

" Transesophageal echocardiography: 93318

" Pulmonary services: 94002, 94200, 94250,94680-94690

" Electroencephalography: 95812-95822, 95829, 95955

" Sequential IV push: +96376.

Other edits have a modifier indicator of 0, meaning you may never override the edit, Cohen explains.

In particular, the following column 2 codes are bundled into 93508 with a 0 indicator:

" Epidural or subarachnoid injection: 62310-62319

" Anesthetic agent injection: 64400-64450, 64470-64475, 64479, 64483.

Typically, payers include injections and other procedures performed during surgery in the main surgical procedure anyway, so these edits shouldnt hurt too badly, says Heather Corcoran with CGH Billing in Louisville, Ky.

ECG Integral to Multiple Services

CCI does devote some of its latest edits to cardiology specific procedures, though. Smart move: Be sure you check CCI edits before reporting ECG with any other service. For example, CCI bundles 93000 (Electrocardiogram,routine ECG, with at least 12 leads; with interpretation and report) into more than 4,700 codes, including the following. All have a modifier indicator of 1:

" 0178T-0180T (Electrocardiogram, 64 leads or greater, with graphic presentation and analysis &)

" Pericardium, cardiac tumor, and transmyocardial revascularization codes 33015-33140

" Pacemaker and pacing cardioverter-defibrillator codes 33202-33203, 33215, 33224, 33226, 33236-33238, 33243

" Electrophysiologic operative codes 33250-33256,33261-33266

" Patient-activated event recorder codes 33282-33284

"Cardiovascular therapeutic codes 92970-92971,92990-92993, 92997

" Cardiac cath codes 93503, 93531-93533

" Septal defect repair codes 93580-93581.

Remember: CCI edits apply to claims submitted by the same physician on the same date. So, for example, if your cardiologist interprets a medically necessary ECG for a patient who has a septal defect repair (such as 93581) by a separate physician on the same date, CCI edits should not prevent you from reporting the ECG for your physician.

Check Edits Before Reporting 64-Lead ECG

Watch your 64-lead ECG claims, too. CCI bundles 0178T-0180T into more than 300 codes, including the following, all of which have a modifier indicator of 1:

" 93015-93018 -- Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise,continuous electrocardiographic monitoring &

" 93025 -- Microwave T-wave alternans for assessment of ventricular arrhythmias &

" 93797 -- Physician services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session).

CCI also bundles technical code 0179T (& tracing and graphics only &) into professional code 0180T (& interpretation and report only) with a modifier indicator of 1. But remember that you should report 0178T (& with interpretation and report) if youre billing the global service.

New Cardioversion Edits a Shock?

If documentation supports reporting 92960 (Cardioversion, elective, electrical conversion of arrhythmia; external), be sure to watch which other codes you add to your claim. CCI bundles the following codes into 92960 with a modifier indicator of 1:

" ICD programming evaluation codes 93282-93284

" In-person interrogation device evaluation codes 93289, 93292

" Remote interrogation device evaluation code 93295.

Remember 93724 for Antitachycardia Pacemaker

If your practice evaluates antitachycardia pacemakers,be sure you catch the following additions to CCIs mutually exclusive edits.

ME meaning: Mutually exclusive procedures cannot reasonably be performed at the same anatomic site or same patient encounter, states Chapter 1 of the NCCI Policy Manual for Medicare Services (

CCI places 93724 (Electronic analysis of antitachycardia pacemaker system [includes electrocardiographic recording, programming of device, induction and termination of tachycardia via implanted pacemaker, and interpretation of recordings]) in the column 1 position with the following codes in the column 2 position:

" 93279-93281 -- Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report &

" 93286 -- Peri-procedural device evaluation and programming of device system parameters before or after a surgery, procedure, or test &

" 93288 -- Interrogation device evaluation (in person) & pacemaker system.

These edits have a modifier indicator of 0, meaning you may never override them.

Tech tip: Most pacemakers are demand pacemakers, which monitor the heartbeat and produce a beat when needed. Antitachycardia pacemakers, on the other hand, treat faster than normal heartbeats.

CPT created 93724 to describe noninvasive evaluation of an antitachycardia pacemaker system, according to AMAs CPT Assistant (Summer 1994).

The code describes recording an ECG, reprogramming the device to allow induction of the tachycardia by noninvasive programmed stimulation, and analyzing device performance by interpreting electrograms and interrogation data, CPT Assistant states.

Bottom line: When the cardiologist evaluates an antitachycardia pacemaker system, choose 93724 and dont tack on other evaluation codes.