Cardiology Coding Alert

Beware of coding transcatheter therapy and vascular imaging on the same date.

Correct Coding Initiative (CCI) Version 16.2 is in full effect, as of July 1. But not all news from CCI Version 16.2 is bad news.

CCI deletes dozens of edit pairs, said Frank Cohen, MPA, MBB, of The Frank Cohen Group, in a June 17 announcement about the CCI changes. Below, see which cardiologyrelated edits have been ousted and what's been added.

What's Out: CCI Deletes Edits for MTWA and Stress Tests

You've faced an edit that has barred reporting cardiovascular stress test codes 93015-93017 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress ...) with 93025 (Microvolt T-wave alternans for assessment of ventricular arrhythmias) since 2002. But starting July 1, you'll be able to report these codes together, thanks to an edit deletion in the new version of CCI.

93025 explained: Microvolt T-wave alternans (MTWA) is a diagnostic test that identifies patients at risk for sudden cardiac death. Medicare covers 93025 for the evaluation of patients at risk for sudden cardiac death only when the physician uses spectral analysis, according to the National Coverage Determination manual, section 20.30 (available from www.cms.gov/Manuals/IOM/list.asp). The test involves gradually elevating the patient's heart rate on a treadmill (or, in some cases, pharmacologically or by atrial pacing). Despite the similarities, 93025 is not the same as the stress test reported using 93015-93017.

CCI snag: CMS still has version 15.3, effective Oct. 1, 2009, of the CCI policy manual posted at www.cms.gov/NationalCorrectCodInitEd/, and it states that you shouldn't report 93015-93017 with 93025.

Specifically, manual section I.8 states, "If a physician performs an MTWA with submaximal stress test followed by a traditional stress test on the same date of service, CMS payment policy allows separate payment of MTWA (CPT code 93025) and the interpretation and report for the traditional stress test (CPT code 93018). The practice expense component of the traditional stress test is not separately payable, and a physician should not report CPT codes 93015-93017 on the same date of service as CPT code 93025."

We'll keep you posted on whether CMS posts an updated CCI manual.

Also watch for: The latest CCI version deletes the edit bundling 93025 into 93351 (Echocardiography, transthoracic, real-time with image documentation [2D], includes M-mode recording, when  performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous  lectrocardiographic monitoring, with physician supervision).

What's In: Comply With New ECG and Imaging Edits

Among all the new CCI edits, be sure you note these areas in particular: CCI now bundles 75896 (Transcatheter therapy, infusion, any method [e.g., thrombolysis other than coronary], radiological supervision and interpretation]) into many codes, including endovascular repair codes 34800-34805, as well as vascular procedure codes 75600-75791 and 75810-75891. These edits have a  modifier indicator of 1, which means that you may override the edit with a modifier, such as 59 (Distinct procedural service), when appropriate.

CCI also now bundles 93000-93010 (Electrocardiogram, routine ECG with at least 12 leads ...) into cardiac CT codes 75571-75574. These edits also have a modifier indicator of 1.

Keep in mind: Because modifier 59 has the potential to bypass CCI edits, practices use this modifier too often, says Suzan Berman, CPC, CEMC, CEDC, senior manager of coding and compliance with the UPMC departments of Surgery and Anesthesiology.

But you should never use modifier 59 just to get paid for a procedure. "Make sure here is well-documented support for a separate and distinct procedure before adding modifier 59," says Rena Hall, CPC, billing/insurance specialist with a Kansas City, Mo., practice.

In addition, CPT instructions dictate that if a more specific modifier describes the situation, you should not use modifier 59. Modifier 59 "should be the modifier of last resort and only used when there is no other modifier to compliantly bypass the bundling edit, and the procedure was clearly distinct and different from that of the other procedure," adds Berman. For example, modifiers LT (Left side) and RT (Right side) may be more appropriate for your case.

In contrast: Some additions to CCI 16.2 have a modifier indicator of 0, meaning that you may not unbundle the edit combination under any circumstances. In other words, you can't automatically override every CCI edit with modifier 59 just because documentation supports a separate site, incision, or patient meeting, says Claudia Kernaghan, CPC, coder for Nevada Imaging Centers in Las Vegas.

Case in point: CCI now bundles 78494 (Cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or without quantitative processing) into 78451-78452 (Myocardial perfusion imaging, tomographic [SPECT] ]including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed]) with a modifier indicator of 0. Keep in mind that 78451-78452 include the services 78494 describes.

Want to see all the edits? Download the edits at www.cms.gov/NationalCorrectCodInitEd/.