Cardiology Coding Alert

If you use 0293T or +0294T, watch out for 339 new edits.   If you code for a cutting edge practice that always has you searching through the Category III codes, be sure to check your claim against Correct Coding Initiative (CCI) version 18.2. Here are some highlights to watch for.   Keep in mind: These edits have an effective date of July 1, 2012, for physicians. If you report both the Column 1 and Column 2 codes in an edit pair, payers who follow Medicare rules will deny the Column 2 code. If the edit has a modifier indicator of 0, you may never override the edit. If the edit has a modifier indicator of 1, you may override the edit with an appropriate modifier if the services are distinct, such as separate sites or separate sessions. For instance, you may append modifier 59 (Distinct procedural service) to the Column 2 code to unbundle and demonstrate medical necessity, says Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, president of Maggie Mac-Medical Practice Consulting in Clearwater, Fla., and Brooklyn, N.Y. Be sure to have documentation backing up your claim.   1. 0234T-0238T Edits Prevent S&I Double Dipping   Glance through the definition of 0234T-0238T (Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation ...), and you won't be surprised that CCI has added edits to bundle in supervision and interpretation (S&I) codes. There are also new edits bundling in vessel repair and blood sampling services.   For instance, all of the following codes are now bundled into Column 1 codes 0234T-0238T:

• 35231, 35236, 35256: Repair blood vessel with vein graft ...
• 36005, Injection procedure for extremity venography (including introduction of needle or intracatheter)
• 36500, Venous catheterization for selective organ blood sampling
• 36620, 36625: Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure)
• 75893, Venous sampling through catheter, with or without angiography (e.g., for parathyroid hormone, renin), radiological supervision and interpretation.

  The S&I edits differ for each Column 1 code based on the vessel the code describes. For instance, visceral artery code 0235T is a Column 1 code for these Column 2 codes:

• 75726, Angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision and interpretation
• 75736, Angiography, pelvic, selective or supraselective, radiological supervision and interpretation
• +75774, Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation (List separately in addition to code for primary procedure).

  2. Verify Tube or Bifurcated for 0255T Accuracy   The latest CCI version creates the following edit:

• Column 1: 75954, Endovascular repair of iliac artery aneurysm, pseudoaneurysm, arteriovenous malformation, or trauma, using ilio-iliac tube endoprosthesis, radiological supervision and interpretation
• Column 2: 0255T, Endovascular repair of iliac artery bifurcation (e.g., aneurysm, pseudoaneurysm, arteriovenous malformation, trauma) using bifurcated endoprosthesis from the common iliac artery into both the external and internal iliac artery, unilateral; radiological supervision and interpretation.

  The edit has a modifier indicator of 0, so you may never override the edit.   Edit rationale: CCI lists 75954 and 0255T as mutually exclusive procedures, according to the NCCI 18.2 Update posted by Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group.   Tip: The term "mutually exclusive" means CMS believes the "procedures cannot reasonably be performed at the same anatomic site or same patient encounter," states the National Correct Coding Initiative Policy Manual for Medicare Services (www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html).   3. TAVR Codes Take on New Edits   As if transthoracic aortic valve replacement (TAVR) didn't have enough rules to learn, CCI has added a few new CCI edits to the mix. The Column 1 codes your interventional cardiologist is most likely to use are:

• 0256T, Implantation of catheter-delivered prosthetic aortic heart valve; endovascular approach
• 0257T, ... open thoracic approach (e.g., transapical, transventricular).

  Bundled into these codes with a modifier indicator of 1 are:

• blood vessel repair codes in the 35xxx range
• 36005, Injection procedure for extremity venography (including introduction of needle or intracatheter)
• 75893, Venous sampling through catheter, with or without angiography (e.g., for parathyroid hormone, renin), radiological supervision and interpretation.

  4. Factor in 43 New OCT Edits   Two optical coherence tomography (OCT) codes were implemented Jan. 1, 2012:

• +0291T, Intravascular optical coherence tomography (coronary native vessel or graft) during diagnostic evaluation and/or therapeutic intervention, including imaging supervision, interpretation, and report; initial vessel (List separately in addition to primary procedure)
• +0292T, ... each additional vessel (List separately in addition to primary procedure)

  CCI 18.2 creates 43 new edits with these codes in the Column 1 spot, according to Cohen's analysis.   The edits listed below have a modifier indicator of 1, which means you may override the edits when documentation supports reporting the services separately. The Column 2 codes include:

• Blood vessel repair codes
• Venous sampling codes 36500 and 75893
• ECG codes 93000-93010 (Electrocardiogram, routine ECG with at least 12 leads ...) and 93040-93042 (Rhythm ECG, 1-3 leads ...)

  Don't miss: CCI also prevents reporting the OCT codes with +0205T (Intravascular catheter-based coronary vessel or graft spectroscopy [e.g., infrared] during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation, and report, each vessel [List separately in addition to code for primary procedure]) and +92978 (Intravascular ultrasound [coronary vessel or graft] during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; initial vessel [List separately in addition to code for primary procedure]), as shown below. All of these have a modifier indicator of 0:

Column 1	Column 2
+0292T	+0205T
+0205T	+0291T
+92978	+0291T

  5. 0293T and +0294T Take on 339 Edits   Two relatively new codes, implemented Jan. 1, 2012, feature heavily in version 18.2:

• 0293T, Insertion of left atrial hemodynamic monitor; complete system, includes implanted communication module and pressure sensor lead in left atrium including transseptal access, radiological supervision and interpretation, and associated injection procedures, when performed
• +0294T, ... pressure sensor lead at time of insertion of pacing cardioverter-defibrillator pulse generator including radiological supervision and interpretation and associated injection procedures, when performed (List separately in addition to code for primary procedure).

  CCI adds 339 edits with 0293T and +0294T in the Column 1 position, according to Cohen's analysis. So before you report these codes, check your claim against the edits to be sure you aren't reporting a bundled code. The code definitions include S&I, so many of the edits bundle 70000 range radiology codes. While most have a modifier indicator of 1, the edits for pulmonary and internal mammary angiography codes 75741-75756 have a modifier indicator of 0.   And as you might expect for a surgical procedure, some of the other areas to watch include:

• 36xxx range, including vascular introduction, injection procedures, and arterial procedures
• 37202, Transcatheter therapy, infusion other than for thrombolysis, any type (e.g., spasmolytic, vasoconstrictive)
• 6xxxx range, pain management/anesthesia
• 93xxx range, ECG and echocardiography.

  6. 0295T Edits Highlight Global/Component Relationship   Another set of Cat. III codes, also implemented Jan. 1, 2012, land in the Column 1 spot at least 11 times each. These codes are:

• 0295T, External electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation
• 0296T, ... recording (includes connection and initial recording)
• 0297T, ... scanning analysis with report
• 0298T, ... review and interpretation.

  CCI now bundles all of the following codes into 0295T-0298T with a modifier indicator of 1:

• 92982, Percutaneous transluminal coronary balloon angioplasty; single vessel
• ECG codes 93000-93010 and 93040-93042
• 94774-94777, Pediatric home apnea monitoring event recording ...

  Don't miss: Code 0295T falls in the Column 1 spot for a few additional edits. Because 0295T represents the global service, CCI bundles component codes 0296T-0298T into 0295T. These edits have a modifier indicator of 0.   7. 37220-+37235 Get G0269 Edit   The latest CCI edits also bundle G0269 (Placement of occlusive device into either a venous or arterial access site, postsurgical or interventional procedure [e.g. angioseal plug, vascular plug]) PLACEMENT OF OCCLUSIVE DEVICE INTO EITHER A VENOUS OR ARTERIAL ACCESS SITE, POST SURGICAL OR INTERVENTIONAL PROCEDURE (E.G. ANGIOSEAL PLUG, VASCULAR PLUG) into endovascular revascularization codes 37220-+37235. These edits have a modifier indicator of 1.   Edit rationale: The reason given for the edits is "CPT® manual or CMS coding instructions."   Tip: CPT® guidelines state that endovascular revascularization codes 37220-+37235 include arteriotomy closure with use of an occlusive device, which supports the rationale for the edit. Also keep in mind that Medicare does not reimburse physicians for G0269.