Cardiology Coding Alert

The 2015 code descriptors leave out a key rule you need to know.

The last Correct Coding Initiative (CCI) edit release of the year is here. Along with the new batch of bundles, you may find that this latest round offers you some insight into what your coding for transcatheter mitral valve repair will look like when CPT® 2015 goes into effect. 

Expect Denials for These Imaging Codes on Your TMVR Claims

CCI version 20.3, effective Oct. 1, adds more than 5,000 new edit pairs, according to Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group in Clearwater, Fla., in his analysis of the update. Included in those additions are more than a dozen edits related to transcatheter mitral valve repair (TMVR).

In 2014, you have three Category III codes for TMVR:

• 0343T, Transcatheter mitral valve repair percutaneous approach including transseptal puncture when performed; initial prosthesis
  
• 0344T, … additional prosthesis(es) during same session (List separately in addition to code for primary procedure)
  
• 0345T, Transcatheter mitral valve repair percutaneous approach via the coronary sinus.
  

0343T, 0344T: The latest CCI edits, effective Oct. 1, bundle the following guidance and angiography codes into 0343T and 0344T with a modifier indicator of 1, meaning that you may override the edit with a modifier when the services are unrelated:

• 76496, Unlisted fluoroscopic procedure (e.g., diagnostic, interventional) 
  
• 76942, Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation
  
• 76998, Ultrasonic guidance, intraoperative
  
• 93454, Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation
  
• 93455, … with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography.
  

0345T: The latest edits also bundle the above codes, except 93454, into 0345T. But don’t let that fool you. There is already an edit in place that prevents you from ever reporting 93454 in addition to 0345T. Additionally, CPT® 2014 guidelines specifically tell you not to report 93454 for coronary angiography performed as part of the 0345T service.

Plan Ahead for 2015 Reporting With This Guideline Review

You won’t be applying the edits for 0343T and 0344T for long. While CPT® 2015 keeps 0345T, you’ll replace 0343T and 0344T with the following codes:

• 33418, Transcatheter mitral valve repair percutaneous approach, including transseptal puncture when performed; initial prosthesis
  
• +33419, … additional prosthesis(es) during same session (List separately in addition to code for primary procedure).
  

Fortunately, getting accustomed to the new edits now will help you in properly reporting 33418 and 33419 in 2015. 

CPT® 2015 includes guidelines for these new codes, including that these new TMVR codes include angiography, radiological supervision, and interpretation performed to guide the repair. 

The new TMVR guidelines for 33418 and 33419 also specify that you should report diagnostic coronary angiography codes, such as 93454 and 93455, in conjunction with TMVR only when the angiography service is a distinct diagnostic service. In other words, the coronary angiography needs to meet the usual CPT® guidelines for reporting diagnostic angiography alongside an intervention, such as having no prior study or no adequate prior study available a highly unlikely scenario for a planned TMVR, says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department.