Cardiology Coding Alert

Remember: Modifier indicator of “0” means you cannot break an edit under any circumstances.

You’ve learned all about the 2019 CPT^® cardiac rhythm monitor, transcatheter, and peripherally inserted central venous catheters (PICC) code additions, changes, and revisions in previous issues of Cardiology Coding Alert. Now, with the release of the Correct Coding Initiative (CCI) 25.0 edits, you should also determine how these edits will impact your cardiology practice’s reimbursement this year.

As is typical of the first round of bundlings for a new year, many of the CCI 25.0 edits focus on the new 2019 CPT^® codes.

Observe Multiple New Cardiac Rhythm Monitor Edits

You’ve got a bunch of edits to learn regarding new cardiac rhythm monitor codes 33285 (Insertion, subcutaneous cardiac rhythm monitor, including programming) and 33286 (Removal, subcutaneous cardiac rhythm monitor).

Codes bundled into 33285 and 33286: For example, codes bundled into new codes 33285 and 33286 include the following:

• »33140 (Transmyocardial laser revascularization, by thoracotomy; (separate procedure))
• 64400 (Injection, anesthetic agent; trigeminal nerve, any division or branch)-64450 (Injection, anesthetic agent; other peripheral nerve or branch)
• 64461 (Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging guidance, when performed)-64463 (… continuous infusion by catheter (includes imaging guidance, when performed))
• 64505 (Injection, anesthetic agent; sphenopalatine ganglion)

These edits cannot be broken under any circumstances because they have a modifier indicator of “0.”

On the other hand: For example, codes bundled into new codes 33285 and 33286 with a modifier indicator of “1” include the following:

• 11000 (Debridement of extensive eczematous or infected skin; up to 10% of body surface)-11006 (Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia, perineum and abdominal wall, with or without fascial closure)
• 36400 (Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; femoral or jugular vein)-36406 (… other vein)
• 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report)-93010 (…interpretation and report only)
• 93040 (Rhythm ECG, 1-3 leads; with interpretation and report)-93042 (… interpretation and report only).

Modifier indicator of “1”: When the modifier indicator is “1,” this means that you may be able to report both codes of an edit pair under certain circumstances by using a modifier. For example, you can overcome the edit, if appropriate with the use of a modifier like modifier 59 (Distinct procedural service), explains Mary I. Falbo, MBA, CPC, president and CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania.

Caveat:  Just because you can add a modifier, that doesn’t mean you should. Be sure you have the supporting documentation for requesting payment for both codes before adding a modifier to the bundled pair.

“Modifier 59 and other CCI-associated modifiers should not be used to bypass a CCI edit unless the proper criteria for use of the modifier 59 are met,” Falbo adds. “Documentation in the medical record must satisfy the criteria required by any CCI-associated modifier that is used.”

You can use modifier 59 when the surgeon performs the bundled procedures for different anatomic sites/regions, different organs, or in limited situations on different, non-contiguous lesions in different anatomic regions of the same organ, Falbo explains.

Caution: You should never append modifier 59 to an evaluation and management (E/M) service

Don’t miss: Although CCI bundles indicate which CPT^® and HCPCS codes you should normally not report together, Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington reminds coders that CCI is more than just a list of codes that bundle together.

“There are general rules for all coding concepts and general rules for each CPT^® chapter,” Bucknam says. “Read through these rules and be sure you understand the concepts for the chapters you work in most often. This will help you understand what is likely to bundle and will guide you even if you don’t have software that tells you when you make a bundling error.

Catch These New Transcatheter Edits

You should also be aware of the numerous edits surrounding new transcatheter codes 33274 (Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed) and 33275 (Transcatheter removal of permanent leadless pacemaker, right ventricular).

Codes bundled into codes 33274 and 33275 with a modifier indicator of “1” include the following: 11000-11006; debridement codes 11042-11047; 12031-12057; 13100-+13153; repair codes 35201-35286; 36400-36410; and 51701-51703

Codes bundled into codes 33274 and 33275 with a modifier indicator of “0” include the following: collection of blood specimen codes 36591 and 36592; injection codes 62320-62327; 64479-+64495; +69990; and moderate sedation codes 99155-+99157

Don’t miss: You should also stay on top of edits where 33274 and 33275 are bundled into other codes.

Code 33274 is bundled into the following codes with a modifier indicator of “1”: insertion of epicardial electrodes codes 33202-33203; insertion of permanent pacemaker code 33208; and repositioning code 33226

Code 33275 is bundled into the following codes with a modifier indicator of “1”: insertion code 33224; repositioning code 33226; and pacemaker removal codes 33235- 33238

Code 33275 is bundled into the following codes with a modifier indicator of “0”: insertion codes 33212 and 33213; repair code 33218; and suture repair codes 33220 and 33221

Highlight These PICC Edit Additions

CCI 25.0 will also add edits for new PICC codes 36572 (Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; younger than 5 years of age) and 36573 (… age 5 years or older).

Codes bundled into 36572 and 36573: Some of the codes bundled into new codes 36572 and 36573 include the following: 36591 and 36592; 62320-62327; and injection codes 64400-64435.

These edits cannot be broken under any circumstances because they have a modifier indicator of “0.”

On the other hand: Some of the codes bundled into new codes 36572 and 36573 with a modifier indicator of “1” include the following: 11042-+11047; 12001-12057; 13100-+13153; 35201-35286; and catheter insertion codes 36555 and 36556.

Editor’s note: These edits are just a sample of what you should be aware of surrounding the new 2019 CCI edits— not an exhaustive list. Visit https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html for the complete list of CCI 25.0 edits.