Cardiology Coding Alert

Plus: See what's new for cardiac rehab.

Conflicting guidelines rank near the top of the "frustrating realities of coding" list.

Case in point: The Correct Coding Initiative (CCI) version for physicians released July 1, 2010, gave information on coding MTWA and stress tests that conflicted with the CCI manual in effect at that time.

But, fear not. The current CCI Manual, version 16.3, provides updated instructions that are in tune with the edits.

Update Chapter 11 of Your CCI Manual

The CCI version effective July 1 deleted the edits that 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 MTWA code 93025 (Microvolt T-wave alternans for assessment of ventricular arrhythmias).

Old version: The manual in effect at that time, however, stated you couldn't report 93015- 93017 on the same date as 93025. The previous wording said, "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."

New version: CCI's updates present in the current manual, version 16.3, reflect the CCI edit deletion that allows you to report both an MTWA with submaximal stress test and a traditional stress test, acknowledging that the tests are different. The current wording says, "Microvolt T-wave alternans (MTWA) (CPT code 93025) testing requires a submaximal stress test that differs from the traditional exercise stress test (CPT codes 93015-93018) which utilizes a standard exercise protocol. CPT codes 93015-93018 should not be reported separately for the submaximal stress test integral to MTWA testing. If a physician performs an MTWA with submaximal stress test followed by a period of rest and then a traditional stress test on the same date of service, both the MTWA and traditional stress test may be reported separately" (chapter 11, section I.9).

Resource: You can download the CCI manual chapters from www.cms.gov/NationalCorrectCodInitEd/.

You will of course still need to meet the requirements of the individual codes for coverage. For example, Medicare covers MTWA 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).

Cardiac Rehab Codes Star in Column 1

CCI 16.3 includes more than 19,000 new edit pairs, according to Frank Cohen, principal and senior analyst for the Frank Cohen Group, in his analysis of the new codes. So you're sure to run across edits for the codes you use.

Don't miss: If you code office or outpatient cardiac rehabilitation, be sure to note the new edits that feature the following codes in column 1:

• 93797 -- Physician services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session)
• 93798 -- ...with continuous ECG monitoring (per session)
• G0422 -- Intensive cardiac rehabilitation; with or without continuous ECG monitoring, with exercise, per session
• G0423 -- ... with or without continuous ECG monitoring, without exercise, per session.

CCI bundles the following ECG codes into 93797, with a modifier indicator of 1, meaning you may override the edit when appropriate:

• 93000-93010 -- Electrocardiogram, routine ECG with at least 12 leads ...
• 93040-93042 -- Rhythm ECG, 1-3 leads ...

CCI bundles the following physical medicine, rehab, and therapy codes into 93797,93798, G0422, and G0423, with a modifier indicator of 1, meaning you may override the edit when appropriate:

• 97001-97004: Physical and occupational therapy evaluations
• 97110, 97112, 97116: Therapeutic procedure, one or more areas
• 97140: Manual therapy techniques
• 97150: Therapeutic procedure(s), group
• 97530: Therapeutic activities, one-on-one
• 97750: Physical performance test or measurement
• 97802-97804: Medical nutrition therapy.

Bonus tip: Medicare recently announced that effective for claims with dates of service on and after Aug. 12, 2010, the Ornish Program for Reversing Heart Disease and the Pritikin Program each meet the intensive cardiac rehabilitation (ICR) program requirements (see transmittal 125, change request 7113, at www.cms.gov/transmittals/downloads/R125NCD.pdf).

Remember to use G0422 and G0423 when reporting ICR to Medicare.