Cardiology Coding Alert

Watch modifier indicators to know when distinct services may be reportable.

When CPT^® 2014 added 93583 for septal reduction therapy, a slew of new guidelines came along for the ride, telling you which services you may and may not report separately. The latest release of Correct Coding Initiative (CCI) edits will help you comply with the guidelines by bundling many of the procedures together.

Sort Through the Edits for Key Players

Code 93583 (Percutaneous transcatheter septal reduction therapy [e.g., alcohol septal ablation] including temporary pacemaker insertion when performed) lands in the column 1 spot in roughly 250 new CCI edits, according to the CCI 20.0 analysis provided by Frank Cohen of Frank Cohen Group.

Many of the edits are from the usual list of anesthesia, integumentary, injection/infusion, and E/M codes (yes, you can override the E/M edits with a modifier when the services are distinct). But you’ll also find a number of bundles that relate directly to the guidelines that come with new code 93583. Here are the highlights.

• Temporary pacemaker: Temporary pacemaker codes 33210-33211 are bundled into 93583 with a modifier indicator of 0, which means you may never override the edit. The reason for this edit is obvious from 93583’s definition: “including temporary pacemaker insertion when performed.” CPT^® stresses this rule in a grand total of three separate instructions with 93583.
• Echo: Code 93583’s guidelines state that the physician may report +93662 (Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation [List separately in addition to code for primary procedure]) for intracardiac echocardiography (ICE) with the ablation. Transesophageal echocardiography (TEE) codes 93312-93317 are reportable when performed by a separate physician, the guidelines state. Similarly, CCI bundles 93312-93317 into 93583 with a modifier indicator of 1, meaning you may override the edit when the TEE is distinct from the ablation service. CCI adds an additional TEE code, 93318, to that list of bundled codes.
• Moderate sedation: The moderate sedation symbol with 93583 tells you that moderate sedation is not separately reportable. Accordingly, CCI bundles 99143-99145 (moderate sedation by the same provider) into 93583 with a modifier indicator of 0. Codes 99148-99150 (moderate sedation by a different provider) are also bundled with 93583.
• Ventriculomyotomy: Code 93583 falls in the column 2 spot for an edit with 33416 (Ventriculomyotomy [-myectomy] for idiopathic hypertrophic subaortic stenosis [e.g., asymmetric septal hypertrophy]). CPT^® guidelines similarly tell you to turn to 33416 for the surgical ventriculomyotomy service.
• Alcohol injection: In line with a new guideline to not report the ablation’s alcohol injection using +93463 (Pharmacologic agent administration [e.g., inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrinone, or other agent] including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration, when performed [List separately in addition to code for primary procedure]), CCI bundles +93463 into 93583.
• Cardiac caths and angiography: A large number of the CCI edits and code guidelines boil down to not reporting cardiac caths or coronary angiography that’s inherent to the 93583 procedure. The accompanying table shows how the edits and guidelines break down. Note: Congenital right heart cath is abbreviated as CRHC, and congenital left heart cath is CLHC.