Cardiology Coding Alert

3 exceptions allow you to report angiograms separately from prior ones If you're wondering whether you can report diagnostic angiograms separately, we'll untangle the NCCI angiogram knots and show you when and how you can earn extra reimbursement by ethically reporting a diagnostic angiogram code in addition to other services. Delve Into Diagnostic Angiograms The National Correct Coding Initiative (NCCI) limits your angiogram coding options. Some edits are "no-brainers," says Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga. Example: You can't get paid for both a bilateral renal angiogram (75724, Angiography, renal, bilateral, selective [including flush aortogram], radiological supervision and interpretation) and a unilateral renal angiogram (75722, Angiography, renal, unilateral, selective [including flush aortogram], radiological supervision and interpretation) on the same day. The modifier indicator status is "0," meaning you can never separate this edit with a modifier. But other edits are less clear-cut. You have to be certain that you can use a modifier and that the documentation supports using one. Example: NCCI bundles a unilateral extremity angiogram (75710, Angiography, extremity, unilateral, radiological supervision and interpretation) into a bilateral extremity angiogram (75716, Angiography, 'extremity, bilateral, radiological supervision and interpretation). Unlike renal angiograms, however, you can override this edit. For instance, if your cardiologist performs the extremity angiograms during different encounters, you can add modifier 59 (Distinct procedural service) to 75710 -- the lesser-valued code. Also, if your cardiologist exams three extremities (both legs, 75716, and one arm, 75710), you can add modifier 59 to 75710, says Sandy Fuller, CPC, compliance officer at Cardiovascular Associates of East Texas in Tyler. Remember: Anytime you use modifier 59, you must have documentation to support its use, says Rehna Burge, billing analyst at North Oaks Medical Center in Hammond, La. For example, your cardiologist must document that he performed these services at different encounters or different locations. "You can also bill 75716 two times, one for upper extremities and one for lower extremities, but you'll have to appeal it to get paid because most carrier systems will deny it as duplicate," Fuller adds. "But we've been successful on getting these paid upon appeal." Get the Modifier 59 Lowdown If you use modifier 59 to override angiogram edits, you should know the rules for using it backward and forward. NCCI bundles 75710 with endovascular repair (75952-75954), stent placement (75960), foreign-body retrieval (75961), peripheral angioplasty (75962), transcatheter biopsy (75970), and atherectomy (75992). Similarly, NCCI bundles 75722 (Angiography, renal, unilateral, selective [including flush aortogram], radiological supervision and interpretation) with endovascular repair (75952-75953), stent placement (75960), foreign-body retrieval (75961), renal/visceral angioplasty (75966), transcatheter biopsy (75970), and renal/visceral atherectomy (75994-75995). With both code situations, you can use modifier 59 to separate [...]