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Cardiology Coding Alert

Imaging Guidance Now Included In Cath Exchange

Published on Mon Oct 18, 2004

NCCI also affects IVC filter, tilt table, and consult codes

The National Correct Coding Initiative (NCCI) targets other cardiology codes and bundles, for example, nervous system testing (95922) into tilt table testing (93660). So keep your eyes attuned.

The last set of NCCI edits for 2004, version 10.3, also includes other major revisions to how you should code various procedures, from imaging guidance to inpatient and follow-up consults.

Follow CPT Manual's Advice for Guidance

NCCI 10.3 bundles 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) and 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) into several cardiology codes. As of Oct. 1, you may not report these imaging procedures with:

  • thrombolysis (37207, Transcatheter placement of an intravascular stent[s], [non-coronary vessel], open; initial vessel)

  • catheter exchange (37209, Exchange of a previously placed arterial catheter during thrombolytic therapy)

  • intravascular non-cors (+37250, Intravascular ultrasound [non-coronary vessel] during diagnostic evaluation and/or therapeutic intervention; initial vessel [list separately in addition to code for primary procedure])

  • inferior vena cava filter (37620, Interruption, partial or complete, of inferior vena cava by suture, ligation, plication, clip, extravascular, intravascular [umbrella device]).

    These new edits may not come as too much of a surprise to many practices. "I have always felt that imaging guidance does not correspond with these types of procedures," says Anne Karl, RHIA, CCS-P, CPC, coding and compliance specialist for St. Paul Heart Clinic in Mendota Heights, Minn.

    NCCI points to "instructions and guidelines" within the CPT manual as its rationale for these edits. You should not report 76003 or 76942 with certain codes, NCCI says, because the CPT manual specifically directs you toward other codes for imaging guidance.

    Note IVC Filter S&I and Tilt Table Edits

    NCCI now includes venography code 75825 (Venography, caval, inferior, with serialography, radiological supervision and interpretation) with IVC filter S&I code (75940, Percutaneous placement of IVC filter, radiological supervision and interpretation).

    You'll also have to stop reporting nervous system testing code 95922 (Testing of autonomic nervous system function; vasomotor adrenergic innervation [sympathetic adrenergic function], including beat-to-beat blood pressure and R-R interval changes during Valsalva maneuver and at least five minutes of passive tilt) separately from the tilt table test (93660, Evaluation of cardiovascular function with tilt table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention).

    Can't Override Inpatient Consult Bundle

    NCCI bundled the initial and follow-up inpatient consultation codes (99251-99263) into the codes for same-day observation or hospital admission and discharge (99234-99236).

    Translation: You can no longer bill for a consult if the physician also placed the patient under observation or admitted him as an inpatient and discharged him on the same day. Further, you can't override these edits using a modifier.

    "If my cardiologist was doing a 'consult,' then I wouldn't expect to report admission or observation codes, too," Karl says. The attending doctor would report the admission and observation codes (99234-99236).

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