Cardiology Coding Alert

In "Case Study: Crack Down on a Top Heart Cath Coding Snafu," correct coding required appending modifier 26 to 93508 and 93556 because the procedures took place in a facility.

But modifier 26 was conspicuously absent from 93545, which the cardiologist performed at the same session. The physician fee schedule's PCTC column holds the key.

Reason: If you look up 93508 (Catheter placement in coronary artery[s], arterial coronary conduit[s], and/or venous coronary bypass graft[s] for coronary angiography without concomitant left heart catheterization) and 93556 (Imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; pulmonary angiography, aortography, and/or selective coronary angiography including venous bypass grafts and arterial conduits [whether native or used in bypass]) in the Medicare physician fee schedule (for example, www.cms.hhs.gov/PFSlookup/), you'll find that the fee schedule shows a "1" in the PCTC column for 93508 and 93556.

Impact: PCTC stands for "Professional Component/Technical Component," and the "1" indicates you may use modifier 26 (Professional component) or TC (Technical component) with the code because the service has both a professional and technical component, according to the "National Physician Fee Schedule Relative Value File Calendar Year 2009," attachment A.

As with any code that has a professional and technical component, you should report only what your cardiologist performs. So if the cardiologist performs the service in a hospital that bears the technical component cost -- as in the sample case on page 65 -- you should append modifier 26 when you need to show you're reporting only the professional component.

93545: Code 93545 (Injection procedure during cardiac catheterization; for selective coronary angiography [injection of radiopaque material may be by hand]) has a "0" in the PCTC column, indicating that the code describes physician services only. You can't split physician services into professional and technical components. As a result, using modifier 26 (or TC) with 93545 would be inappropriate.

Checking each code's PCTC indicator on the CMS site for every claim can be time consuming, but you can turn to software to speed things up.

Some products include automatic updates, while others require you to update information manually. For example, you can choose software that allows you to enter whether modifier 26 is an appropriate option for the codes you use and for the places of service likely for each procedure, says Jennifer Crowell, CPC, CCC, CEMC, lead hospital coordinator and coder for Spokane Cardiology. Then when you key in charges, a pop-up will alert you to those modifier and place of service notes, she says.

But using this sort of software does require diligence -- watch for new codes and changes to the fee schedule to keep your entries up to date.