Cardiology Coding Alert

                Find out which diagnostic supervision and interpretation codes are affected

If you regularly report radiological supervision and interpretation (S&I) codes with S&I codes applicable to percutaneous interventions (such as angioplasty, atherectomy, and stents), get ready to start maneuvering edit pairs.

NCCI version 10.3 bundles a slew of radiological S&I procedures into 75960-75962, 75970, 75978, 75992 and 75994.

Because these edits will affect cardiology coders so significantly, we've created this handy chart that you can use as a reference when determining which codes your carrier will start bundling.

Remember: Column 2 represents the procedures/services that a cardiologist cannot reasonably perform in the same session as the procedure/service listed in column 1. Therefore, carriers would not recognize the column 2 service as separate and only pay the column 1 code.

Also, these edits have a Correct Coding Edit Modifier Indicator of "1," meaning "that a modifier is allowed ... to differentiate between the services provided." In most cases, modifier -59 (Distinct procedural service) is appropriate to unbundle NCCI edits and allow for separate payment.

Start Disclosing Angio as True Diagnostic
 
CMS submitted notice to the Society of Interventional Radiology (SIR) that the agency has concerns that coders report unnecessary repeat diagnostic angiography and venography when the "lesion is previously diagnosed and only the definitive procedure is performed."

Another concern CMS cited in its notice to SIR is that coders inappropriately report radiological supervision and interpretation (RS&I) services "already captured by the RS&I code for the therapeutic intervention using diagnostic angiography/venography RS&I codes."

Keep in mind, however, that "a full and complete diagnostic arteriogram/venogram commonly precedes many therapeutic arterial/venous interventions and when this occurs these services are separately reportable," according to SIR. 

In other words: "The physician needs to disclose the fact that his diagnostic angio was not a 'guiding' angio prior to the intervention but is a true diagnostic angio that determined an intervention was necessary," says Anne Karl, RHIA, CCS-P, CPC, coding and compliance specialist for St. Paul Heart Clinic in Mendota Heights, Minn.

For example, a cardiologist performs a selective bilateral renal angiogram (75724-26, Angiography, renal, bilateral, selective [including flush aortogram], radiological supervision and interpretation; professional component). The findings determine that he should proceed with an angioplasty or stent. You should append modifier -59 (Distinct procedural service) to 75724-26 because this service was separate and distinct.

In contrast, suppose the cardiologist performed that selective renal angiogram last week and the findings determine that the patient should return for a renal stenting (37205, Transcatheter placement of an intravascular stent[s], [non-coronary vessel], percutaneous; initial vessel; and 75960-26, Transcatheter introduction of intravascular stent[s], [non-coronary vessel], percutaneous and/or open, radiological supervision and interpretation, each vessel; professional component).

In this case, you should not report [...]