Cardiology Coding Alert

Changes are playing catch up to CPT® manual and edit rules.

In the last issue of Cardiology Coding Alert, "2 CCI Manual Updates to Know Before You Code Your Next Cardiology Claim" looked at revisions to sections on RHC with biopsy and limited EP tests with cardiac device services.

Now let's see what the updated manual has to say about diagnostic angiography and stress tests.

Remember: The CCI manual receives regular updates, and checking the manual updates is important for proper coding. If you're lucky, you'll get a detailed explanation of the "why" behind the edits, says Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, president of KGG Coding and Reimbursement Consulting.

Set Your Sights on Surgery Chapter

For the January 2016 manual, the first changes we'll look at are in Chapter V: Surgery: Respiratory, Cardiovascular, Hemic, and Lymphatic Systems (CPT^® Codes 30000-39999). The Cardiovascular System is in section D.

#12: Diagnostic Code Is OK ... If Both AMA and CMS Say So

The first language change (at Chapter V.D.12) involves reporting diagnostic angiography along with an intervention.

2015: Last year, the manual stated that at the time of an interventional vascular procedure, "A separately reportable diagnostic angiogram/venogram may be reported with modifier 59."

2016: The updated manual gets more specific, rephrasing to state that at the time of an interventional vascular procedure, "A diagnostic angiogram/venogram may be separately reportable with modifier 59 if it satisfies CPT^® Manual guidelines, national Medicare guidelines, and local Medicare Administrative Contractor guidelines."

Takeaway: The 2016 language helps put in black and white an approach to coding that you're likely already following. For Medicare patients, you know that you have to take into account CPT^®, local MAC, and national Medicare rules to determine correct coding for a case.

# 41: See Above, and Apply to Vascular Embolization

The change to Chapter V.D.41 looks a lot like the change to V.D.12, but V.D.41 makes the rule specific to vascular embolization codes 37241-37244.

2015: The 2015 manual added this text: "For vascular embolization procedures (CPT^® codes 37241-37244) physicians may separately report selective catheterization CPT^® codes. However, physicians should not separately report non-selective catheterization CPT^® codes for these procedures."

2016: The 2016 manual keeps the 2015 language and adds, "Vascular embolization procedures include associated radiological supervision and interpretation, intra-procedural guidance, road-mapping, and imaging necessary to document completion of the procedure. Angiography may be a separately reportable procedure with modifier 59 only if it satisfies guidelines for diagnostic angiography included in the 'Vascular Embolization and Occlusion' section of the CPT^® Manual, national Medicare guidelines, and local Medicare Administrative Contractor guidelines."

Takeaway: Review CPT^® and Medicare guidelines before deciding whether a service qualifies as reportable angiogram. One helpful hint is that the new CCI language matches CPT^® guidelines found with 37241-37244.

Move On to the Medicine Chapter

The next group of changes relates to Medicine codes and is in Chapter XI of the manual. Section I covers Cardiovascular Services.

# 11: Reporting Stress Test With MTWA Is Out

In Chapter XI.I.11, both the 2015 and 2016 manuals state, "Microvolt T-wave alternans (MTWA) (CPT^® code 93025) testing requires a submaximal stress test that differs from the traditional exercise stress test (CPT^® codes 93015-93018) which utilizes a standard exercise protocol. CPT^® codes 93015-93018 should not be reported separately for the submaximal stress test integral to MTWA testing."

2015: The 2015 manual indicated reporting a traditional stress test in addition to MTWA in certain circumstances was OK: "If a physician performs an MTWA with submaximal stress test followed by a period of rest and then a traditional stress test on the same date of service, both the MTWA and traditional stress test may be reported separately."

2016: The 2016 manual removes the option to report both: "CPT^® codes 93015-93018 should not be reported on the same date of service as CPT^® code 93025."

Takeaway: Veteran cardiology coders have seen this language and related edits change before. This latest change in position brings the manual in line with recent CCI edit additions that prevent you from ever reporting the two test types for the same date of service.

Huey advises using software with up-to-date CCI edits to simplify the process of reviewing edits before billing.