Cardiology Coding Alert

Hint: You’ll receive several new modifiers related to clinical decision support mechanisms.

The Centers for Medicare & Medicaid Services (CMS) recently published the 2020 HCPCS Level II code changes. These updates will become effective on Jan. 1, 2020.

“I’m excited that CMS has added more provider-friendly codes,” says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee.

Answer the following questions to learn more about how the new HCPCS Level II revisions, additions, deletions, and new modifiers will impact your cardiology practice during the coming year.

Focus on New Catheter Code

Question 1: Did CMS add any new HCPCS Level II codes for catheters?

Answer 1: Yes. CMS actually added C1982 (Catheter, pressure-generating, one-way valve, intermittently occlusive). As you can see from the descriptor, you should report this code for a pressure-generating catheter, with a one-way valve that is intermittently occlusive.

Delve Into Brand-New Code C1824

Question 2: Will I have any new HCPCS Level II options to report for a generator for implantable cardiac contractility modulation?

Answer 2: Yes. You will gain new code C1824 (Generator, cardiac contractility modulation (implantable)) that you can use to report for a generator for implantable cardiac contractility modulation?

Discover New Heart Failure Code

Question 3: I heard that CMS added a new code related to heart failure. Can you tell me more about it?

Answer 3: CMS added new code C9758 (Blinded procedure for nyha class iii/iv heart failure; transcatheter implantation of interatrial shunt or placebo control, including right heart catheterization, trans-esophageal echocardiography (tee)/intracardiac echocardiography (ice), and all imaging with or without guidance (e.g., ultrasound, fluoroscopy), performed in an approved investigational device exemption (ide) study).

Don’t miss: “Doctors usually classify patients’ heart failure according to the severity of their symptoms,” according to the American Heart Association (AHA). The most commonly-used classification is the New York Heart Association (NYHA) Functional Classification, which categorizes patients in one of four categories based on how much they are limited during physical activity. Code C9758 relates to class III/IV heart failure.

Say Good-Bye to This Vessel Mapping Code

Question 4: Will I lose any cardiology HCPCS Level II codes in 2020?

Answer 4: Yes. You will say goodbye to G0365 (Vessel mapping of vessels for hemodialysis access (services for preoperative vessel mapping prior to creation of hemodialysis access using an autogenous hemodialysis conduit, including arterial inflow and venous outflow)) in 2020.

Welcome 3 Documentation-Related Options

Question 5: A colleague mentioned that we will get some new documentation-related cardiology 2020 HCPCS Level II codes. Is this true?

 Answer 5: Yes. You will receive three new documentation-related cardiology 2020 HCPCS Level II codes:

• G2093 (Documentation of medical reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., hypotensive patients who are at immediate risk of cardiogenic shock, hospitalized patients who have experienced marked azotemia, allergy, intolerance, other medical reasons))
• G2094 (Documentation of patient reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., patient declined, other patient reasons))
• G2095 (Documentation of system reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., other system reasons))

Don’t miss: “I would advise  your readers, namely cardiology coders, to be sure to review these new HCPCS Level II codes and learn their correct use for the procedures performed,” says Catherine Brink, BS, CMM, CPC, president of Healthcare Resource Management in Spring Lake, New Jersey. “Coders need to make sure the medical record Documentation supports the use of these new codes, especially G2093 through G2095.”

CMS Introduces Modifiers Regarding Clinical Decision Support Mechanisms

Question 6: I have heard that CMS added new HCPCS Level II modifiers for 2020. Can you tell me more about them?

Answer 6: CMS has added some eight new HCPCS Level II modifiers. They are as follows:

• MA (Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition)
• MB (Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access)
• MC (Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues)
• MD (Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of extreme and uncontrollable circumstances)
• ME (The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional)
• MF (The order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional)
• MG (The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional)
• MH (Unknown if ordering professional consulted a clinical decision support mechanism for this servicev, related information was not provided to the furnishing professional or provider)

All of the above new modifiers relate to a Clinical Decision Support Mechanism (CDSM), which CMS defines as an “interactive, electronic tool for use by clinicians that communicates appropriate use criteria (AUC) information to the user and assists them in making the most appropriate treatment decision for a patient’s specific clinical condition.”

In 2020, CMS expects ordering professionals to begin consulting qualified CDSMs before they order advanced imaging services in applicable settings for Medicare patients and providing information to the furnishing professionals for reporting on their Medicare Part B claims, says Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania. Examples of this advanced imaging services include computed tomography, positron emission tomography, nuclear medicine, and magnetic resonance imaging.

According to MLN Matters^® article MM11268, “The CDSM will provide the ordering professional with a determination of whether that order adheres to AUC, does not adhere to AUC, or if there is no AUC applicable (for example, no AUC is available to address the patient’s clinical condition) in the CDSM consulted.”

CMS developed new modifiers MA-MH especially for the AUC program, and you should report these modifiers on the same line as the CPT^® code for the advanced diagnostic imaging service, per CMS Transmittal 2323, Change Request 11268.

Don’t miss: If you report modifier ME, MF, or MG on your claim, you should also include a corresponding new HCPCS Level II G code(s) on a separate claim line to identify the qualified CDSM the physician consulted. These new G-codes are G1000 (Clinical decision support mechanism applied pathways, as defined by the medicare appropriate use criteria program) through G1011 (Clinical decision support mechanism, qualified tool not otherwise specified, as defined by the medicare appropriate use criteria program).