Cardiology Coding Alert

Question: When a national coverage determination doesn't specify which codes to use, how do we know which particular codes apply?

Nevada Subscriber

Answer: When a national coverage determination (NCD) doesn't list specific codes for use, your next step should be to check for a local coverage determination (LCD) or local payer policy.

For example: Palmetto GBA offers a list titled "J1 A/B MAC Palmetto GBA Assigned ICD-9-CM Codes for National Coverage Determinations." It doesn't supply codes for all NCDs, but it's a good starting point for J1 providers. It features codes for items including:

• Ambulatory Blood Pressure Monitoring
• External Counterpulsation (ECP) Therapy for Severe Angina
• Hyperbaric Oxygen Therapy
• Implantable Automatic Defibrillators.

Check the list, and you'll see, for instance, that covered codes for ECP include G0166 (External counterpulsation, per treatment session) accompanied by one of the following:

• 413.0, Angina decubitus
• 413.1, Prinzmetal angina
• 413.9, Other and unspecified angina pectoris.

You can reach the site by starting at the J1 home page: www.palmettogba.com/palmetto/providers.nsf/DocsCatHome/Jurisdiction%201%20Part%20B. In the search box, enter "Assigned ICD-9-CM Codes for National Coverage Determinations." The results should show you the link for the NCD code list.

When a local payer doesn't define the covered codes, you'll need to compare the patient's case to the covered conditions listed in the NCD or contact your payer to get information on whether treatment for the patient will be covered.

Remember: Documentation must support your code choice. You should never choose a code simply because you know it will allow reimbursement.