Cardiology Coding Alert

TEE, fluoro, and drug administration codes didn't escape the Correct Coding Initiative's notice, and you're responsible for making certain you implement these edits -- sooner rather than later. These edits, CCI version 14.1, go into effect April 1, and that's no joke.

If your physician performs TEEs using 93318 (Echocardiography, transesophageal [TEE] for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing [continuous] assessment of [dynamically changing] cardiac pumping function and to therapeutic measures on an immediate time basis), you'll want to pay attention to this next series of edits.

Code 93318 is now a component of operative tissue ablation codes (33265-33266), closure of ventricular septal defects codes (33675-33677, 33681, 33684), pulmonary venous stenosis repair code 33726, complete repair of anomalous venous return code 33730, and repair of cor triatriatum or supravalvular mitral ring code 33732. You can apply a modifier to bypass any of these edits, but only if you have supporting documentation that shows that the multiple procedures involve a separate session or distinct service.

Remember: CPT 2008 coughed up a new thoracentesis code. No longer should you report 32002 (Thoracentesis with insertion of tube with or without water seal [e.g., for pneumothorax] [separate procedure]). Instead, you should use the 2008 code 32422 (Thoracentesis with insertion of tube, includes water seal [e.g., for pneumothorax], when performed [separate procedure]).

Impact: The language change -- from "with or without water seal" to "includes water seal" -- makes for more accurate coding, says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.

CCI 14.1 wants to hone that accurate coding. This procedure is now a component of cardiology codes 33250, 33254-33256, 33265-33266 and 33724-33726. These edits have a status indicator of "1," meaning that you could possibly apply modifier 59 (Distinct procedural service) to 32422 -- but only if you have supporting documentation.

You've got new changes that affect fluoroscopy procedures.

For instance, you should now consider 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) as part of the operative tissue ablation codes (33265-33266). This edit, like the rest of the imaging guidance edits, carries a status indicator of "1."

Here are the other fluoro edits you should learn:

CCI 14.1 hits drug administration codes (90760-90774) especially hard.

"Because you can bypass most of the edits with a modifier, these represent an administrative burden for physician coders," says Jim Collins, CPC-CARDIO, ACS-CA, CHCC, president of The Cardiology Coalition in Saratoga Springs, N.Y. In other words, if you "do not accurately attach a modifier when indicated, you will need to appeal the denial, assuming you don't accidentally write them off at the time of payment posting."

You should now consider these codes included in the facility-based E/M codes (99217-99318).

In all of these edits with the exception of the nursing assessment code (99318), if you have documentation to support the E/M as significant and separately identifiable from the minor E/M included in 90760-90774, you can use modifier 25 to separately report the drug administration. CMS does not allow you to bypass the 99318-facility-E/M bundle with a modifier.

If your physician interprets cardiac output measurements and wants to report 93561-93562 in addition to an E/M service, you should be careful.

You know CCI already bundles these codes into critical care services, but as of April 1, you should be wary of reporting them with office visit codes (99201-99215), office consultation codes (99241-99245), prolonged services codes (99354-99355), or initial hospital neonatal care code 99477.

You cannot use a modifier to bypass the 93561-93562 into 99477 bundle, but for all the other edits, you can -- if your documentation warrants it.

Finally, you should be aware of three more cardiology-related edits.

CCI 14.1 bundles 93701 (Bioimpedance, thoracic, electrical) into critical care code 99291. Keep in mind: CCI forbids you from using any modifier to bypass this edit.

Critical care code 99291 now includes 94610 (Intrapulmonary surfactant administration by a physician through endotracheal tube). "Surfactant can be given in hospital and delivery room and on transport," says Richard A. Molteni, MD, FAAP, medical director at Children's Hospital and Regional Medical Center in Seattle. Now you'll have to justify reporting the surfactant code in addition to a critical care service to warrant separately submitting both services for reimbursement.

And CCI 14.1 bundles ventilation management code 94004 (Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; nursing facility, per day) into 94002 (... hospital inpatient/observation, initial day). You can bypass this mutually exclusive edit with a modifier.