General Surgery Coding Alert

Know when to override code pairs.

If your surgeon performs vascular procedures such as iliac revascularization or endovenous ablation, you need to know about some new coding restrictions in the latest update of the Correct Coding Initiative (CCI).

Read on to learn what you need to know to align your coding with CCI version 22.2 to avoid claims denials and earn the pay you deserve.

Watch for Treatment Zone Outside of Iliac

A handful of the new CCI edits bundle iliac artery revascularization (angioplasty and stenting) into endovascular repair of iliac and aortic aneurysm and dissection. The edits have a modifier indicator of 1, which means you may override the edits with a modifier when documentation supports reporting the codes as distinct services.

Helpful: To apply these edits correctly, keep in mind that CPT^® guidelines for 34800-34826 state, “Balloon angioplasty and/or stent deployment within the target treatment zone for the endoprosthesis, either before or after endograft deployment, are not separately reportable.” But you may separately report angioplasty or stenting of an artery outside of the endoprosthesis treatment zone.

Important: Medical necessity in the documentation is the key to properly overriding these edits, says Christina Neighbors, MA, CPC, CCC, coding quality auditor for Conifer Health Solutions. An example would be that during a planned AAA procedure, the physician identifies 80 percent stenosis in the internal iliac and makes a medical decision to intervene immediately, Neighbors says.

Choose Method for Endovenous Ablation

Another group of edits keep you from mixing your codes for endovenous ablation therapy.

The descriptors for the codes involved, 36475-+36479, all begin this way: Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous …

CPT^® offers one set of codes for radiofrequency (RF) ablation and another set of codes for laser ablation.

The new edits prevent reporting the add-on codes for the treatment of the second and subsequent vein using one modality into the codes for the opposite modality.

In other words: If you report laser treatment, don’t also report RF treatment, and if you report RF treatment, don’t also report laser treatment.

These new edits join a similar existing edit that prevents you from reporting primary laser code 36478 (col. 2) with primary RF code 36475 (col. 1). That edit also has a modifier indicator of 0, which means you may never override the edit, even if you append a modifier indicating the column 2 code is a distinct service.

In the rare event that the surgeon uses both modalities at a single session, each on a different extremity, Neighbors advises coding what the physician performs with the appropriate modifiers and watching for the denial so you can appeal. Of course you need to be sure that the treatments meet Medicare’s detailed medical necessity requirements for ablation, such as being symptomatic despite conservative therapy, and meeting anatomic conditions, such as absence of aneurysm and thrombosis, Neighbors says. Check payer policies for details.

Confirm Noncoronary, Non-Intracranial for 37184, +37186

The next group of edits reflects CPT^® 2016 code updates. CPT^® 2016 introduced +61651 for intracranial administration of pharmacologic agents, the key word there being intracranial.

The July edits bundle +61651 into thrombectomy codes 37184 and +37186. Both of these noncoronary codes gained the word “non-intracranial” in their 2016 descriptors, as R. Patrick Jacob, MD, FACS, explained in the Neurological Surgery presentation at the AMA CPT^® and RBRVS 2016 Annual Symposium.

You may override the edits with a modifier, which makes sense considering they represent work in different parts of the body.