General Surgery Coding Alert

Follow CCI changes that tell the tale. 

When your general surgeon places an intravascular stent using a transcatheter approach for both an artery and a vein on the same day, you’ll have some explaining to do.

That’s because Medicare’s Correct Coding Initiative (CCI) has left a trail of added and deleted edit pairs that restrict and guide the way you can report the following codes:

• 37236 — Transcatheter placement of an intravascular stent(s) (except lower extremity arteries for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery
• +37237 — … each additional artery (List separately in addition to code for primary procedure)
• 37238 — Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; initial vein
• +37239 — … each additional vein (List separately in addition to code for primary procedure).

Edits/Deletions Direct Stent Coding

When the stent codes 37236-+37239 became effective Jan. 1 of this year, CCI was quick to bundle the codes with the following edit pairs in version 20.1:

Then CCI version 20.2 deleted all of the above edits retroactive to Jan. 1, 2014, according to the analysis by Frank Cohen MPA, MBB, principal and senior analyst for The Frank Cohen Group in Clearwater, Fla.

But there’s a catch. CCI version 20.2 also adds back two new edits for these codes:

What this means for you: If the surgeon performs a transcatheter stent for an initial artery and initial vein, you should bill 37236 and 37238 instead of using either of the add-on codes.

Problem: What if your surgeon performs a transcatheter stent placement for an initial and additional vein plus an initial artery, or vice versa. In that case, you’ll run afoul of the CCI 20.2 edit pairs. 

Do this: The modifier indicator of 1 for these edit pairs means that you may override the edit with a modifier when appropriate. Specifically, to report additional vein code +37239 on the same date as initial artery code 37236, you’ll need to append a modifier to +37239. You’ll also need to report initial vein code 37238 as the primary code for +37239.

Similarly, to report additional artery code +37237 on the same date as initial vein code 37238, you’ll need to append a modifier to +37237. You’ll also need to report initial artery code 37236 as the primary code for +37237.

Forget These Edit Pairs, Too

The preceding aren’t the only edit pairs that CCI has put in place for these four codes since their introduction the first of this year. CCI 20.0 added edit pairs preventing you from reporting 37236 with +37237 and 37238 with +37239.

Problem: According to CPT® instruction for add-on codes, you should bill these codes in pairs when the surgeon performs transcatheter stent placement in an initial and additional artery or an initial and additional vein — 37238 with +37239 for veins and 37236 with +37237 for arteries.

Fortunately, CCI 20.1 retroactively deleted the edit pairs that bundled the parent code with the add-on code. 

Code 37236 is the only appropriate primary code for add-on code +37237, so an edit that prevents payment of 37236 when you report it with +37237 is illogical. The same reasoning applies to the 37238/+37239 edit. As Marchelle Cagle, CPC, CPC-I, PCS, of Cagle Medical Consulting, explains, you should not need a modifier to report an add-on code with its primary code, so deleting these edits made sense.