Part B Insider (Multispecialty) Coding Alert

Published on Sat Mar 05, 2005 PDF

And new meniscal transplantation code includes debridement

One new National Correct Coding Initiative (NCCI) edit has aroused controversy before even taking effect.

Starting in April, 78472 (Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress [exercise and/or pharmacologic], wall motion study plus ejection fraction, with or without additional quantitative processing) will become a component of 78465 (Myocardial perfusion imaging; tomographic [SPECT], multiple studies [including attenuation correction when performed], at rest and/or stress [exercise and/or pharmacologic] and redistribution and/or rest injection, with or without quantification).

You won't be able to use a modifier to override this edit.

To perform a "pass technique"  to examine the right ventricle (78496), a physician has to be able to use both cardiac blood pool imaging and myocardial perfusion imaging, says Belinda Inabinet, technical support manager with South Carolina Heart Center in Columbia, SC. If NCCI forbids providers from billing both 78472 and 78465 in the same session, they won't be able to bill for the services associated with 78496.

Reason: This edit is based on an outdated understanding of the technology available, Inabinet insists. In the past, you couldn't safely perform together the services those three codes describe. But new cameras that came out between 2003 and 2004 make performing both types of imaging on the same day safe, Inabinet says.

Another edit: CPT 2005 introduced a new code for meniscal transplantation: 29868. But starting April 1, you won't be able to bill knee debridement/shaving code 29877 with 29868. No modifier can undo this edit.

"Although the parenthetical note in CPT didn't say that coders can't bill chondroplasty with the meniscal transplant code, CPT Changes 2005 did imply that chondroplasty is included," notes Kendra Sykes, office manager at Orthopaedic Associates and Sports Medicine in Dallas. The CPT Changes book describes meniscal transplantation that "consists of preparation of the defect area with removal of the damaged portion of the meniscus."