NCCI re: atherectomy/stent
I received a letter today from Dr. Neil Rosen, medical director of the National Correct Coding Initiative, regarding the 2007 change to NCCI regarding billing for multiple peripheral interventions in the same vessel. It seems CMS is going to rescind this change effective October 1. Please see below for further details.
This paragraph in version 13.3 states:
“16. If an atherectomy fails to adequately improve blood flow and is followed by an angioplasty at the same site/vessel during the same patient encounter, only the successful angioplasty may be reported. Similarly if an angioplasty fails to adequately improve blood flow and is followed by an atherectomy at the same site/vessel at the same patient encounter, only the successful atherectomy may be reported. If atherectomy and/or angioplasty fail to adequately improve blood flow and are followed by a stenting procedure at the same site/vessel during the same patient encounter, only the successful stenting procedure may be reported. These principles apply to percutaneous or open procedures.”
As explained above, this paragraph replaced a paragraph that had been present in the Manual since 1996.
CMS will temporarily rescind the new paragraph and replace it with the one originally published in 1996 which states:
“When percutaneous angioplasty of a vascular lesion is followed at the same session by a percutaneous or open atherectomy, generally due to insufficient improvement in vascular flow with angioplasty alone, only the most comprehensive atherectomy that was performed (generally the open procedure) is reported (see sequential procedure policy, Chapter I, Section M).”
This change will be retroactive to October 1, 2007. The original paragraph will appear in version 14.3 of the Manual scheduled for publication on October 1, 2008. The change will also occur in the online version of the Manual published on the CMS website as early as possible.
Stacy Gregory, CPC, CCC, RCC