Coding Corner: Reporting Diagnostic Angiographies? Read This First

Plus: 82 edits just for codes 76003 and 76942

The latest version of the National Correct Coding Initiative (NCCI) edits doesn't cut you any slack just because it's the end of the year. Here's the rundown on NCCI version 10.3 and how it will affect your guidance and transcatheter claims.
Double-Check That Diagnostic Angiography
Before you report an angiography code with a transcatheter code, make sure you analyze these edits. Codes 75960 (Transcatheter introduction ...), 75961 (Transcatheter retrieval ...), and 75970 (Transcatheter biopsy ...) now include all of the angiography codes from 75650   to 75756.
"It's a huge departure from how people are used to coding them," says Dawn Hopkins, senior manager for reimbursement with the Society of Interventional Radiology (SIR). Now, if you want adequate reimbursement "when you do a diagnostic that's converted to a therapeutic, same patient, same day, you've got to append modifier -59 (Distinct procedural service)," she adds. Modifier -59 will override the edits, and you should append it when circumstances merit separately reporting transcatheter and angiography codes.
Generally, for interventional radiology (IR), diagnostic studies are more quickly converted to therapeutic than in other specialties, so this edit doesn't correct coding for IR in the same way it does for other fields, Hopkins says. But if your payer adopts these edits, you need to report the codes properly if you want to be reimbursed.
The bottom line: Don't report diagnostic angiography along with therapeutic services if, for example, the diagnostic angiography isn't necessary because the diagnostic information is known from another test. You include angiography inherent in the therapy in the supervision and interpretation (S&I) code for that therapy.
 
If the physician performs a diagnostic angiography prior to the therapeutic service, and, as is often the case, uses the results to decide on the therapy, you may code for angiography S&I separately by appending modifier -59.
Check Out These Related Edits
Other radiology codes incorporate different portions of this set of angiography codes.

NCCI includes angiography codes 75650-75756 in 75962 (Transluminal balloon angioplasty ...) and 75992 (Transluminal atherectomy ...).

Angiography codes 75722-75746 are included in 75966 (Transluminal balloon angioplasty ...) and 75995 (Transluminal atherectomy ...).

Don't report angiography codes 75722 and 75724 with 75994 (Transluminal atherectomy ...). Only 75994 will be paid.

Only 75992 (Transluminal atherectomy ...) will be paid if you submit angiography code 75756 with it.

If you report angiography code 75756 with 75962 (Transluminal balloon angioplasty ...), fiscal intermediaries (FIs) that adopt the edits will only pay 75962.

You may not report venography code 75825 with percutaneous placement code 75940. FIs will only reimburse you for 75940.


- Published on 2005-01-22