Cardiology Coding Alert

You've got a batch of edits to learn, but you can use a modifier

Category III codes CPT 0075T, CPT 0078T-CPT 0080T began their temporary tenure on Jan. 1, so it's no wonder that National Correct Coding Initiative, version 11.0, has handed down a slew of edits discouraging various code combinations.
 
Not to worry though. In every case, you can still report these services separately - as long as your documentation supports the use of a modifier. Be Wary of 0075T Alongside AAA Codes

When you get ready to report 0075T (Transcatheter placement of extracranial vertebral or intrathoracic carotid artery stent[s], including radiologic supervision and interpretation, percutaneous; initial vessel), you may want to think twice before including an abdominal aortic aneurysm (AAA) repair code.

For example: Your cardiologist performs a carotid artery stent along with an AAA repair. You know you have to report the Category III code, but if you include it with the AAA repair code for an aorto-aortic tube prosthesis (34800), you'll receive a denial.

The reason is that NCCI 11.0 edits make 0075T a component of a few AAA repair codes (such as 34800-34808), but NCCI also includes other similar AAA repair codes (such as 34812-34820) in the work of 0075T.

For full details, see the chart to the right:

For example: If you accidentally submit 0075T in conjunction with 34812 (Open femoral artery exposure for delivery of endovascular prosthesis, by groin incision, unilateral) without a modifier, carriers will only pay for the Column 1 code. In this case, they would reimburse for 0075T only.

Remember: If you need to report 0075T separately, you can do so - as long as your documentation backs up the use of a modifier, such as modifier -59 (Distinct procedural service).

Such documentation would include an explicit diagnosis supporting the medical necessity of the additional service, and/or documentation proving that the additional procedure occurred at a distinct anatomic location, says Annette Grady, CPC, CPC-H, a consultant with Eide Bailly in Bismarck, N.D. Match Up Endovascular AAA Code Edits You may have to carefully pick and choose from the regular CPT Codes for endovascular AAA repairs when reporting them in conjunction with 0078T-0079T. You should have started using these temporary category III codes as of Jan. 1:

0078T - Endovascular repair of abdominal aortic aneurysm, pseudoaneurysm or dissection, abdominal aorta involving visceral vessels (superior mesenteric, celiac or renal), using fenestrated modular bifurcated prosthesis (two docking limbs)

0080T - ... radiological S&I

+0079T [...]