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 - Placement of visceral extension prosthesis for endovascular repair of abdominal aortic aneurysm involving visceral vessels, each visceral branch.

So you may make some sense out of NCCI's desire to bundle these codes into other regular CPT codes describing similar services.
 
For example, if you try to report 0078T with 34803 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated prosthesis [two docking limbs]), you'll receive a denial. You can report this combination with a modifier as long as you have supporting documentation. But remember - this would only be appropriate under certain clinical circumstances.

Check out the other edits affecting these codes:  Please see the chart to the right.

For example: If a cardiologist performs an AAA repair through an arterial access (0078T), a code like 36000 (Introduction of needle or intracatheter, vein) might come into play if he had to access a vein for some reason during the procedure, says Deb Ovall, CMA, CCS, CIC, lead coder and data quality analyst with Medical College Hospitals of Ohio at Toledo.

Because the cardiologist works in different systems, you may want to report these two codes separately. If so, you'll have to apply modifier -59, but make sure you can back it up with foolproof documentation.

Don't Overlook 'Welcome' Edits

NCCI also applies a slew of edits to G0344 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first six months of Medicare enrollment).

"As I understand it, G0344 is intended to cover the initial 'preventive maintenance' visit by a new Medicare recipient within the first six months of enrollment - which includes the E/M levels previous charged for this kind of office visit on the physician's side," Ovall says.

Therefore, you can understand why NCCI 11.0 targets many common services you may have reported at the same time as this screening examination. For instance, NCCI specifically includes edits pertinent to electrocardiographic services (93000-93014 and 93040-93042). You'll also discover edits pertinent to new outpatient services (99201-99205), established outpatient services (99211-99215), outpatient consultations (99241-99245), confirmatory consultations (99271-99275) and emergency department services (99281-99285). 

NCCI 11.0 also created a new edit that prevents you from separately reporting G0250 (Physician review, interpretation and patient management of home INR testing for a patient with mechanical heart valve[s] who meets other coverage criteria; per four tests [does not require face-to-face service]) from G0344.

This edit, as well as those mentioned above that are pertinent to electrocardiographic and E/M services, has a modifier indicator of "1." This means that with supporting documentation, you can report a modifier to bypass these NCCI edits. 

However, NCCI gave the three edits that include the work associated with nutrition therapy (G0270 and G0271) and digital rectal examinations (G0102) in the "welcome to Medicare" examination an indicator of "0." This means you cannot report these services together under any circumstance.