Cardiology Coding Alert

NCCI 10.2 bundles septal defect codes from the 30000 series with those from the 93580 series

The National Correct Coding Initiative (NCCI), version 10.2, went into effect on July 1, and although the edits shouldn't be too burdensome to cardiology practices, you should keep your eyes on the open septal defect repair codes 33641-33697 if you want to avoid denials.

NCCI 10.2, effective through Sept. 1, bundles 93580 (Percutaneous transcatheter closure of congenital interatrial communication [i.e., Fontan fenestration, atrial septal defect] with implant) and 93581 (Percutaneous transcatheter closure of a congenital ventricular septal defect with implant) into the septal defect repair codes 33641-33647, 33660-33665, 33670-33688 and 33692-33697. "These codes are open repairs," says Anne Karl, RHIA, CCS-P, CPC, coding and compliance specialist for St. Paul Heart Clinic in Mendota Heights, Minn. "Since these codes are performed by cardiac surgeons, and 93580 and 93581 are performed by cardiologists, I doubt this will have much effect on those doing transcatheter procedures."

Because these edits feature a "1" modifier, you can use a modifier (such as -59, Distinct procedural service) to separate the codes if you perform both services on the same date. Keep in mind that you still have to meet the criteria of modifier -59, says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting in Denver. Otherwise you cannot separate the services.

For example: "The use of modifier -59 would be appropriate in cases where a cardiologist fixes one anatomical area via a transcatheter method and a separate area was performed open, but what are the chances of that?" Karl says.

NCCI bundles 93581 into the codes for transposition of the great vessels, 33770-33781. And NCCI bundles hundreds of codes into 93580-93581. For example, if you bill the new catheter insertion codes 36555-36556 with 93580 or 93581, Medicare and other insurers that follow the NCCI edits will deny the catheter insertion code unless you append a modifier to demonstrate that you performed the services at separate sessions and that both procedures were medically necessary.

NCCI also takes aim at the endovascular aortic aneurysm repair codes 0033T-0035T, which are now bundled into the thoracic aortic aneurysm codes 33860-33877, the aneurysm repair codes 35002, 35022 and 35162, and the transcatheter stent placement code 37205. NCCI bundles fluoroscopy codes 76000-76003 and several other procedure codes (including 35001, 35206 and 36625) into 0033T-0034T and 0038T-0040T. "This seems very appropriate because the supervision and interpretation for 0033T is 0038T, and the supervision and interpretation for 0034T is 0040T," Karl says. "Therefore, the use of 76000-76003 would be double-billing or an incorrect code assignment."

NCCI 10.2 also bundles the brain magnetic resonance imaging (MRI) codes 70551-70553 into the new codes 70558 (Magnetic resonance [e.g., proton] imaging, brain [including brain stem and skull base], during open intracranial procedure [e.g., to assess for residual tumor or residual vascular malformation]; with contrast material[s]) and 70559 (...without contrast material[s], followed by contrast material[s] and further sequences). "This also makes total sense because 70558 and 70559 are specific to MRI during open brain procedures," Karl says.

And NCCI bundles several cardiology codes, including 36000, 36406 and 36410, into 70558-70559.

Note: Visit www.cms.hhs.gov/physicians/cciedits/default.asp for links to documents that explain the edits, including the NCCI Policy Manual for Part B Medicare Carriers, the Medicare Carriers Manual, and an NCCI Question-and-Answer page.