Cardiology Coding Alert

Overlooking modifier indicators is a big mistake









When you're coding selective arterial catheter placements as well as atherectomies, you may need to consult the Correct Coding Initiative (CCI) before you submit your claim.

Although you don't have many CCI edits to learn this time around, you're still expected to apply the following edits to your coding practice by July 1. Our experts break down what you need to know. Attack This Solitary Atherectomy, Catheter Edit You've got one addition that promises to have you scratching your head in confusion.

CCI bundles catheterization code 36247 (Selective catheter placement, arterial system; initial third-order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family) into atherectomy code 35485 (Transluminal peripheral atherectomy, open; tibioperoneal trunk and branches).

In other words, if your cardiologist performs both the selective arterial catheter placement (36247) as well as an atherectomy (35485), then you'll report only 35485.

Why: "The logic, I presume, is that the 35485 is an open procedure and that coders would not typically bill for percutaneous third-order selective catheter placement with an open intervention," says Jim Collins, CPC, ACS-CA, ChCC, president of The Cardiology Coalition in Matthews, N.C.

Here's the strange part: CCI 13.2 does not impact the other open atherectomy procedures in this section (35480-35485) with other catheter placement codes (36245-36247). "There does not appear to be much logic in having one edit and not a whole slew of them," Collins says.

Good news: This edit has a modifier indicator of "1," which means you may use a modifier to override the edit if the procedures are distinct from one another (for instance, if they occur in separate anatomic locations). You can append modifier 59 (Distinct procedural service) to the lesser code (in this case, 36247) to indicate to the payer that the billed procedures are distinct and separately identifiable, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, director of outreach programs for the American Academy of Professional Coders, the coding organization based in Salt Lake City. But don't forget to back up your claim with documentation.

For instance, your cardiologist performs a percu-taneous diagnostic lower extremity study. You report this with 36247 and 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation). The study's findings trigger an immediate open atherectomy procedure during the same operative session. In this case, you can report both procedures, Collins says. Apply modifier 59 to 36247. Don't forget: Your cardiologist's documentation should demonstrate how these were two distinct procedural services. Endovascular 'T' Codes Don't Escape Unscathed You've got a mix of edits that involve endovascular aortic aneurysm repair codes 0153T (Transcatheter placement of wireless physiologic sensor in aneurysmal sac during endovascular repair, including radiological supervision and interpretation [...]