Cardiology Coding Alert

Oct. 1 brought adjustments to the way you report angiography codes alongside codes for various cardiology procedures, thanks to Correct Coding Initiative (CCI) version 13.3. Discover how you should apply these edits, as well as codes for electrophysiology during operative ablation services, and your claims will sail through every time.

Medicare applies CCI edits to services reported by the same provider for the same beneficiary on the same date of service, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, director of outreach programs for the American Academy of Professional Coders based in Salt Lake City.

Each CCI code-pair edit includes a correct coding modifier indicator of 0 or 1. A "0" indicator means that you may not unbundle the edit combination under any circumstances, according to CCI guidelines. An indicator of "1" means that 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).-

Good news: You've got some relief from a diagnostic angiography edit deletion.

Rationale: When you look at the CPT instructions specific to 37215 (Transcatheter placement of intravascular stent[s], cervical carotid artery, percutaneous; with distal embolic protection), you'll see that you should include any diagnostic angiogram of the target vessel performed at the same time as a carotid stent as part of the stent placement service itself, says Jim Collins, CPC-CARDIO, ACS-CA, CHCC, president of The Cardiology Coalition in Saratoga Springs, N.Y.

CCI 13.3 deleted the edit binding 75650 (Angiography, cervicocerebral, catheter, including vessel origin, radiological supervision and interpretation) to 37215 because the original intention was more specific to aortic arch angiography, not carotid angiography.

In other words, when your cardiologist performs 37215 (the stent placement) and includes any diagnostic imaging of the vessel involved, but not of the aortic arch (75650), you should report that service separately. Since CCI repealed this edit, you do not need to attach any CCI-recognized modifier, Collins says.

However, you have a slew of angiography edits to take into account.

Modifier allowed: You should amend the way that you report 75600 (Aortography, thoracic, without serialography, radiological supervision and interpretation) and 75605 (Aortography, thoracic, by serialography, radiological supervision and interpretation). These codes are now components of codes 93501, 93503, 93505, 93508, 93510, 93511, 93514, 93524-93533, and 93556. The edits carry a modifier indicator of "1," meaning that you may separate them with a modifier when you have supporting documentation.

For example, the doctor may need to conduct a thoracic aortogram (75600) at the same time he is conducting a diagnostic heart catheterization (such as 93508, Catheter placement in coronary artery[s], arterial coronary conduit[s], and/or venous coronary bypass graft[s] for coronary angiography without concomitant left heart catheterization). When this service is separately identifiable, medically necessary, and diagnostic in nature, you can add an appropriate modifier (such as 59, Distinct procedural service) to 75600. Make certain you have the documentation to back it up.

No modifier allowed: Angiography code 75756 (Angiography, internal mammary, radiological supervision and interpretation) is now a component to codes 93501, 93503, 93505, 93508, 93510, 93511, 93514, 93524-93533, and 93556. You cannot separate these edits because they have a modifier indicator of "0."

Attention, electrophysiology coders: If your electrophysiologist assists in operative ablation cases -- even though they are usually performed by surgeons -- you need to be aware of the following edits.

First, you should be cautious when coding 92960 (Cardioversion, elective, electrical conversion of arrhythmia; external) or 93624 (Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or attempted induction of arrhythmia) in these situations. The reason is that both 92960 and 93624 are now components to operative ablation codes 33250-33266.

Rationale: "These edits reinforce that when a physician performs cardioversion or follow-up testing to confirm the success of the ablative procedure, then you cannot report these services in addition to the ablation procedure," Collins says.

Second, you should now consider electrophysiology code 93624 a component of surgical ablation code 93650, Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement.

Keep in mind: You can bypass these edits, because they carry a modifier indicator of "1."