Cardiology Coding Alert

Don’t miss: You will see this capitalization throughout the entire manual. This revision just seems to be an example of establishing consistency in the manual.

You will also see other ways in which small details have been added to the manual for clarity and consistency. For example, Section 13 of Part D “The Cardiovascular System,” now reads, “Open and percutaneous interventional vascular procedures include operative angiograms and/or venograms which shall not be separately reported as diagnostic angiograms/venograms. The ‘CPT^® Manual’ describes the circumstances under which a provider may separately report a diagnostic angiogram/venogram at the time of an interventional vascular procedure.” (Emphasis added.” The quotation marks around “CPT^® Manual” are an editorial choice that designates the CPT^® Manual as a certain resource.

Manual Adds New Modifier Options in 2020

Throughout the manual, you will see the addition of the X{EPSU} modifiers. For, example, Section 3 of Part D “The Cardiovascular System,” reads, “During venous or combined arterial venous coronary artery bypass grafting procedures (CPT^® codes 33510-33523), it is occasionally necessary to perform epi-aortic ultrasound. This procedure may be reported with CPT^® code 76998 (Ultrasonic guidance, intraoperative) by appending modifier 59 or XS.” (Emphasis added).

Modifier XS (Separate structure) is one of the X{EPSU} modifiers that you may be able to use instead of modifier 59 (Distinct procedural service) to break a procedure-to-procedure (PTP) edit, if appropriate.

You will also see examples of these new modifier additions in Section 17 of Part D “The Cardiovascular System.” For example, this paragraph now reads, “Peripheral vascular bypass CPT^® codes describe bypass procedures with venous and other grafting materials (CPT^® codes 35501-35683). These procedures are mutually exclusive since only one type of bypass procedure may be performed at a site of obstruction. If multiple sites of obstruction are treated with different types of bypass procedures at the same patient encounter, multiple bypass procedure codes may be reported with anatomic modifiers or modifier 59 or XU.” (Emphasis added).

So, it is extremely important that you understand the rules for appending modifier 59 and the X-modifiers, including XS and XU (Unusual non-overlapping service). A modifier indicator of “1” for a PTP pair lets you know that an edit can be overcome, if appropriate, with the use of a modifier. However, you should not use modifier 59 and other CCI-associated modifiers to bypass a CCI edit unless you meet the proper criteria for the use of the modifier. The documentation in the medical record must satisfy the criteria required by any CCI-associated modifier that you use.

“Before immediately appending modifier 59, always review the modifier lists for a more appropriate/specific modifier,” says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee. “It is extremely important to use the X{E, S, P, U} modifiers accordingly.”