Cardiology Coding Alert

Hint: Brush up on these edits for new all-encompassing codes 34701-34708.

You've learned all about the 2018 CPT^® vascular surgery code additions, changes, and revisions in previous issues of Cardiology Coding Alert. Now, with the release of the Correct Coding Initiative (CCI) 24.0 edits, you should also determine how these edits will impact your cardiology practice's reimbursement this year.

As is typical of the first round of bundlings for a new year, many of the CCI 24.0 edits focus on the new 2018 CPT^® codes.

Come to Grips With All-Encompassing Endovascular Edits

You've got a slew of edits to learn and they surround the new all-encompassing endovascular codes 34701-34708. These codes describe various distinct methods for endovascular repair of infrarenal aorta and/or iliac artery(ies).

Codes are bundled into 34701-34708: Some of the codes bundled into new codes 34701-34708 include the following:

• 34710 and +34711 (Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration, ...)
• 34841-34844 (Endovascular repair of visceral aorta (eg, aneurysm, pseudo­aneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft ...)
• 34845 and 34846 (Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft ...)
• +69990 (Microsurgical techniques, requiring use of operating microscope ...).

These edits cannot be broken under any circumstances because they have a modifier indicator of "0."

On the other hand: Some of the codes bundled into 34701-34708 with a modifier indicator of "1" include:

• 12004-12007 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet)...)
• 12034-12036 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet)...)
• 13100-+13102 (Repair, complex, trunk...)
• 93040-93042 (Rhythm ECG, 1-3 leads;...)
• 96365-+96368 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug)...).

The modifier indicator of "1" means these edits can be overcome, if appropriate, with the use of a modifier such as modifier 59 (Distinct procedural service), according to Mary I. Falbo, MBA, CPC, president and CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania.

Don't miss: Although CCI bundles indicate which CPT^® and HCPCS codes you should normally not report together, Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, manager of clinical compliance with PeaceHealth in Vancouver, Washington, reminds coders that CCI is more than just a list of codes that bundle together.

"There are general rules for all coding concepts and general rules for each CPT^® chapter," Bucknam says. "Read through these rules and be sure you understand the concepts for the chapters you work in most often. This will help you understand what is likely to bundle and will guide you even if you don't have software that tells you when you make a bundling error.

Examine These Extension Prosthesis Placement Edits

You should also be aware of the numerous edits surrounding new extension prosthesis placement codes +34709 (Placement of extension prosthesis(es) distal to the common iliac artery(ies) or proximal to the renal artery(ies) for endovascular repair of infrarenal abdominal aortic ...) through +34711 (Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal ...).

For an example of some edits to note, know that endovascular repair codes 34841-34848 are bundled into 34710. These edits have a modifier indicator of "0."

Codes bundled into 34710 with a modifier indicator of "1" include the following: simple wound repair codes 12007, 12011, 12013-12018; and treatment of superficial wound dehiscence codes 12020 and 12021.

Code 34710 is bundled into the following codes with a modifier indicator of "0": endovascular repair codes 33880 and 33881; and new codes 34701-+34709.

Codes 34710 is bundled into the following graft codes with a modifier indicator of "1": 33870 and 33875.

Break Down These Delivery to Endograft, Endo Prosthesis Edit Additions

CPT^® 2018 added new codes 34712 (Transcatheter delivery of enhanced fixation device(s) to the endograft ...) through +34716 (Open axillary/subclavian artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass ...) to represent the delivery to the endograft and delivery of endovascular prosthesis.

To ace the edits associated with these new codes, take a look at the following examples featuring +34715 (Open axillary/subclavian artery exposure for delivery of endovascular prosthesis by infraclavicular or supraclavicular incision, unilateral ...).

Codes bundled into +34715 with a modifier indicator of "0" include the following: operating microscope code +69990 and arterial pressure waveform analysis code 93050.

Codes bundled into +34715 with a modifier indicator of "1" include the following: simple wound repair codes 12004-12007, 12011, and 12013-12018.

Code +34715 is bundled into these codes with a modifier indicator of "1": direct repair of aneurysm, pseudoaneurysm, or excision codes 35011, 35013, 35045, and 35081.

Watch Edits For These Revised Codes

CPT^® 2018 made +34812 (Open femoral artery exposure for delivery of endovascular prosthesis...), +34820 (Open iliac artery exposure for delivery of endovascular prosthesis...), +34833, and +34834 add-on codes. This means you need to list them in addition to the appropriate code for the primary procedure. Check out the following edits worth remembering:

Codes +34833 and +34834 are bundled into these codes with a modifier indicator of "0": extracorporeal membrane oxygenation codes 33953 and 33954.

Editor's note: These edits are just a sample of what you should be aware of surrounding the 2018 vascular surgery updates - not an exhaustive list. Visit www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Version_Update_Changes.html for the complete list of CCI 24.0 edits.