Cardiology Coding Alert

Make sure you learn the modifier indicators for these new edits to avoid denials.

CMS recently released its quarterly Procedure-to-Procedure (PTP) Correct Coding Initiative (CCI) updates for 2018. CCI 24.2 became effective on July 1, 2018.

Read on to see how CCI 24.2 will impact your cardiology practice’s bottom line.

Catch These Central Venous Access Device/Catheter Additions

Make sure you don’t miss the new PTP edits with either 36595 (Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access) or 36596 (Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen) as the Column 2 codes.

The Column 1 codes for these new PTP edits include 36578 (Replacement, catheter only, of central venous access device, with subcutaneous port or pump, central or peripheral insertion site) through 36590 (Removal of tunneled central venous access device, with subcutaneous port or pump, central or peripheral insertion).

This means that if you report both codes of these PTP pairs for the same patient on the same date the service, the Column 1 code, for example, 36578, is eligible for payment, but your payer will deny the Column 2 code — either 36595 or 36596.

Don’t miss: The modifier indicator for all of these new PTP pairs is “1, which lets you know that an edit can be overcome, if appropriate. You would use a modifier, such as 59 (Distinct procedural service). However, just because you can add a modifier, this doesn’t mean you should. Be sure you have the supporting documentation for requesting payment for both codes before adding a modifier to the bundled pair.

“Modifier 59 and other CCI-associated modifiers should not be used to bypass a CCI edit unless the proper criteria for use of the modifier 59 are met,” says Mary I. Falbo, MBA, CPC, president and CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania, adds. “Documentation in the medical record must satisfy the criteria required by any CCI-associated modifier that is used.”

Example: You can use modifier 59 when the surgeon performs the bundled procedures for different anatomic sites/regions, different organs, or in limited situations on different, non-contiguous lesions in different anatomic regions of the same organ, Falbo explains.

Caution: You should never append modifier 59 to an evaluation and management (E/M) service.

Bonus tip: Do not forget to append modifier 52 (Reduced services) for pro-fee or modifier 74 (Discontinued out-patient hospital/ambulatory surgery center (ASC) procedure after administration of anesthesia) for a facility to 36595 and 75901 (Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access, radiologic supervision and interpretation), when performed, 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.

The use of a balloon during “fibrin sheath disruption” or “fibrin septoplasty” is not a venoplasty; therefore, modifier 52 and/or 74 must be appended to this procedure, Neighbors adds. When 36595 is reported, 36593 (Declotting by thrombolytic agent of implanted vascular access device or catheter) is included and should not be reported separately.

Discover These New Path and Lab Additions

The following HCPCS codes are now Column 2 codes for the aortic dysfunction or dilation codes 81410 and 81411 and cardiac ion channelopathies codes 81413 and 81414:

• JAK2 code 0027U
• CYP2D6 code 0028U
• Drug metabolism codes 0029U and 0030U
• TPMT code 0034U

Also, there are new edits for hereditary cardiomyopathy code 81439 and the above mentioned HCPCS codes. For example, look out for 81439/0027U.

In addition, there are now PTP edits for cardiology (heart transplant), mRNA, gene expression profiling code 81595 and the above mentioned HCPCS codes. For example, don’t miss new PTP edit 81595/0034U.

The modifier indicator for all of these edits is “1.”

Observe These New Edits With Column 1 Code 93668

There are now a slew of new edits with 93668 (Peripheral arterial disease (PAD) rehabilitation, per session) as the Column 1 code. They include the following Column 2 codes:

• 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) through 93010 (…; interpretation and report only) with a modifier indicator of “1.”
• 93040 (Rhythm ECG, 1-3 leads; with interpretation and report) through 93042 (… interpretation and report only) with a modifier indicator of “1.”
• 94760 (Noninvasive ear or pulse oximetry for oxygen saturation; single determination) and 94761 (… multiple determinations (eg, during exercise)). These edits have a modifier indicator of “0,” which means you cannot use a modifier to override the edit under any circumstances.
• 97110 (Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility) through 97116 (… gait training (includes stair climbing)) with a modifier indicator of “1.”
• 97140 (Manual therapy techniques (eg, mobili­zation/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes) through 97150 (Therapeutic procedure(s), group (2 or more individuals)) with a modifier indicator of “1.”

Other Column 2 codes on this list include physical therapy evaluation codes 97161 through 97163; physical therapy established plan reevaluation code 97164; occupational therapy evaluation codes 97165 through 97167; occupational therapy established plan reevaluation code 97168; therapeutic activities code 97530; physical performance test or measurement code 97750; and medical nutrition therapy codes 97802 through 97804. The modifier indicator for all of these edits is “1.”