Cardiology Coding Alert

Remember: Always pay attention to modifier indicators.

You’ve learned all about the 2020 CPT^® pericardial drainage and aorta graft additions, changes, and revisions in recent issues of Cardiology Coding Alert. Now, with the release of the Correct Coding Initiative (CCI) 26.0 procedure-to-procedure (PTP) edits, you should also learn 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 26.0 edits focus on the new 2020 CPT^® codes.

Explore Multiple Pericardiocentesis and Pericardial Drainage Edits

You’ll see many edits involving new codes 33016 (Pericardiocentesis, including imaging guidance, when performed)-33019 (Pericardial drainage with insertion of indwelling catheter, percutaneous, including CT guidance).

Codes bundled into 33016-33019: For example, codes bundled into new codes 33016-33019 include the following:

• 33210 (Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter (separate procedure)) and 33211 (Insertion or replacement of temporary transvenous dual chamber pacing electrodes (separate procedure))
• 36591 (Collection of blood specimen from a completely implantable venous access device) and 36592 (Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified)
• 64400 (Injection(s), anesthetic agent(s) and/or steroid; trigeminal nerve, each branch (ie, ophthalmic, maxillary, mandibular))-64449 (Injection(s), anesthetic agent(s) and/or steroid; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement))
•  64479 (Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, single level)-+64495 (Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure))
• 64505 (Injection, anesthetic agent; sphenopalatine ganglion)-64530 (Injection, anesthetic agent; celiac plexus, with or without radiologic monitoring)

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

On the other hand: For example, codes bundled into new codes 33016-33019 with a modifier indicator of “1” include the following:

• 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less)-12007 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); over 30.0 cm)
• 36400 (Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; femoral or jugular vein)-36410 (Venipuncture, age 3 years or older, necessitating the skill of a physician or other qualified health care professional (separate procedure), for diagnostic or therapeutic purposes (not to be used for routine venipuncture))
• 51701 (Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine))-51703 (Insertion of temporary indwelling bladder catheter; complicated (eg, altered anatomy, fractured catheter/balloon))
• 94680 (Oxygen uptake, expired gas analysis; rest and exercise, direct, simple)-94690 (Oxygen uptake, expired gas analysis; rest, indirect (separate procedure))
• 95812 (Electroencephalogram (EEG) extended monitoring; 41-60 minutes)-95822 (Electroencephalogram (EEG); recording in coma or sleep only)

Don’t miss: A modifier indicator of “1” lets you know that an edit can be overcome, if appropriate, with the use of a modifier, such as modifier 59. 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.

Reminder: “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.

Discover New Aorta Graft Edits

You should also be aware of the numerous edits surrounding new aorta graft codes 33858 (Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed; for aortic dissection), 33859 (Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed; for aortic disease other than dissection (eg, aneurysm)), and 33871 (Transverse aortic arch graft, with cardiopulmonary bypass, with profound hypothermia, total circulatory arrest and isolated cerebral perfusion with reimplantation of arch vessel(s) (eg, island pedicle or individual arch vessel reimplantation).

Codes bundled into codes 33858, 33859, and 33871 with a modifier indicator of “1” include the following: blood vessel repair codes 35201-35226; catheter codes 36010-36014, 36140-36217, and 36245-36247; naso or oro-gastric tube placement code 43752; ECG codes 93000-93010 and 93040 -93042; 94680-94690; and 95812-95822.

Codes bundled into codes 33858, 33859, and 33871 with a modifier indicator of “0” include the following: Transmyocardial laser revascularization code 33140; operative tissue ablation and reconstruction of the atria codes 33254-33256; collection of blood specimen codes 36591 and 36592; injection codes 62320-62327; 64400-64449; 64479-+64495; and moderate sedation codes 99155-+99157.

Don’t miss: You should also stay on top of edits where 33858, 33859, and 33871 are bundled into other codes.

Code 33858 is bundled into the following codes with a modifier indicator of 0: ascending aorta graft codes 33863 and 33864

Code 33859 is bundled into the following codes with a modifier indicator of 0: 33863, 33864, and 33858

Code 33871 is bundled into the following codes with a modifier indicator of 0: 33858 and 33859

Don’t miss: Coders should always be aware of CCI edits because they will let you know how to code a procedure and what services may be bundled in that code, says Jim Pawloski, BS, MSA, CIRCC, R.T. (R)(CV), interventional radiology technologist/coder at William Beaumont Hospital in Royal Oak, Michigan, and coder at Adreima in Phoenix, Arizona. Knowing the edits will let you know what can be reported, which will give you a clean bill and maximize your reimbursements. 

Editor’s note: These edits are just a sample of what you should be aware of surrounding the new 2020 CCI edits — not an exhaustive list. Visit  https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits for the complete list of CCI 26.0 edits.