Cardiology Coding Alert
Pay Attention to New Coarctation of Aorta Repair Edits to Submit Clean Claims
Hint: A modifier indicator of “0” means you cannot break an edit. You’ve learned about the 2022 CPT® left atrial appendage (LAA) exclusion, coarctation of aorta repair and congenital heart catheter additions, changes, and revisions in recent issues of Cardiology Coding Alert. Now, with the release of the National Correct Coding Initiative (NCCI) 28.1 procedure-to-procedure (PTP) edits, you should also review 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 28.1 edits focus on the new 2022 CPT® codes. Look at These New LAA Exclusion Edits You’ll see many edits involving the new LAA exclusion codes 33267 (Exclusion of left atrial appendage, open, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip)) through 33269 (Exclusion of left atrial appendage, thoracoscopic, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip)). Codes bundled into 33267-33269: For example, codes bundled into 33267-33269 with a modifier indicator of “1” include the following: Remember: A modifier indicator of “1” lets you know that you can override an edit, if appropriate, using a modifier, such as modifier 59 or modifiers XE (Separate encounter…), XS (Separate structure…), XP (Separate practitioner…), or XU (Unusual non-overlapping service…). However, you should never use modifier 59 and other NCCI-associated modifiers to bypass an NCCI edit unless you meet the proper criteria for using the modifier. The documentation in the medical record must satisfy the criteria required by any NCCI-associated modifier that you use. On the other hand: For example, codes bundled into 33267-33269 with a modifier indicator of “0” include: pacemaker codes 33210 and 33211; collection of blood specimen codes 36591 and 36592; and injection codes 62320-62327, 64400-64425, 64479-+64484, 64486-+64495, and 64505-64530. These edits cannot be broken under any circumstances because they have a modifier indicator of “0.” Don’t miss: “One category of NCCI edits is known as Column 1/Column 2 edits or procedure-to- procedure (PTP). These list procedures that may be part of a more extensive surgery,” says Robin Peterson, CPC, CPMA, manager of professional coding, Pinnacle Integrated Coding Solutions, LLC. “The second category of NCCI edits is the medically unlikely edits or MUEs. MUEs give a maximum number of units of service for a single beneficiary on a single calendar day.” Discover New Coarctation of Aorta Repair Edits You will also see some edits involving the new codes for transcatheter interventions for revascularization or repair of the coarctation of the aorta: 33894 (Endovascular stent repair of coarctation of the ascending, transverse, or descending thoracic or abdominal aorta, involving stent placement; across major side branches), 33895 (… not crossing major side branches), and 33897 (Percutaneous transluminal angioplasty of native or recurrent coarctation of the aorta). Codes bundled into 33894, 33895, and 33897: For example, codes bundled into 33894 and 33895 with a modifier indicator of “1” include the following: Additionally: Codes bundled into 33894, 33895, and 33897 with a modifier indicator of “0” include endovascular repair codes 34701-34706; introduction of catheter code 36200; injection codes 64400-64425, 64479-+64484, 64486-+64495, and 64505-64530; aortography codes 75600 and 75625; and moderate sedation codes 99155-+99157. Focus on Congenital Heart Cath Edits You will also see edits with new congenital heart cath codes 93593 (Right heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone; normal native connections)-+93598 (Cardiac output measurement(s), thermodilution or other indicator dilution method, performed during cardiac catheterization for the evaluation of congenital heart defects (List separately in addition to code for primary procedure)). Codes bundled into 93593-+93598: For example, codes bundled into 93593-+93598 with a modifier indicator of “1” include the following: Don’t miss: Codes bundled into 93593-+93598 with a modifier indicator of “0” include collection of blood specimen codes 36591 and 36592, paravertebral bloc (PVB) codes 64461-64463, transversus abdominus plane (TAP) block codes 64486-64489, and moderate sedation codes 99155-+99157.
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