Cardiology Coding Alert

The Correct Coding Initiative (CCI) edits version 8.3, effective Oct. 1 to Dec. 31 will not have a dramatic impact on cardiology coding, thanks to the deletion of proposed edits that would have bundled angioplasties and atherectomies with stents in noncoronary vessels.

The final edits omit bundling 37205 (Transcatheter placement of an intravascular stent[s], [non-coronary vessel], percutaneous; initial vessel) with codes in the transluminal angioplasty series (35470-35476) and codes in the transluminal atherectomy series (35490-35495).

In addition, final edits omit proposed bundling of codes for catheter placement in transluminal atherectomies (35490-35495) with codes for transluminal balloon angioplasty (35470-35476).

The American College of Cardiology (ACC) advocated deleting the version 8.3 edits involving percutaneous angioplasty, atherectomy and stenting. The ACC argued in an Aug. 14 letter to the National Correct Coding Initiative that these edits "are not clinically justified, contradict established CPT coding conventions, and do not reflect the valuation process and relative values assigned to these codes."

Had these codes been in the final edits, reimbursement for stents in noncoronary vessels might have been significantly reduced.

"When stents are put in noncoronary vessels, we were able to bill for that balloon angioplasty in the same vessel," says Martha Gerant, CPC, a practice coder with Cardiology Services in Shawnee Mission, Kan. The proposed edits incorporated the balloon angioplasty into the stent, and this would have resulted in lost reimbursement, she notes.

Otherwise, version 8.3 includes edits that prevent the reporting of electrocardiograms (ECGs) (93000-93010) and rhythm ECGs (93040-93042) when performed with intracardiac electrophysiological (EP) procedures and studies (93600-93624 and 93631-93642).

ECGs are part of intracardiac electrophysiological studies, which include arrhythmia induction, mapping and ablation. During an EP study, ECGs record heart rhythms before and during pacing or programmed stimulation of multiple locations in the heart.

"This group of edits should not pose problems for our practice because we don't perform any of those procedures on the same day," says Anne Karl, RHIA, CCS-P, CPC, a coding and compliance specialist with St. Paul Heart Clinic in Mendota Heights, Minn. "If we did, we would support the codes with modifer -59 (Distinct procedural service)."

If cardiologists perform ECGs separately, they will need to make sure to describe the separate studies in their reports, Gerant says.

A final group of edits bundles fluoroscopy (76000), fluoroscopic guidance for needle placement (76003), ultrasonic guidance for needle placement (76942) and intraoperative ultrasonic guidance (76986) into aortography, angiography and venography (75600-75978), transluminal atherectomy (75992-75996), myocardial perfusion and cardiac blood pool imaging studies (78414-78458, 78460-78483 and 78494-78496).

Fluoroscopy is inherent in aortography, angiography and venography, and all of the services in these procedures are performed under fluoroscopic guidance. Fluoroscopic procedures, however, are not part of myocardial perfusion and blood pool imaging studies and would not be performed together.

Note: For more information about the CCI edits, contact the National Technical Information Service at its Web site, www.ntis.gov, or call (800) 363-2068. Coding experts suggest that if you are concerned about the prospect of future edits including bundling of stents in noncoronary vessels, you should contact your local chapter of the American College of Cardiology.