Cardiology Coding Alert

Thousands of new edits will affect your claims, but common sense should see you through.

As you implement Correct Coding Initiative (CCI) 19.2, effective July 1, there are two areas you'll want to watch. The first involves Category III codes for subcutaneous implantable cardioverter defibrillators (S-ICDs). The second is the bundling of E/M codes with thousands of cardiology-related codes.

Use CCI to Help Keep S-ICD Rules Straight

Codes 0319T-0328T fall into Column 1 of roughly 1,000 new edits total, according to Frank Cohen, of Frank Cohen Group, in his NCCI 19.2 Analysis. The codes involved relate to S-ICDs:

• 0319T, Insertion or replacement of subcutaneous implantable defibrillator system with subcutaneous electrode
• 0320T, Insertion of subcutaneous defibrillator electrode
• 0321T, Insertion of subcutaneous implantable defibrillator pulse generator only with existing subcutaneous electrode
• 0322T, Removal of subcutaneous implantable defibrillator pulse generator only
• 0323T, Removal of subcutaneous implantable defibrillator pulse generator with replacement of subcutaneous implantable defibrillator pulse generator only
• 0324T, Removal of subcutaneous defibrillator electrode
• 0325T, Repositioning of subcutaneous implantable defibrillator electrode and/or pulse generator
• 0326T, Electrophysiologic evaluation of subcutaneous implantable defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters)
• 0327T, Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording and disconnection per patient encounter implantable subcutaneous lead defibrillator system
• 0328T, Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis; implantable subcutaneous lead defibrillator system.

Most of the services bundled into the S-ICD codes are incidental to the larger procedure, such as anesthesia, skin repair, vascular introduction and injection, insertion of GI tubes and bladder catheters, imaging guidance, cardioversion, electrocardiography, transesophageal echocardiography, and conscious sedation.

Watch for: The S-ICD codes also have edits with each other. The Mod column below shows the modifier indicators for the edits. An indicator of 0 means you may never override the edit. An indicator of 1 means you may override the edit with a modifier when you have supporting documentation.

Double Check Edits Before Reporting E/M

CCI 19.2 also adds an impressive number of edits bundling E/M codes into most of the cardiovascular surgery procedures in the 30000 range. As one of about 12,750 examples, 99223 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history A comprehensive examination and Medical decision making of high complexity...) is bundled into 33264 (Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator pulse generator; multiple lead system).

You'll find similar bundles for many cardiology codes in the 90000 range, including the new percutaneous coronary intervention codes. For instance, 99233 (Subsequent hospital care, per day, for the evaluation and management of a patient ...) is bundled into 92924 (Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; single major coronary artery or branch).

Expect to see a modifier indicator of 1 for these edits, meaning you may override the edit with a modifier when you have a truly distinct E/M service on the same date as the procedure.

Smart move: Checking a code's global surgery days will help keep you from violating these edits. For example, 33264 has a 90-day global, so you know Medicare will not pay separately for same-day hospital care (such as 99223) that's part of a planned 33264 service. Code 92924 has 000 global days, which means "related preoperative and postoperative relative values on the day of the procedure" are included in payment for 92924.