Cardiology Coding Alert

Correct Coding Manual/Version 7.3 (CCM 7.3), the latest version of the manual that compiles all changes to the Correct Coding Initiative (CCI), was released Oct. 1. Although CCM 7.3 includes few edits specific to cardiology, significant revisions to long-standing coding policies are worth the attention of all physicians. Changes to Chapter One of the CCI, for example, include:
 
Reintroducing the requirement that modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) be appended to any E/M service provided on the same day as a diagnostic test.
 
Elaborating on the use of modifiers "designated specifically for use with the correct coding and mutually exclusive code pairs."
 
Bundling "general fluoroscopic services" with placement of central access devices, such as catheters, unless a specific CPT code has been defined for this service.
Chapter One of the CCI, titled "General Correct Coding Policies," has not been revised for years, which makes the changes even more important, says Kathleen Mueller, RN, CPC, CCS-P, a coding and reimbursement specialist in Lenzburg, Ill. Many of the changes, Mueller notes, reflect existing coding conventions and principles that CMS is putting in writing in the CCI Edits for the first time. For example, the following principles provide the rationale for including individual services with a more comprehensive procedure:
 
1. The service represents the standard of care in accomplishing the overall procedure.
 
2. The service is necessary to successfully accomplish the comprehensive procedure; failure to perform the service may compromise the success of the procedure.
 
3. The service does not represent a separately identifiable procedure unrelated to the comprehensive procedure planned.
CCM 7.3 uses cardiology-specific situations to drive home the point. For instance, "procurement of a rhythm strip in conjunction with an electrocardiogram (ECG) would not be separately reported if it was procured by the same physician performing the interpretation, since it is an integral component of the interpretation." Similarly, obtaining an ECG as part of a cardiac stress test should not be separately reported "if procured as a routine serial ECG typically performed before, during or after a cardiac stress test."
Modifier -25
The change to the CCI that is likely to have the greatest impact involves wording in Chapter One reminiscent of the controversial policy of bundling E/M services with diagnostic tests. The policy was first introduced in CCM 6.3 (October 2000) and suspended several months later, following outcries from the American College of Cardiology and others that the more than 56,000 edits that this policy generated [...]