Cardiology Coding Alert

Correct Coding Initiative (CCI) version 14.0 showers you in new edits, but we've broken down the principles behind the new edits. Master these essentials to help avoid the hassle of edit-related denials.

Bundles often back up instructions in the CPT manual not to report two codes together. "You'll find instances where CCI and CPT instructions directly conflict each other," says Christina Neighbors, MA, CPC, ASC-CA, charge capture reconciliation specialist and coder at St. Joseph Heart & Vascular Center in Tacoma, Wash. "But on the whole, CCI mimics CPT instructions."

Case in point: CCI 14.0 creates several new edits that match new instructions in the CPT manual. For instance, 3D rendering codes 76376 and 76377 are now a part of cardiac MRI codes 75557, 75559, 75561 and 75563, supporting the CPT instruction under these codes, "Do not report 75557-75564 with 76376, 76377."

Also, you should pay attention to code combinations that include the interpretation of cardiac output measurement codes (93561, 93562). They're part of combined right heart catheterization and retrograde left heart catheterization codes 93531-93533. In addition, 93561 is part of heart catheterization code 93530 (Right heart catheterization, for congenital cardiac anomalies). Code 93562 is now part of Swan-Ganz code 93503 and the codes for injection procedure during cardiac cath (93539-93540). You cannot use a modifier to separate these procedures, except for the Swan-Ganz code case.

These edits echo the guidelines in the "Cardiac Catheterization" instructions of CPT (i.e., those introductory notes in the first paragraph of the CPT instructions preceding CPT code 93501).

CCI edits usually have a series of codes they habitually bundle, says Melissa Bedford, CPC, coding specialist II in Austin Heart PA in Austin, Texas.

For instance, you know to expect a long list of codes bundling fluoroscopy and other guidance codes into new surgery codes, and CCI 14.0 doesn't disappoint.

Check out this nonexhaustive list of examples:

32550 (Insertion of indwelling 76000 (Fluoro) tunneled pleural cath with cuff) 34806 (transcatheter sensor placement, with RS&I) 75561, 75563 (Cardiac magnetic resonance imaging) 34806 76001 (fluoro)

You can use a modifier to separate most of these edits.

Second, you should remain wary of needle or intracatheter introduction code 36000 (Introduction of needle or intracatheter, vein). CCI 14.0 bundles 36000 into 78 other codes, including cardiac MRI codes (75561-75563), new operative ablation codes (33257-33259), and catheterization codes (32550-32551).

Finally, you should also be cautious about reporting collection of venous blood (36415), collection of blood specimen (36591), and respiratory flow volume loop (94375) services with critical care code 99291 and subsequent care codes 99296-99300.

When you're learning new CCI edits, you should take into account category III codes.

For instance, CPT brought you three new category III codes for EKGs with 64 or more leads this year. Although you'll still use 93000-93010 for a routine EKG with at least 12 leads, you'll report 0178T-0180T for an EKG with 64 or more leads.

Breakdown: New code 0178T covers an EKG with graphics and analysis, and interpretation and report. You'll use 0179T for tracing and graphics only, and 0180T for interpretation and report only.

Like regular EKG codes, you've got to size up the edits for this service as well. CCI bundles 0178T, 0179T and 0180T into several established CPT codes: 93278 (SAECG), 93600 (bundle of His recording), 93602 (intra-atrial recording), 93603 (RV recording), 93610, 93612, 93615, 93616, 93618, 93619, 93620, 93624, 93631, 93640, 93641, 93642, 93650, 93651, 93660; and all the device interrogation codes: 93724-93744 (with the exception of codes 93733, 93736, and 93740), 93745, 93798, 94621, 95805, 95806, 95807, 95808, 95810, 95811. CCI also bundles 0179T and 0180T into 0178T.