Cardiology Coding Alert

The Correct Coding Initiative's (CCI) new edits version 8.2 bring relatively minor changes for cardiology coding, affecting T-wave alternans, catheterization, electrophysiology and tilt table billing.

Version 8.2 is effective from July 1 until Sept. 30. For example, CCI has bundled the rhythm electrocardiogram (ECG) codes 93040-93042 (Rhythm ECG, one to three leads ) into 93025 (Microvolt T-wave alternans for assessment of ventricular arrhythmias). The microvolt T-wave alternans test examines the standard ECG for alterations in the T-wave amplitude that are not apparent to the naked eye. The T-wave represents the period when the lower heart chambers are relaxing and preparing for their next muscle contraction. "The CCI is just following suit; as with all other cardiography tests, the ECG is included in the main procedure the microvolt T-wave alternans test and cannot be billed separately," says Nikki Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan. Additionally, version 8.2 has included extremity artery needle or intracatheter introduction (36140) into combined right and left catheterization (93526, 93528, 93529, 93532 and 93533). Similarly, intracardiac electrophysiologic three-dimensional mapping (+93613) now includes catheter introduction (36000, 36010 and 36410), intravenous infusion (90780 and 90784) and intraventricular and/or intra-atrial tachycardial site mapping (+93609). This may be important to electrophysiologists because some perform regular mapping to determine the point to point of the tachycardia that needs to be treated before doing the three-dimensional mapping. "As with other catheter-based procedures, the introduction and manipulation of the catheter are included in the primary CPT code and should not be reported separately," Vendegna says.

Finally, 93660 (Evaluation of cardiovascular function with tilt table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention) now includes 12-lead electrocardiography (93000-93010). Cardiologists often use the tilt table to determine if a patient suffers from an abnormal neural reflex that causes them to faint when they become excited or nervous. ACC Files Appeal In response to CCI version 8.2, the American College of Cardiology (ACC) submitted a formal letter of appeal to CMS. In April, the organization expressed disagreement with the proposed edits listed above, but CMS decided to implement the new edits despite ACC's objection. In the appeal letter, ACC argued that ECGs are not a component of microvolt T-wave alternans and electro-physiology studies, and physicians should be allowed to bill for them on the same date without using a modifier. The results of the appeal had not been announced as of press time for this publication. To obtain additional information about the CCI edits, you can purchase a quarterly subscription from the National Technical Information Service at its Web site: www.ntis.gov. Or you can call 1-800-363-2068.