Cardiology Coding Alert

Experts warn that illogical reduction to this EP procedure means a loss of $171 Modifier 51 exemptions to common catheterization and electrophysiological codes mean that your bottom line could be affected -- in a big, bad way. Red flag: "You should note this in case you start receiving denials on things that were previously paid; it could be the code needs modifier 51," says Staci Dougherty, CPC, certified procedure coder at the Internal Medicine Billing ...quot; Cardiology department of VCUHS/MCVH (Virginia Commonwealth University Health Systems/Medical College of Virginia) in Richmond. Get the Basics CPT 2008 reassessed codes that AMA has previously designated as modifier 51 (Multiple procedures) exempt. "Modifier 51 exempt" means that you don't need to add this modifier to a code that CPT has not designated as an add-on procedure/service, says Diane Hoffman, CPC, coder/biller for a private practice in Madison, Wis. These are typically codes that do not involve significant pre- or postoperative work. However, the CPT 2008 revision to modifier 51 exempt status to cath and electrophysiology procedures means that you'll be applying modifier 51 more often. What happens: When you apply modifier 51 to claims specifying separate procedures on the same patient on the same session, you trigger multiple-procedure payment reductions. Your payer will reimburse the highest-ranked procedure at 100 percent and any additional procedures at 50 percent. When procedures are "modifier 51 exempt," they are not subject to this multiple-procedure payment-reduction rule. Capture These Catheterization Amendments No longer will you see the modifier 51 exempt symbol (X) beside the following cath codes in your book: 93505, 93508, 93510, 93511, 93514, 93524, 93526-93533, 93541-93543. Therefore, you will need to use modifier 51 when your cardiologist performs any of these services and suffer the multiple-procedure reduction hit. Example: The withdrawal of the modifier 51 exemption status means that 93510-26 (Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous; professional component) will now require a modifier when your cardiologist performs this service with other procedures (such as 92980, Transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel). In that case, your claim should look like this: • 92980 • 93510-26-51. What this means to you: Your payer will pay the highest-ranked procedure at 100 percent and any additional procedures at 50 percent, Hoffman says. In other words, your payer will pay the full $869 for 92980 but will reduce the fee for 93510-26-51 to only $129. This shouldn't be a terrible surprise, because CMS has reduced 93510's reimbursement by 50 percent for many years, says Jim Collins, CPC-CARDIO, ACS-CA, CHCC, president of The Cardiology Coalition in Saratoga Springs, N.Y. "Now the modifier 51 status [...]