Cardiology Coding Alert

NCCI 11.0 deletes 2 mutually exclusive edits that have burdened your practice The latest version of the National Correct Coding Initiative edits (NCCI, version 11.0) changes the way you should report diagnostic electrophysiology (EP) studies performed on the same days as an electrophysiologic test of an internal defibrillator test, a change that will benefit your practice. Here's the rundown on how this mutually exclusive edit deletion will shape your claims. 

Mutually exclusive edits pair procedures or services that the physician could not reasonably perform at the same session on the same beneficiary, says Kelly Dennis, CPC, EFPM, owner of the consulting firm Perfect Office Solutions in Leesburg, Fla. Celebrate the 93620 Deletion
 
You may have been subject to reimbursement woes when you tried to report 93620 (Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording) alongside the following codes:

 93641 - Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator
 93642 - Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters). A previous version of NCCI paired 93620 and these two codes together, but thankfully, NCCI has withdrawn this decision.

"The most difficult edit we had was 93620 and 93641," says Anne Karl, RHIA, CCS-P, CPC, a coding and compliance specialist at St. Paul Heart Clinic in Mendota Heights, Minn. "Now that NCCI is deleting it, we are jumping up and down!"
 
Implement This NCCI Correction A related batch of seven additions and seven deletions involve five common EP studies - and these changes will be extremely beneficial to your practice. 

To appreciate the benefit of these changes, you should first understand how Medicare carriers handle NCCI edit violations. When a mutually exclusive edit combination is violated, carriers are supposed to pay for the code listed in the first column and deny the code listed in the second column.

The seven edits NCCI deleted had a higher-paying service listed in column two than in column one. That means that before Jan. 1, 2005, if you violated the edit, carriers would reimburse the lesser paying of the two codes, even though your cardiologist performed both services.

Consider the first edit of the table below. The old edit paired 93620, a procedure generating 17.15 RVUs in the facility setting, with the work represented by [...]