Cardiology Coding Alert

A previous version of NCCI paired 93620 and these two codes together, but thankfully, NCCI has withdrawn this decision.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 93624 (Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or attempted induction of arrhythmia), a procedure generating 7.3 RVUs in the facility setting. Now those RVUs are reversed. Credit for this NCCI edit correction goes to the Heart Rhythm Society, whose advocacy efforts made the change possible.  

All of the newly added edits have an indicator of "0" except pairs 93640/93642 and 93641/93642. 

Note: In general, you should not report 93641 and 93642 for a single surgical session because NCCI considers these services mutually exclusive when performed at the same encounter. However, when appropriately performed together, you are allowed to use modifier -59 (Distinct procedural service), according to the Heart Rhythm Society's "Coding Guide for Heart Rhythm Procedures and Services, 2005."

Join 93741 and 93742 in a CRM Edit
 
In another important edit, NCCI 11.0 joins two defibrillator interrogation codes (93741 and 93742) with 93745, a new code in CPT 2005 that represents wearable cardioverter-defibrillator set-up services. 

This edit carries a modifier indicator of "1," which "facilitates separate billing of these services in those instances where a patient has a WCD set up at one point in the day and needs to have it interrogated later in the day, perhaps due to defibrillation," says Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition in Matthews, N.C.  

You may also bypass this edit and separately report these codes if "a cardiologist interrogates and turns off an implanted, single-chamber defibrillator, then prescribes and sets up a WCD applied as a bridge until the old generator can be explanted and a new one implanted," Collins says.

Don't Forget Doppler, Hospital Discharge Edits

NCCI makes 93888 (Transcranial Doppler study of the intracranial arteries; limited study) a component to the three new codes that describe variations of transcranial Doppler study: 93890-93893.

Transcranial Doppler studies produce a sonographic scan of carotid arteries that physicians can use to predict strokes and diagnose other problems related to artery stenosis or vasospasm, says Gregory L. Barkley, MD, clinical vice chair of the department of neurology at the Henry Ford Hospital in Detroit.

Also, if you report 99238 (Hospital discharge day management; 30 minutes or less), don't try to report subsequent hospital care codes 99231-99233. The edit involving this combination of codes cannot be bypassed with a modifier. This edit is logical, Collins says: "The hospital discharge code is defined as management for the day, so this would include any subsequent hospital care services provided by the discharging doctor on the same day. Doctors, however, need to make note of the total time spent caring for the patient on the date of discharge if they want to obtain proper reimbursement."