Cardiology Coding Alert

Get ready for some administrative burden, thanks to a curious edit

If you've got a handle on what it takes to report modifier 59 correctly, you're likely to breeze by the latest batch of National Correct Coding Initiative (NCCI) edits, effective Oct. 1--but here's what you should know, just in case you're staring at a denial and wondering why.

Thank Your Lucky Modifier Indicator

When you get ready to report angioplasty code 35458 (Transluminal balloon angioplasty, open; brachiocephalic trunk or branches, each vessel) or 35475 (Transluminal balloon angioplasty, percutaneous; brachiocephalic trunk or branches, each vessel), you'll need to have a bit of extra documentation ready.

The reason is that NCCI bundles both of these codes into catheter placement codes 37215 (Transcatheter placement of intravascular stent[s], cervical carotid artery, percutaneous; with distal embolic protection) and 37216 (... without distal embolic protection).

Red flag: These edits seem to be set up wrong. You would expect NCCI to bundle the catheter placement codes into the angioplasty codes. Also, NCCI goes against specific instructions in your CPT book. When you're reporting 35475, CPT instructs you also to report "codes for catheter placement and the radiologic supervision and interpretation" in addition to "code(s) for the therapeutic aspect of the procedure."

The reason you report the catheter placement code separately is that "the relative value units for [these procedures] do not include the work of getting the catheter into the blood vessel," says Jackie Miller, RHIA, CPC, senior consultant at Coding Strategies Inc. in Dallas, Ga.

Regardless, you have a modifier indicator of "1," meaning that you can use a modifier, such as 59 (Distinct procedural service), to bypass the edit. Modifier 59 will tell the payer that the procedures were not components of one another but were both medically necessary and separate from one another, says Heather Corcoran, coding manager at CGH Billing Services in Louisville, Ky. Remember: You'll have to supply documentation to prove these procedures were separate and distinct to use this modifier.

Adapt to Your New EKG Edits

Your echocardiographic codes (93303-93318) now encompass more than meets the eye--including the introduction-of-needle code 36000 (Introduction of needle or intracatheter, vein) and venipuncture code 36410 (Venipuncture, age 3 years or older ... ), thanks to a slew of EKG-specific edits from NCCI 11.3.

These new bundles may not be surprising, but sure to create a buzz of confusion are the following two edits:

• Code 93005 (Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report) now includes the work represented by 93010 (... interpretation and report only).

• Code 93042 (Rhythm ECG, one to three leads; interpretation and report only) now includes the work represented by 93041 (... tracing only without interpretation and report).

Did you catch that? One of these edits bundles the "tracing only" service into the "interpretation only" service, while the other one approaches the same service in the opposite direction.

A way to bypass: "A facility could bill the tracing only (93005) and have the professional read done by another facility, which would report the interpretation only (93010)," says Anne Karl, RHIA, CCS-P, CPC, codingand compliance specialist at St. Paul Heart Clinic in Mendota Heights, Minn. Just remember to include modifier 59 and provide documentation showing how these two procedures were separate and distinct.

No Way to Code IM Injections Separate for Nurses

If your nurse does intramuscular (IM) and arterial injections for your cardiology practice, you'll no longer be able to report the nurse visit separately.

"We sometimes report IM and arterial injections with a nurse visit if the nurses provided a significant, separately identifiable E/M service in addition to the injection," Miller says.

That's changed: In one of the few edits with a modifier indicator of "0," you'll have to include the work involved with 99211 (Office or other outpatient visit for the E/M of an established patient ...) into the arterial injection (90783, Therapeutic, prophylactic or diagnostic injection [specify material injected]; intra-arterial) or into the IM injection (90788, Intramuscular injection of antibiotic [specify]). There's no way to report a modifier to get around this edit.

Note: Want to know more about how NCCI 11.3 will impact your cardiology practice? E-mail the editor at suzannel@eliresearch.com for a free PDF chart.