Cardiology Coding Alert

You could feel a pinch in your peripheral vascular (PV) reimbursement if your payer follows Medicare's bundling policy that prevents you from coding more than one PV intervention in one vessel when the initial intervention failed.

Many societies, including the American College of Cardiology, protest this change because it won't allow you to report the procedure with the highest relative value units (RVUs) -- just the "successful" intervention. Some had hoped the Correct Coding Initiative (CCI) version 14.1 would have changed this guideline or at least applied edits consistent with the guideline, but that wish went unanswered.

"The most interesting thing about [the latest version of CCI] is what's not included," says Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga. CCI still hasn't created edits to enforce controversial language added to the CCI manual last October.

In chapter 5 of the 13.3 manual, page v-11, you'll find the following language, says Stacie Buck, RHIA, CCS-P, LHRM, RCC, vice president of Southeast Radiology Management, in a recent Coding Institute audioconference, "2008 Radiology Coding Update."

Medicare says: If an atherectomy fails to adequately improve blood flow and the cardiologist follows it with an angioplasty at the same site/vessel during the same patient encounter, you should only report the successful angioplasty.

Similarly, if an angioplasty fails to adequately improve blood flow and the cardiologist follows it with an atherectomy at the same site/vessel at the same patient encounter, you should only report the successful atherectomy.

If atherectomy and/or angioplasty fail to adequately improve blood flow and the cardiologist follows it with a stenting procedure at the same site/vessel during the same patient encounter, you should only report the successful stenting procedure.

These principles apply to percutaneous or open procedures.

Example: Your cardiologist's documentation shows that a patient underwent unsuccessful angioplasty (35474, Transluminal balloon angioplasty, percutaneous; femoral-popliteal; and 75962-26, Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation; professional component) and successful stenting (37205, Transcatheter placement of an intravascular stent[s] [except coronary, carotid and vertebral vessel], percutaneous; initial vessel; and 75960-26, Transcatheter introduction of intravascular stent[s] [except coronary, carotid and vertebral vessel], percutaneous and/or open, radiological supervision and interpretation, each vessel; professional component). The total procedure reimbursement is about $700.

According to this 13.3 guideline, you should report only one intervention per vessel. In this case, you should report the successful stent procedure, 37205 and 75960-26, which returns about $475. But you can't report the unsuccessful angioplasty (35474 and 75962-26). That's a loss of about $225.

Although not coding failed interventions is a big change, the rule is similar to those for surgery and cardiac interventions, Buck says.

"To enforce this rule, though, Medicare and payers following Medicare's lead would have to go through every procedure note to determine which intervention actually opened the vessel," says Nikki M. Vendegna, CPC, a cardiology coding consultant in Overland Park, Kan., who spoke at the Coding Institute's 2008 Cardiology Coding, Billing and Reimbursement Conference in Denver.

This CCI rule conflicts with what many specialty societies and the AMA recommend, says Stacy Gregory, RCC, CPC, of Tacoma, Wash.-based Gregory Medical Consulting Services. But when you're reporting to payers that follow CCI guidelines, she suggests following this new rule.

Check this policy: You can find the CCI Policy Manual at www.cms.hhs.gov/NationalCorrectCodInitEd/.

Future: Watch Cardiology Coding Alert for updates on whether the CCI manual revises this rule. To buy CDs of the recent Cardiology Coding, Billing and Reimbursement conference, go to http://www.codingconferences.com.