Cardiology Coding Alert

Neglecting indicators '1' and '0' could incite denials

You know the routine: Your cardiologist performs an endovascular repair of an infrarenal aortic aneurysm and an iliac repair procedure on the same day, so you report 34803 and 34900. Not so fast. National Correct Coding Initiative edits, version 11.0, change how you will report 34803 when your cardiologist performs this service on the same day as an endovascular repair.

Look at Indicators '1' or '0' for 34803

Before reporting 34803 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated prosthesis [two docking limbs]) with another procedure, be sure to check the NCCI 11.0 edits.

Code 34803 now includes the work associated with abdominal aortic aneurysm (AAA) repair codes 34800, 34802, 34804 and 34805, iliac repair code 34900, as well as direct repair of aneurysm or excision (partial or total) and direct aneurysm repair codes 35081, 35091 and 35102. These edits have a status indicator of "0," which means you cannot separate them with a modifier.

Edits for 34803 don't end there. When you report 34803 with any of the following codes, you'll need to justify the combination with a modifier because they're marked with a status indicator of "1":

When you append modifier -59 (Distinct procedural service), you are indicating that there is documentation on file to support using it, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for the CRN Institute, an online coding certification training center. "You should always be prepared to submit additional documentation demonstrating that your procedures were separate and distinct from one another." If your documentation can't prove the separate nature of the bundled services, don't append modifier -59, she adds. 

For example, you can circumvent these edits when a cardiologist performs a diagnostic abdominal angiogram with runoff (75635) and identifies the clinical necessity to  proceed immediately with an endovascular AAA repair (34803), says Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition in Mathews, N.C.

However, you should not bypass these edits when the AAA repair is planned and the cardiologist performs the abdominal study as a routine portion of the procedure, Collins adds.

Note: You'll discover that NCCI also makes 34803 a component of open repair of infrarenal aortic aneurysm or dissection plus repair of associated arterial trauma codes 34830-34832, as well as the hotly debated "G" codes specific to renal and iliac angiography performed at the time of a heart catheterization (G0275 and G0278, respectively). These edits also carry a status indicator of "0," meaning you cannot use a modifier to separate these services.

Intravascular Stent Codes Not Immune to NCCI

NCCI also tackles intravascular carotid stent codes 37215 (Transcatheter placement of intravascular stent[s], cervical carotid artery, percutaneous; with distal embolic protection) and 37216 (... without distal embolic protection).

These edits have a status indicator of "1." So don't make reimbursement harder on yourself by reporting the following services separately without documentation justifying the use of a modifier.

"These new edits are in line with the CPT definitions of these new carotid stent codes," Collins says. "However, they contradict traditional peripheral vascular coding logic, so make sure you take note of the substantial shift in coding methodology."  

Avoid Ventriculography of the Brain

Don't be confused by the term "ventriculography." In the context presented in the CPT descriptor of 78635 (Cerebrospinal fluid flow, imaging [not including introduction of material]; ventriculography), ventriculography traces the flow of cerebrospinal fluid in the ventricles of the brain. Again, that's ventricles of the brain, not heart. Don't accidentally report this cerebrospinal fluid study when you mean to report imaging of the heart ventricles.

Your cardiologist won't likely perform the ventriculography represented by code 78635, so you don't need to report 78635. "Someone must be mistakenly reporting this code to trigger the edit," Collins says.

Just in case, NCCI 11.0 makes this test a component code to various other radiology and catheterization codes and cites the reason as "misuse of Column 2 code with Column 1 code." These edits have a status indicator of "0," which means you cannot report these services separately.



Correction:

On page 11 of the February 2005 Cardiology Coding Alert, in the story titled "Get Ready to Change Your Repair and Stent Coding," there is a misprint.
 
Jim Collins, CPC, ACS-CA, CHHC, CEO of Cardiology Coalition in Matthews, N.C., is quoted as saying that you can use 75635 (Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, radiological supervision and interpretation, without contrast material[s], followed by contrast material[s] and further sections, including image post-processing) to report abdominal angiogram with runoff. This code is, rather, specific to a CT study with and without contrast. Collins actually said that you should use 75630 (Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation).