Cardiology Coding Alert
Go With the Flow by Sticking to 4,000 Infusion G Code Edits
Tread carefully when reporting infusion G codes, because the National Correct Coding Initiative, version 11.2, has dropped thousands of new bundles on your doorstep - and you should have already implemented them.
Translation: Expect denials for claims submitted on or after July 1 that indicate separate drug administration pay when performed with a slew of cardiology procedures.
For example, if a cardiologist injects dye into a vein to light the way for a pacemaker replacement (33207, Insertion or replacement of pacemaker with transvenous electrode[s]; ventricular), you shouldn't report the IV and injection because these are incidental parts of the procedure, says Nancy Reading, RN, BS, CEO of Cedar Edge Medical Coding and Reimbursement in Centerfield, Utah. In other words: You shouldn't report G0351 (Therapeutic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) in addition to 33207.
For this reason, NCCI has made injection code G0351 a component of 4,531 codes, and made intravenous push codes G0353-G0354 components of 4,833 codes.
Payers consider injection to be an inherent part of most procedures, says Dawn Hopkins, senior manager for reimbursement with the Society for Interventional Radiology. Either CMS is seeing "widespread abuse" of the new injection G codes by physicians trying to bill for them with many procedures, or this is a precaution. CMS may simply be trying to block all of the code combinations that haven't been commonly used so far, because they assume nobody ever bills them together, she says. NCCI gave these edits a modifier indicator of "1," so if the situation warrants it, you may be able to use a modifier to override those edits.
What this means for you: Don't expect payment for the G codes along with the CPT procedure codes such as those for the insertion of a pacemaker (33200-33208). Each of these has a modifier indicator of "1," meaning that if your documentation supports it, you may override these edits.
Don't miss: Code G0363 (Irrigation of implanted venous access device for drug delivery systems [do not report G0363 if an injection or infusion is provided on the same day]) is now a component of 87 evaluation and management and worker's compensation codes, from 99201 to 99456. You won't be able to use a modifier to override those edits, because NCCI gave these a modifier indicator of "0."
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