Cardiology Coding Alert

But keep your eyes peeled for X {EPSU} guidance coming soon.

The coding world has been buzzing with confusion about Medicare's new-for-2015 X {EPSU} modifiers, the ones designed to replace modifier 59 (Distinct procedural service) with more specific options.

Good news: You may continue to use modifier 59 in 2015, according to MLN Matters SE1503: "Please note that providers may continue to use the -59 modifier after January 1, 2015, in any instance in which it was correctly used prior to January 1, 2015. The initial CR establishing the modifiers was designed to inform system developers that healthcare systems would need to accommodate the new modifiers.

"Additional guidance and education as to the appropriate use of the new –X {EPSU} modifiers will be forthcoming as CMS continues to introduce the modifiers in a gradual and controlled fashion."

"I think the reason we haven't heard anything more out of CMS is the fact that what they thought was clear (from the original transmittal) was not clear at all to the rest of the industry," says Joan Gilhooly, MBA, CPC, CPCO, president and consultant for Medical Business Resources LLC in Lebanon, Ohio. "I suspect that they're doing some regrouping to come out with more clear guidance."

See What Novitas Has to Suggest

Once CMS provides more information about the modifiers, you will better understand their full intent and purpose. In the meantime, check to see whether your MAC has provided any helpful hints. JL MAC Novitas has offered some opinions, stating, "Until CMS provides official guidance, Novitas offers the following suggestions for the use of the -X {EPSU} modifiers, should you decide to use them." The examples are in the Feb. 3, 2015, article "Modifier 59 and New Modifiers XE, XS, XP, XU" on the MAC's "Provider Articles & Bulletins: Medicare Part B" page. Remember these are only suggestions and that you may continue to use modifier 59 until further notice.

Here are a few examples from Novitas for cardiology services:

Heart cath and distinct fluoro: Suppose you report 93453 (Combined right and left heart catheterization including intraprocedural injection[s] for left ventriculography, imaging supervision and interpretation, when performed).

In some cases, you may also need to report 76000 (Fluoroscopy [separate procedure], up to 1 hour physician or other qualified health care professional time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) for an unrelated procedure on the same date as the cardiac cath.

Novitas suggests using modifier XU (Unusual non-overlapping service) on 76000.

Note: The 93453/76000 scenario is unlikely to occur. But you can use the example to guide your coding if you need to report a more likely scenario, like the performance of 93458 (Catheter placement in coronary artery[s] for coronary angiography, including intraprocedural injection[s] for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection[s] for left ventriculography, when performed) or 93460 (Catheter placement in coronary artery[s] for coronary angiography, including intraprocedural injection[s] for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection[s] for left ventriculography, when performed).

Stress test and distinct ECG: Suppose you report 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, with interpretation and report).

In some cases, you may also need to report 93040 (Rhythm ECG, 1-3 leads; with interpretation and report) for an ECG at a separate encounter on the same date as the stress test.

Novitas suggests using XE (Separate encounter) on 93040.

Angioplasty and distinct angiography: Suppose you report 37220 (Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty).

In some cases you may also need to report 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation) for a truly diagnostic angiography on the same date as the angioplasty.

Novitas suggests using XE or XU on 75710.

Final thought: "It remains to be seen whether this added measure of transparency will actually facilitate MAC claim processing and reduce denials or requests for extra information prior to claim adjudication," says Dennis Padget, MBA, CPA, FHFMA, lead consultant at PathConsulting in Laguna Beach, Calif. "Deciding which of the alpha 'separate procedure' modifiers fits a particular situation will take a while to get used to, but we'll overcome the transition fairly quickly I hope. But I still have to wonder about the practical benefit this change will ultimately have for MACs and providers."

Resource: Review the MLN Matters article at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1503.pdf.