Cardiology Coding Alert

 Pay attention to which codes have ‘bundled’ status. 

The Correct Coding Initiative (CCI) policy manual offers you some insights into Medicare’s coding rules for percutaneous coronary intervention (PCI). But one major issue isn’t obvious in the CCI manual -- the bundled status of the "additional branch" add-on codes.

The intent of the new PCI codes is to provide a "base" code for the primary coronary vessel service and then provide add-on codes to allow you to report up to two interventions in branches of the major coronary vessel.

However, Medicare does not plan on reimbursing you separately for those branch add-on codes. The 2013 Medicare Physician Fee Schedule (MPFS; final rule with comment period) makes that clear. As explained in Cardiology Coding Alert, vol. 16, no. 1, Medicare is giving the following codes status B, which means payment is bundled into any other services performed that day: +92921 (angioplasty), +92925 (atherectomy), +92929 (stent), +92934 (atherectomy and stent), +92938 (revascularization of or through graft), +92944 (revascularization of chronic total occlusion).

In other words, Medicare "chose to bundle the branch vessel services into the major vessel codes," said Kenneth P. Brin, MD, PhD, FACC, of the American College of Cardiology and CPT^® Editorial Panel Vice Chair, in the CPT^® and RBRVS 2013 Annual Symposium presentation, "Medicine: Cardiology Procedures/Services." CMS factored the possibility of additional branch services into the RVU calculations for the primary artery codes.

Still, many experts are advising practices to report the add-on codes in case the add-on code status changes. And keep in mind that private payer rules may vary.

Review the MPFS discussion of the new PCI codes beginning on PDF page 173 of the Nov. 16, 2012, Federal Register: www.gpo.gov/fdsys/pkg/FR-2012-11-16/pdf/2012-26900.pdf.