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Cardiology Coding Alert

NCCI 10.0:

Get the Scoop on AAA Prosthesis Bundles

Published on Tue Jan 27, 2004

After the monumental changes to nonselective and selective catheterization coding in the last round of NCCI edits (version 9.3), you may welcome the relatively minor modifications in the latest version (10.0), which went into effect Jan. 1.
 
Here are the cardio-relevant changes that could affect your billing:
 
Ambulatory blood pressure monitoring package changes: You won't be able to report full-service ambulatory blood pressure monitoring with lesser ambulatory monitoring services, thanks to version 10.0 edits. Code 93784 (Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report) now includes 93786 (...recording only) and 93790 (...physician review with interpretation and report). These edits have a "0" indicator, which means you can't override the edit with an NCCI-approved modifier.
 
Venography is now part of LV lead repositioning: When the physician repositions the left ventricular lead during biventricular pacing procedures, you should not report sinus venography (75860) separately. The edits bundle 75860 into 33226 (Repositioning of previously implanted cardiac venous system [left ventricular] electrode [including removal, insertion and/or replacement generator]) and list a "0" indicator, so you can't unbundle the edit. This edit comes as no surprise because the AMA says that venography is part of the initial LV lead placement, and the new edit carries this logic through, one coding expert says.
 
Heparin injections in with nuclear studies, echoes: Heparin (J1642), an anti-coagulant, is now bundled with a raft of nuclear imaging codes (78414, 78428, 78460, 78461, 78465, 78466, 78468, 78469, 78472, 78473, 78481, 78483 and 78494) and two echo codes (93312 and 93314). But these edits have a "1" indicator, which means that you can append a modifier when applicable, such as modifier -59 (Distinct procedural service), to bypass the edits, says Cynthia Swanson, RN, CPC, a cardiology coding specialist with Seim, Johnson, Sestak and Quist LLP in Omaha, Neb.
  
New endovascular prosthesis code includes direct repairs, supplemental work: The new abdominal aortic aneurysm prosthesis code (34805) triggers a number of surgical procedure bundles: prosthesis codes 34800 and 34900; direct aneurysm repair codes 35081, 35091 and 35102; and a range of supplementary procedure codes, such as catheterization codes 35472-35474. Most of these edits have a "1" indicator, but not all, so check with your payer before reporting 34805 with other related procedure codes, Swanson says.
  
Central line placement gets attention: If your practice bills central line placement procedures, you'll want to check NCCI 10.0 before billing claims with multiple procedures on the same day. The edits include a long list of bundles.
 
Note: To view the NCCI edits free online, go to www.cms.hhs.gov/physicians/cciedits/default.asp. The same Web page also includes links to documents that explain the edits, including the NCCI Policy Manual for Part B Medicare Carriers, the Medicare Carriers Manual, and an NCCI Question-and-Answer page.

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