Cardiology Coding Alert

Find out which diagnostic supervision and interpretation codes are affected

If you regularly report radiological supervision and interpretation (S&I) codes with S&I codes applicable to percutaneous interventions (such as angioplasty, atherectomy, and stents), get ready to start maneuvering edit pairs.

NCCI version 10.3 bundles a slew of radiological S&I procedures into 75960-75962, 75970, 75978, 75992 and 75994.

Because these edits will affect cardiology coders so significantly, we've created this handy chart that you can use as a reference when determining which codes your carrier will start bundling.

Remember: Column 2 represents the procedures/services that a cardiologist cannot reasonably perform in the same session as the procedure/service listed in column 1. Therefore, carriers would not recognize the column 2 service as separate and only pay the column 1 code.

Also, these edits have a Correct Coding Edit Modifier Indicator of "1," meaning "that a modifier is allowed ... to differentiate between the services provided." In most cases, modifier -59 (Distinct procedural service) is appropriate to unbundle NCCI edits and allow for separate payment.

Start Disclosing Angio as True Diagnostic
 
CMS submitted notice to the Society of Interventional Radiology (SIR) that the agency has concerns that coders report unnecessary repeat diagnostic angiography and venography when the "lesion is previously diagnosed and only the definitive procedure is performed."

Another concern CMS cited in its notice to SIR is that coders inappropriately report radiological supervision and interpretation (RS&I) services "already captured by the RS&I code for the therapeutic intervention using diagnostic angiography/venography RS&I codes."

Keep in mind, however, that "a full and complete diagnostic arteriogram/venogram commonly precedes many therapeutic arterial/venous interventions and when this occurs these services are separately reportable," according to SIR. 

In other words: "The physician needs to disclose the fact that his diagnostic angio was not a 'guiding' angio prior to the intervention but is a true diagnostic angio that determined an intervention was necessary," says Anne Karl, RHIA, CCS-P, CPC, coding and compliance specialist for St. Paul Heart Clinic in Mendota Heights, Minn.

For example, a cardiologist performs a selective bilateral renal angiogram (75724-26, Angiography, renal, bilateral, selective [including flush aortogram], radiological supervision and interpretation; professional component). The findings determine that he should proceed with an angioplasty or stent. You should append modifier -59 (Distinct procedural service) to 75724-26 because this service was separate and distinct.

In contrast, suppose the cardiologist performed that selective renal angiogram last week and the findings determine that the patient should return for a renal stenting (37205, Transcatheter placement of an intravascular stent[s], [non-coronary vessel], percutaneous; initial vessel; and 75960-26, Transcatheter introduction of intravascular stent[s], [non-coronary vessel], percutaneous and/or open, radiological supervision and interpretation, each vessel; professional component).

In this case, you should not report the guiding abdominal aortogram or selective renal angiogram a second time, unless you have documentation supporting medical necessity, Karl says.

Reimbursement Reduction Possible

Even if your practice doesn't own the equipment and your cardiologist performs the professional component only, you'll see a reduction of up to $65 per procedure - especially if you're accustomed to billing these diagnostic studies at the time of a planned intervention (unless reimbursement for surgical codes goes up proportionately). So if your cardiologist performs more than one procedure, the hit will be even harder, says Roseanne Wholey, president of Roseanne R. Wholey and Associates, a medical reimbursement consulting firm in Oakmont, Pa.

Want to know the bottom line? "You can find out what the effect will be on your bottom line by running a computer report for each of the codes involved to see how many are performed each year," Wholey says. "If you can break out the overall reimbursement by code, it will give you a good indication of how hard you'll be hit."

Do These Edits Foreshadow the Future?

These new edits may suggest more than immediate changes - but changes for the future as well. "It looks as if carriers are trying to move back to a more bundled type of interventional radiology procedure, after totally unbundling all procedures," Wholey says.

Look for two new bundled carotid stent codes that will include catheter placement, preprocedure imaging, and supervision and interpretation "as the first aberration to the usual interventional radiology coding guidelines for 2005," Wholey says.