Cardiology Coding Alert

Mutually exclusive pairs mean you'll receive payment for lesser-valued codes

If you are not appending modifier 59 when reporting 93975-93979 (Duplex scan) along with IVC filter placement supervision and interpretation code 75940, you need a coding makeover.

The National Correct Coding Initiative (NCCI), version 11.2, is responsible for thousands of new edits this quarter. Traverse the bundle jungle with ease by focusing your coding and compliance efforts on these five cardiology highlights. #1: Mark 0076T as Mutually Exclusive Tread carefully when reporting +0076T (Transcatheter placement of extracranial vertebral or intrathoracic carotid artery stent[s], including radiologic supervision and interpretation, percutaneous; each additional vessel [list separately in addition to code for primary procedure]) alongside the following stent placement codes:
  37205 - Transcatheter placement of an intravascular stent(s) (except coronary, carotid, and vertebral vessel), percutaneous; initial vessel
  37215 - Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; with distal embolic protection
  37216 - ... without distal embolic protection. NCCI 11.2 says these procedures are mutually exclusive. This means that you cannot report both 0076T and one of these codes on the same day and expect to receive reimbursement for both procedures. Instead, Medicare will only pay for the lesser-valued of the pair. Because the modifier indicator is a "1," however, you can override this edit using a modifier - if the procedures are distinct from one another.

Example: The four codes listed above actually reference different vessels. A common example in which you may need to separate this edit with a modifier is when the doctor places a stent in a renal artery (37205) and one in the vertebral artery (0076T). These are in separate vessels, so you can use modifier 59 (Distinct procedural service) to separate the procedures #2: Double-Check Claims With 0078T and 0080T According to NCCI 11.2, you can no longer report certain cardiology codes together because you are unlikely to perform them during the same session.

In particular, you can't report codes 0078T (Endovascular repair of AAA, pseudoaneurysm or dissection, abdominal aorta involving visceral vessels, using fenestrated modular bifurcated prosthesis) and 0080T (... radiological supervision and interpretation) with the following:   open aorto prosthetic repair (34830-34832)
  endovascular graft placement for repair of iliac artery (34900)
  direct repair of abdominal or iliac artery aneurysm (35082, 35091, 35092, 35103, 35121*, 35122, 35131, 35132).  * This code is the only edit with a modifier indicator of "1." Every other edit is listed with a "0," meaning you cannot bypass the edit under any circumstances.

Understanding the direct repair edit won't be too difficult. "You're not likely to find cardiologists completing or performing an endovascular repair at the same time of an open direct repair unless, of course, the endovascular procedure was unsuccessful. In that situation, you'd look to codes 34830-34832 instead," says [...]