NCCI 12.0 Update:
4 Ways to Avoid Denials--Check Out These EP, Endovascular Repair Code Edits
Published on Sun Jan 01, 2006
Watch out for edits with modifier indicators of '0'--you can't separate them
You'll have to modify the way you've been reporting electrophysiology (EP) procedures, intravascular stents and 3-D imaging codes thanks to a slew of edits included in the National Correct Coding Initiative (NCCI), version 12.0. Be Cautious When Reporting 93501 With EP Codes NCCI 12.0, effective Jan. 1 through March 31, bundles the right heart catheterization code (93501) into many intracardiac electrophysiological procedure/study codes (93600-93603, 93610-93612, 93615-93619, 93624-93652).
All of these edits have a modifier indicator of "1," meaning you can add a modifier to separate them (such as 59, Distinct procedural service) if your cardiologist performs the services during separate sessions or on separate sites.
"This makes sense because the cardiologist needs to place multiple electrode-tipped catheters into the area to perform an electrophysiological procedure," says Sandy Fuller, CPC, compliance officer at Cardiovascular Associates of East Texas in Tyler. Follow CPT Advice for New Endovascular Repair Codes The CPT manual provides great guidance in the new section for "Endovascular Repair of Descending Thoracic Aorta" about which codes 33880-33891 do and don't include, so any NCCI edits that re-emphasize this guidance aren't a huge surprise, says Rhena Burge, a cath lab coding and billing analyst at North Oaks Medical Center in Hammond, La.
Example: CPT says that you cannot report 33880 (Endovascular repair of descending thoracic aorta [e.g., aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption]; involving coverage of left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension[s], if required, to level of celiac artery origin) or 33881 (... not involving coverage of left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension[s], if required, to level of celiac artery origin) along with 33886 (Placement of distal extension prosthesis[es] delayed after endovascular repair of descending thoracic aorta).
NCCI 12.0 adds this edit to reaffirm this advice. Code 33886 is now a component to both comprehensive codes 33880 and 33881. You'll see that the modifier indicator is "0," meaning that you cannot separate this edit with a modifier--even if your cardiologist performs the services on distinctly different anatomic regions or during separate sessions.
Similarly, each of these codes (33880 and 33881) now include 35452 (Transluminal balloon angioplasty, open; aortic) and 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation). These edits, however, have a modifier indicator of "1," meaning that you can separate them with a modifier--as long as you have the supporting documentation.
The same goes for the edits that make 35452 and 76942 components of the other endovascular repair codes 33883-33886. They also have a modifier indicator of "1."
Note: For more information, see "CPT 2006 Update: Start Your Year [...]
