Cardiology Coding Alert

Find out how cath and US changes affect your EPs

If you think you've got the whole story for this latest round of National Correct Coding Initiative updates, you'd better think again. As of April 1, you need to make sure you've got your stent, electrophysiology and moderate  sedation coding practices down pat--or you could find yourself landed with a denial. 1. Implement These Stent Changes You'll have to be cautious when reporting intravascular stent codes because NCCI version 12.1 tacks on several new edits for codes 37215 (Transcatheter placement of intravascular stent[s], cervical carotid artery, percutaneous; with distal embolic protection) and 37216 (... without distal embolic protection).

For instance, 37207 (Transcatheter placement of an intravascular stent[s] [non-coronary vessel], open; initial vessel) now includes the work represented by both 37215 and 37216. If you try to report 37207 with either of these codes, you'll only be paid for 37207.
 
If you've got supporting documentation, you can separate this edit with a modifier (such as 59, Distinct procedural service). This would be appropriate, for example, when you are billing for peripheral vascular studies/interventions in vascular families that are distinct from the vascular family in which the cardiologist is placing the carotid stent.  

Bonus: You'll also find that 37215 is now a component of 37216. In most cases, your cardiologist will use distal embolic protection (37215) alone. But when the cardiologist stents both carotid arteries, you may have a situation in which he treated one with distal embolic protection (37215) and the other without distal embolic protection (37216).

In that case, report both codes with modifier 59 attached to 37215 to bypass the NCCI edit. Remember: If your cardiologist treated both carotid arteries with the same approach, you should list the same code (either 37215 or 37216) on your claim with a unit measurement of 2.

NCCI also includes the peripheral procedures 34812, 34820, 34834, 35201, 35261, 36620, and 36625 into 37215-37216. You can also separate these codes with a modifier, should your documentation warrant the use of one. 2. Electrophysiology Not Immune to 12.1 Your electrophysiology codes did not pass unnoticed under NCCI 12.1's radar.

Cardiac catheterization codes 93508-93533 and 93541-93556 all become components of every code in the Intracardiac Electrophysiological Procedures/Studies section (93600-93662), except for add-on codes and evaluation code 93660.

Rationale: This makes sense because "most of the listed heart catheterization codes occur on the left side of the patient's heart, while the EP study codes listed take place on the right side of the patient's heart," says Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition in Matthews, N.C.

Also, a slew of edits bundle ultrasound guidance codes 76986 (Ultrasonic guidance, intraoperative) and 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, [...]