Cardiology Coding Alert

Prepare to change how you report blood imaging, MPI codes

When your cardiologist studies or scans a patient's heart, you'd better know how to report these codes in conjunction with other procedures. The National Correct Coding Initiative (NCCI) version 12.1 lays out dozens of new edits, and it's your responsibility to know whether you can use a modifier. 76350 Now Among NME Edits NCCI removed any temptation you might feel to report 76350 (Subtraction in conjunction with contrast studies) with about 150 other codes, including cardiac MRI codes 75552-75555, aortography codes 75600-75790 and venography codes 75801-75891.

NCCI categorizes these edits as nonmutually exclusive (NME) and gives them a modifier indicator of "0," meaning that you may not use a modifier to break the edit and if you report a bundled pair together, payers won't reimburse 76350. 

These edits make sense, because you shouldn't be billing 76350 any longer, says Donna Richmond, CPC, RCC, a consultant with CodeRyte in Bethesda, Md.

Why? "Subtraction is a technique for removing images of bone and soft tissue so that all that remains in the picture is the vasculature," says Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc. in Powder Springs, Ga. Subtraction used to be a labor-intensive manual process, which is why CPT has a separate code for it, she says. Now, software performs subtraction, so your documentation is unlikely to support reporting 76350 legitimately. 

Common mistake: Many coders erroneously report 76350 for other types of image manipulation, such as CAD with a breast MRI, Miller says. See How Your CT Coding Changes If you're wondering about the new computed tomography edits, you're not alone. CT scan codes 71250-71275 all become components of new CT angiography codes 0144T-0150T, but you can override those edits with a modifier.

Rationale: "You're not supposed to be doing a CT of the chest as well as a CTA of the chest," says Jeff Fulkerson, BA, CPC, CMC, certified coder in the radiology department at Emory Health Care in Stockbridge, Ga. "Those should be few and far between."

But 71275 (Computed tomographic angiography, chest, without contrast material[s], followed by contrast material[s] and further sections, including image postprocessing) does reflect CTA of the chest (lungs, aorta, etc.)  In some cases, your cardiologist may have medical necessity to perform this study in addition to the new coronary CTA services (0144T-0150T). For this reason, these edits have a modifier indicator status of "1," meaning you can override the edit with a modifier (such as 59, Distinct procedural service). Treat TEE as a Component to Cardio Surgery Codes Transesophageal echocardiography code 93318 (Echocardiography, transesophageal [TEE] for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing [continuous] assessment of [dynamically changing] [...]