Cardiology Coding Alert

Warning: You could land in hot water for automatically separating edit

The latest round of National Correct Coding Initiative (NCCI) edits, version 12.3, promises a much harder time when you bill for two basic venous catheterization codes. You may be able to use a modifier, but you've got to be prepared to justify it with documentation.

Secure These Venous Sampling Edits

As of Oct. 1, 75893 (Venous sampling through catheter, with or without angiography [e.g., for parathyroid hormone, renin], radiological supervision and interpretation) becomes a component of:

• catheterization codes 36010-36015, 36120-36247 and 37200-37215

• aortography/angiography codes 75600-75756 

• transcatheter procedures codes 75894-75995

• IV infusion codes 90760 and 90765

• cardiovascular procedure codes 92975-92997

• cardiac catheterization codes 93503-93561

• chemotherapy administration 96409-96425.

Because the descriptor for 75893 includes angiography, bundling it with many of these other codes makes sense, says consultant Donna Richmond, CPC, RCC, a consultant with CodeRyte in Bethesda, Md. "It would not be appropriate to code catheterization or angiogram with 75893 unless the angiogram was being done in a different location," she says.

Notice: These edits don't differentiate venous from arterial procedures. "I don't see the logic behind bundling these procedures," says Linda Cunningham, CMC, coder at Texas Cardiology Associates of Houston in Kingwood, Texas.

Cardiologists perform pulmonary venous studies to observe the return of blood to the pulmonary artery, especially to see if there are blood clots or venous incompetencies that inhibit this process. In contrast, arterial studies assess blood flow through the arteries and determine if there is narrowing or occlusions that restrict blood flow to vital organs, Cunningham says.

Example: A patient's presenting symptoms include leg pain and swelling, which means the cardiologist wants to perform diagnostic tests in both vascular territories. Your cardiologist performs 75893 and 36215 (Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family). Because 75893 takes place in the venous system and 36215 is in the arterial system, you can separate this edit with modifier 59 (Distinct procedural service).

Don't miss: Venography codes 75810-75891 become components of 75893. Think of it this way: You can consider 75893's code definition as saying "with or without venography" rather than "with or without angiography."

Heads up: You can use a modifier (such as 59) to override any of these edits if you can justify the need for separate venous catheterization. Make sure your documentation shows how these procedures were separate and distinct from one another.

More Venous Catheterization Edits

Like 75893, 36500 (Venous catheterization for selective organ blood sampling) is now a component of 146 codes, including many of the same catheterization, angiography, transcatheter therapy, cardiovascular procedures and chemotherapy codes as 75893. Some of these are:

• 36140 -- Introduction of needle or intracatheter; extremity artery

• 36200 -- Introduction of catheter, aorta

• 36215 -- Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family

• 36216 -- ... initial second order thoracic or brachiocephalic branch, within a vascular family

• 36217 -- ... initial third order or more selective thoracic or brachiocephalic branch, within a vascular family

• 36245 -- Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family

• 36246 -- ... initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family

• 36247 -- ... initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family.

Notice: These edits mix venous and arterial procedures.

"Upon review of documentation, I would append modifier 59 to 36500," Cunningham says.

Watch out: "It's inappropriate to automatically append modifier 59 without proper review of the documentation and understanding the context of the modifier in any given code pair," Cunningham says.

Also, like 75893, code 36500 becomes a component of venography codes 75810-75891.

These edits, too, will yield before the appropriate modifierDon't Overlook These Final Edits

Don't Overlook These Final Edits

NCCI 12.3 cleans house, experts say, and one of the previous rounds of edits failed to include a new edit bundling 75962 (Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation) into 37215 (Transcather placement of intravascular stent[s] ...). This shouldn't be a huge surprise because this edit merely confirms CPT instructions. Because this edit carries a modifier indicator of "1," you can separate this edit with a modifier when appropriate.

Also, you should be wary of reporting emergency department visit codes 99281-99285 alongside critical care code 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes). The ED visit is now a component to the comprehensive critical care service, and you can't separate this with a modifier -- no matter what, thanks to a modifier indicator of "0."

Also, a new set of 36 mutually exclusive edits guarantees that you won't be able to bill any of the new nursing facility E/M codes on the same day as any other code from that series. All of the codes from 99304-99316 will become mutually exclusive with most of the other codes from the Inpatient Nursing Facility Care section, which CPT introduced in 2006. Also, every code from 99305 and higher is mutually exclusive with every lower code.

Learn the change: Previously, the inpatient nursing facility E/M codes were components of each other, not mutually exclusive, and you could use a modifier to override those edits. But these new edits have a "0" in the modifier column, meaning you can't append a modifier and overcome them.