Cardiology Coding Alert

Red flag: The new fluoro codes aren't the only fluoro codes affected

If you want the full NCCI version 13.0 picture and want to know how it affects your cardiology practice, you've got to learn these radiologic edits, too.

1. Get 3D Rendering Edits Straight

You now have no possible way of reporting 76376 (3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; not requiring image postprocessing on an independent workstation) and 76377 (...  requiring image postprocessing on an independent workstation) together. NCCI 13.0 bundles 76376 into 76377 and gives this edit a "0" modifier indicator.

Another 3D rendering change is that codes 76376 and 76377 are now a part of CTA cardiac category III codes 0144T-0151T. This makes sense because these codes specifically include "image postprocessing."

Bonus: NCCI 13.0 bundles these CTA cardiac category III codes into each other with a modifier indicator of "0" to establish that you should report only one of the base codes (0145T-0151T) per procedure.

2. Don't Miss Ultrasonic Guidance Changes

You should hesitate before reporting 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) with the new codes for epicardial electrode implants (33202-33203) and operative tissue ablations (33254-33256). You can separate these edits with a modifier if you have supporting documentation, but that's a situation of last resort.

Watch for: NCCI also adds a tremendous number of edits for intraoperative ultrasound, says Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga. Code 76986 described this service in 2006, but in 2007 you should use 76998 (Ultrasonic guidance, intraoperative).

Code 76998 is now a component to many common cardiovascular procedures, including the entire Pacemaker or Pacing Cardioverter-Defibrillator section (33202-33249). Again, you can separate all of these edits with a modifier, but you must have supporting documentation.

3. New CT/MR Guidance Codes Impacted

The new computed tomography guidance codes 77012 (Computed tomography guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], radiological supervision and interpretation) and 77021 (Magnetic resonance guidance for needle placement [e.g., for biopsy, needle aspiration, injection, or placement of localization device], radiological supervision and interpretation) are now components to several common cardiology procedures.

Example: Code 77012 is now part of peripheral transluminal balloon angioplasty procedures 35470-35476. If you try to report these codes together, without a modifier and supporting documentation, your payer will only reimburse the angioplasty code.

4. Figure on These Fluoro Edits

The fluoroscopic guidance code +77001 (Fluoroscopic guidance for central venous access device placement, replacement ...) is now a component to three codes:

• 36595 -- Mechanical removal of pericatheter obstructive material (e.g., fibrin sheath) from central venous access device via separate venous access

• 36596 -- Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen

• 36597 -- Repositioning of previously placed central venous catheter under fluoroscopic guidance.

You can separate these edits with a modifier, but these edits exist because of "misuse of column 2 code (77001) with the column 1 code." "In my opinion, you're not likely to bypass these types of edits often," says Susan Vogelberger, CPC, CPC-H, CMBS, CCP, owner and president of Healthcare Consulting & Coding Education LL in Boardman, Ohio.

The next set of edits concerns the new fluoro codes 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) and 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve, or sacroiliac joint], including neurolytic agent destruction).
 
NCCI 13.0 makes 77002 a component of many cardiology procedures, including the majority of the Endovascular Repair of Abdominal Aortic Aneurysm section (34800-34834). Code 77003 is now a component of many radiological procedures, such as 75952-75953. All the edits have a modifier indicator of "1."

Rationale: "This is an example of codes whose relative value units (RVUs) already include the fluoroscopy, so you shouldn't separately report the fluoroscopy" unless you've got a good reason, Vogelberger says.

Resource: For a full list, you can access NCCI updates through the CMS Web site at www.cms.hhs.gov/NationalCorrectCodInitEd/01_overview.asp This site contains a listing of the NCCI edits by specific CPT sections and is available free for downloading.