Cardiology Coding Alert

Learn what good news you can apply to your E/M coding practices The overriding trend for NCCI version 13.0 is bundling the new epicardial implant and operative tissue ablation codes into tons of cardiology procedures -- but you need to know which ones, and now. You have no grace period. Tackle These Temporary Pacemaker Edits If you use temporary pacemaker implant codes 33210 (Insertion or replacement of temporary transvenous single-chamber cardiac electrode or pacemaker catheter [separate procedure]) or 33211 (Insertion or replacement of temporary transvenous dual-chamber pacing electrodes [separate procedure]), you shouldn't miss this.
 
The National Correct Coding Initiative bundles both these codes into the new epicardial placement codes 33202 (Insertion of epicardial electrode[s]; open incision [e.g., thoracotomy, median sternotomy, subxiphoid approach]) and 33203 (... endoscopic approach [e.g., thoracoscopy, pericardioscopy]) as well as the new operative tissue ablation procedure codes (33255-33256, 33265-33266).

Heads up: You can use a modifier to separate these edits, except for the ones bundling 33210-33211 into the operative tissue ablation codes (33255-33256, 33265-33266) because these edits have a "0" modifier status.

Keep in mind: When an edit pair has a modifier indicator status of "1," this means you can separate it using a modifier (such as 59, Distinct procedural service) -- as long as you have supporting documentation. When the modifier indicator is "0," you cannot separate the edit under any circumstances.

Example: A patient presents to the emergency department with extreme symptomatic bradycardia. The cardiologist must place a temporary pacemaker until he can insert a pacemaker with epicardial leads later in the day. In this case, you should report either 33202 or 33203, depending on the cardiologist's approach, and 33210-59 for the temporary pacemaker. 

"If your documentation supports the physician doing services above and beyond, then I would use a modifier to bypass the edit and see if the claim will be paid. Appeal it if necessary," says Rebecca Lopez, CPC, certified coder for Bright Medical Associates in Whittier, Calif.

Educate Yourself on Epicardial Electrode Edit Similarly, the new epicardial code 33202 now includes the work represented by 33215 (Repositioning of previously implanted transvenous pacemaker or pacing cardioverter-defibrillator [right atrial or right ventricular] electrode).

NCCI includes the rationale for this edit as "a standard of surgical practice," meaning that when your cardiologist implants an epicardial electrode, he'll also reposition the previously implanted pacemaker. This edit has a modifier indicator of "1," however, so you can separate it with an appropriate modifier.

Example: If your cardiologist repositions one electrode intracardiac but also places another epicardially, you should report both 33202 and 33215-59, says Jim Collins, CPC, ACS-CA, CHCC, president of The Cardiology Coalition in Matthews, N.C.

Watch out: If you don't have the documentation to demonstrate that these two procedures involved different placement methods, [...]