NCCI 13.1 Update:
Guard Against Denials by Implementing These Angioplasty Edits Now
Published on Fri Apr 13, 2007
Find out how edits affect HCPCS codes G0392 and G0393 Angioplasty codes didn't escape the National Correct Coding Initiative's notice, and you're responsible for making certain you implement these edits--sooner rather than later. These edits, NCCI version 13.1, went into effect April 1, and that's no joke.
Good news: Unless indicated otherwise, these edits have a "1" modifier status indicator, which means you may override them with a modifier when appropriate. In other words, you would append a modifier, such as 59 (Distinct procedural service), to the lesser-valued procedure code to indicate to the payer that the billed procedures are distinct and separately identifiable, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, director of outreach programs at the American Academy of Professional Coders. Update Your PTA, Ultrasound Coding Practices First, you already know that you should hesitate before trying to report 76998 (Ultrasonic guidance, intraoperative) with the entire Pacemaker or Pacing Cardioverter-Defibrillator section (33202-33249)--but now you'll have to hesitate before you report this code with percutaneous transluminal angioplasties (PTAs) as well.
For instance, when you report arterial (35475, Transluminal balloon angioplasty, percutaneous; brachiocephalic trunk and branches, each vessel) and/or venous (35476, ... venous) PTAs, you won't also report intraoperative ultrasound code 76998. NCCI bundles this code into 35475-35476.
Along the same lines, thanks to NCCI, 76998 is now part of endovenous ablation of incompetent veins (36475, Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated; and 36478, Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated).
Rationale: Endovenous ablation includes "all imaging guidance" by CPT definition.
NCCI also bundled 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) into 36860 (External cannula declotting [separate procedure]; without balloon catheter) and 36861 (... with balloon catheter).
As stated before, you can separate all these edits with a modifier, such as 59. Be sure your physician provides documentation demonstrating that the lesser-valued procedure represents a different session, different procedure or surgery, a different anatomical site or organ system, separate incision or excision, separate lesion, or separate injury (or area of injury in extensive injuries). Read Up on These Other 2 PTA Edits Ultrasounds aren't the only procedures PTAs will now absorb under NCCI 13.1.
For instance, PTA codes 35475 and 35476 will now include the work represented by 35236 (Repair blood vessel with vein graft; upper extremity). In the past, only some carriers were reimbursing this code combination. Now you will not be able to report the vein graft code (35236) separately unless you've got a modifier and [...]
