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 supporting documentation.

Also, a venous PTA (35476) will now include the injection for venogram (36005, Injection procedure for extremity venography [including introduction of needle or intracatheter]), says Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga.

Get the Most Out of Your G0392, G0393 Claims

One of the biggest sets of PTA edits affects angioplasty HCPCS codes G0392 (Transluminal balloon angioplasty, percutaneous; for maintenance of  hemodialysis access, arteriovenous fistula or graft; arterial) and G0393 (... venous). Because these codes are new, you probably won't find the amount of edits applied to them surprising.

NCCI now bundles PTA of a dialysis fistula (G0392-G0393) into the corresponding regular PTA code (35475-35476), Miller says. You may use a modifier to override the edits when your cardiologist performs PTA in a dialysis fistula and in a separate vessel on the same day, she adds. Keep in mind: "According to the Society of Interventional Radiology (SIR) guidelines, you should include PTA of the outflow vein in the dialysis fistula PTA," Miller says.

The lowdown: NCCI 13.1 bundles the following procedures into arterial (G0392) and/or venous (G0393) PTA of a dialysis fistula, Miller says:

• Anesthesia (01924, 01930) (Note: This edit has a "0" modifier indicator, so you can't override the edit with a modifier.)

• Venous catheterization (36000, 36005)

• Thrombin injection for pseudoaneurysm (36002)

• Venipuncture (36410)

• Mechanical thrombectomy (37184) (Note: Use 36870 when your physician performs mechanical thrombectomy in a dialysis fistula, Miller says.)

• Transcatheter non-thrombolytic infusion (37202)

• Continuous epidural injection (62318, 62319)

• Brachial plexus injection (64415, 64416)

• Axillary nerve injection (64417)

• Other peripheral nerve injection (64450
• Facet joint injection (64470, 64475)

• Ultrasound guidance (76942, 76998)

• Fluoroscopic guidance (77002)

• Injections and intravenous infusions (90760, 90765, 90772, 90774, 90775)

• Moderate sedation by the same physician (99143-99144) (Note: This edit has a "0" modifier indicator, meaning you can't override the edit with a modifier.)

Prevent AVF/Non-AVF Denials  - Here's How

Keep an eye out for cases in which your provider performs an arteriovenous fistulae (AVF) angioplasty along with a separate non-AVF angioplasty, Miller says.

Example: "You can legitimately report G0393 and 35476 if the physician does PTA of the dialysis fistula and also of the brachiocephalic vein," but now you need to remember to put modifier 59 on G0393, Miller says.

Most of the other edits for the new G codes prevent you from unbundling anesthesia and contrast administration, both of which are included in the PTA, she adds.