Cardiology Coding Alert

The latest National Correct Coding Initiative (NCCI) edits version 9.1, effective in April could bring changes to the way you report myocardial perfusion (SPECT) studies, blood pool imaging (MUGA), and cardiac catheterization.

Only eight of 2,738 mutually exclusive additions (which means you cannot report the listed codes at the same session) have any effect on the cardiology coder, says Martha Gerant, CPC, professional coder and reimbursement specialist for Cardiology Services in Olathe, Kan.

Even so, the edits could be especially significant for practices that perform SPECT and MUGAscans, because the comprehensive codes for these procedures now bundle several codes for lesser studies. So you should read the documentation carefully to verify exactly what aspects of these tests the physician performed, Gerant advises.

Specifically, comprehensive SPECT code 78465 (Myocardial perfusion imaging; tomographic [SPECT], multiple studies, at rest and/or stress [exercise and/or pharmacologic] and redistribution and/or rest injection, with or without quantification) now includes 78473 (Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and stress [exercise and/or pharmacologic], with or without additional quantification) and 78483 (Cardiac blood pool imaging, [planar], first pass technique; multiple studies, at rest and with stress [exercise and/or pharmacologic], wall motion study plus ejection fraction, with or without quantification).

The reason for this bundling is that myocardial perfusion imaging, whether done by SPECT or planar, would include all the MUGAprocedures as well, Gerant says.

Both 78473 and 78483 now also include 78461 (Myocardial perfusion imaging; multiple studies [planar], at rest and/or stress [exercise and/or pharmacologic], and redistribution and/or rest injection, with or without quantification) and 78494 (Cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or without quantitative processing).

Moreover, 78494 now includes 78472 (Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress [exercise and/or pharmacologic], wall motion study plus ejection fraction, with or without additional quantitative processing) and 78481 (Cardiac blood pool imaging [planar], first pass technique; single study, at rest or with stress [exercise and/or pharmacologic], wall motion study plus ejection fraction, with or without quantification).

The edits also indicate that you should not report modifier -59 (Distinct procedural service) with any of the mutually exclusive component codes, such as 78478 and 78480, which are add-on codes for planar and SPECT studies, and 78496, which is an add-on code for blood pool imaging, Gerant says.

Several of the MUGA comprehensive codes 78472, 78473, 78481, 78483, 78494 and 78496 are non-mutually exclusive, which means you can sometimes report these together if the procedure is medically necessary, Gerant adds. Coders should pay attention to the use of modifier -59 with the non-mutually exclusive codes, she says. Modifier usage may be indicated for these codes when used for separate, distinct procedures, but check with payers before adding modifier -59, she recommends.

The cardiac catheterizations codes in the 93508-93533 range now include component extremity catheter placement codes 36140 (Introduction of needle or intracatheter; extremity artery), 36245 (Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family) and 36200 (Introduction of catheter, aorta).

For instance, 93508 now includes as its components 36245 and the following codes for radiological supervision and interpretation (S&I) for extremity artery imaging, Gerant says: 75625, 75630, 75710, 75716, 75722, 75724 and 75774. In addition, several catheterization codes in the above range also now include 36140 and 36200.

Moreover, the new G codes for renal and iliac angiography with cardiac catheterization G0275 (Renal artery angiography [unilateral or bilateral] performed at the time of cardiac catheterization, includes catheter placement, injection of dye, flush aortogram and radiologic supervision and interpretation and production of images [list separately in addition to primary procedure]) and G0278 (Iliac artery angiography performed at the same time of cardiac catheterization, includes catheter placement, injection of dye, radiologic supervision and interpretation and production of images [list separately in addition to primary procedure]) bundle catheterization codes 36140, 36200, 36245, 36246 and 36247, as well as radiologic S&I codes 75625, 75630, 75722, 75724, 76003 (Fluoroscopic guidance for needle placement) and 76942.

NCCI 9.1 bundles the component codes with the new G codes because the catheter manipulation in the extremity arteries and the S&I are part of the comprehensive procedure, Gerant says. She says you should examine the comprehensive cardiac cath codes to determine which ones are used in your practice.

As with the non-mutually exclusive MUGAscan codes, you may use some of the catheterization codes with modifier -59, so check the NCCI edits carefully for modifier use, particularly for those codes that you use frequently in your practice, Gerant says.

The edits also include deletions of the HCPCS codes for rhythm strips: G0015, G0004 and G0006. You should now report codes 93012 (Telephonic transmission of post-symptom electrocardiogram rhythm strip[s], 24-hour attended monitoring, per 30-day period of time; tracing only), 93268, 93270, 93271 and 93272, Gerant says.