Cardiology Coding Alert

Think you've got interventional coronary procedure coding beat? Think again. A dozen new National Correct Coding Initiative (NCCI) edits bundle additional vessel procedures, such as PTCAs and atherectomies, into primary coronary interventions.

But take heart: If you pay attention to these crucial new edits - which went into effect July1 - and remember your vessel-coding basics, you should receive the pay you deserve for your interventional coronary claims.  Primary Stent Placement Includes 92981 When the physician places two coronary stents in separate coronary vessels, you should bill 92980 (Transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel) for the initial stent placement and +92981 (... each additional vessel) for stent placement in the additional vessel, according to CPT instruction and established coding methodology. One of the new edits, however, bundles the additional vessel code (92981) into 92980, which means that you would not report additional vessel stent procedures with the primary code. (For a synopsis of these new interventional procedure edits, see the chart on page 59.)

The remaining 11 edits may also surprise you, coding experts say. For instance, initial stent placement (92980) now includes +92984 for additional vessel percutaneous transluminal coronary angioplasties (PTCA), as well as +92996 (... atherectomy; each additional vessel [list separately in addition to code for primary procedure]), says Christie Okoro, billing supervisor for Island Wide Medical Associates, a multi-cardiologist group in Mineola, N.Y. She adds that she learned about the edits when she reported these codes to her local Medicare carrier.

The edits include all of the PTCA and atherectomy codes (92982, 92984, 92995 and 92996) as component codes of 92981 for additional vessel coronary stent placement. For example, if the physician places a stent in the left anterior descending artery (LAD) and performs a PTCA or atherectomy in an additional vessel, which is subsequently stented, you cannot bill for the PTCA or atherectomy in that vessel.

Code 92982 for PTCAs in initial coronary vessels now includes the work of 92984 - the add-on code that CPT specifies you should report for each additional vessel PTCA. Code 92995 (Percutaneous transluminal coronary atherectomy ... with or without balloon angioplasty; single vessel) for initial vessel atherectomies now includes 92984 for additional vessel PTCAs and 92996. Code 92996 for additional vessel atherectomy now includes the work of 92982 for initial vessel PTCAs and 92984 for additional vessel PTCAs. Append Vessel Modifiers to Avoid Edit Violations
 
Although these coronary intervention edits may seem alarming, coding experts advise that the edits do not change CMS coding or payment policy. The bottom line: Don't forget vessel modifiers if you want to navigate these edits successfully.

Indeed, the key to accurately reporting multiple interventions, such as [...]