Cardiology Coding Alert

Are your peripheral vascular (PV) coding methods out of date? Changes are coming down fast, and if you're still reporting nonselective catheter placement codes 36140 and 36200 with certain selective catheter placement codes, you'll experience denials. Here's how to avoid reimbursement losses. Look to CPT Guidelines CPT specifies under "Vascular Injection Procedures" that "selective vascular catheterization should be coded to include introduction and all lesser order selective catheterization used in the approach." This is a basic peripheral vascular coding convention, but many coders don't follow it and continue to report nonselective studies along with selective studies, coding experts say. Examine Your Bilateral Studies Coding Here's an illustration: Often, during PV studies, the cardiologist will image vessels with the catheter in both selective and nonselective positions. One common scenario is when the cardiologist performs a bilateral lower-extremity study from a femoral puncture site with the catheter tip positioned in each of the lower extremities.
 
Until now, you may have reported the nonselective catheter placement on the ipsilateral side (the punctured side) with 36140 (Introduction of needle or intracatheter; extremity artery), along with the appropriate selective catheter placement code (36245-36247) for the cath placement on the contralateral side (the extremity artery opposite the access point).
 
This coding approach had widespread acceptance, says Deb Ovall, CMA, CCS, CIC, lead coder and data quality analyst with Medical College Hospitals of Ohio at Toledo. Ovall, who trained two years ago on PV billing, says, "At that time, they stressed that it was OK to report the ipsilateral cath placement this way, and that 36140 ... should be used to indicate that the nonselective vessel was selected." But "the logic actually feels a little weak now," she says. Review NCCI 9.3 PV Changes By now, you know that the National Correct Coding Initiative (NCCI) edits, version 9.3, effective Oct. 1, 2003, bundled certain nonselective catheterization codes into selective catheterization codes, which changes the way you report these nonselective catheterizations performed with selective cath services, coding experts say. (See "Get the Lowdown on New Coronary Intervention, Pacer Bundles" in the November 2003 Cardiology Coding Alert for more on NCCI, version 9.3.)
  
Specifically, the 9.3 edits bundle 36140 into 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) into 36215 (Selective catheter placement, arterial system; each first-order thoracic or brachiocephalic branch), 36216 (... initial second-order thoracic or brachiocephalic branch), and 36217 (... initial third-order or more selective thoracic or brachiocephalic branch). These bundles close the gaps in NCCI that would permit billing nonselective catheterization codes with selective catheterization codes without a modifier, coding experts say.
 
Certain associations are challenging the edits. "We [...]