Cardiology Coding Alert

You know you shouldn't report nonselective catheterization in addition to selective catheterization during peripheral vascular procedures, but now NCCI is making it official.
 
The latest National Correct Coding Initiative (NCCI) edits, which went into effect Oct. 1, bundle certain nonselective codes into selective cath procedures.
 
Specifically, the edits designate nonselective cath code 36200 (Introduction of catheter, aorta) as a component of selective cath codes 36215-36217. So, you shouldn't bill 36200 with 36215-36217 for selective catheterization of first-, second-, and third- order thoracic or brachiocephalic branch arteries.
 
The edits also indicate that you should not report 36140 (Introduction of needle or intracatheter; extremity artery) with 36245 (Selective catheter placement, arterial system; each first-order abdominal, pelvic, or lower-extremity artery branch ...) when the cardiologist performs selective catheterization procedures below waist level. NCCI bundled 36140 into 36215-36217 prior to version 9.3, so this edit further limits your reporting of nonselective extremity-artery cath insertions with selective extremity-artery placements, coding experts say.
 
Although the edits bundle 36200 into 36215-36217, and bundle 36140 into 36245, the status indicator for both edits is "1," which means you can append a modifier, such as modifier -59 (Distinct procedural service), to the nonselective and selective cath codes to override the edit, if appropriate.
 
For example, a cardiologist may perform a nonselective study such as abdominal aortography through the right femoral artery, and an unrelated selective study such as a carotid angiogram, through another puncture site, such as the brachial artery, says Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.
 
In this situation, you would report 36200-59 separately for the nonselective study through the femoral artery puncture site and 36215 for the selective placement in the carotid artery through the brachial insertion site. Coronary Interventions Include Selective Caths Intervention codes for coronary stents, angioplasties and atherectomies now include even more selective cath procedures.
 
In general, these new edits bundle a collection of 10 cath placement codes (36120, 36140, 36160, 36200, 36215, 36216, 36217, 36245, 36246 and 36247) into each of the base intervention codes (92980, 92982 and 92995), says Jim Collins, CHCC, CPC, a cardiology coding consultant and president of Compliant MD Inc.
 
Specifically, selective catheter placement codes 36215-36217 and 36245-36247 are now components of 92980 (Transcatheter placement of an intracoronary stent[s]), 92982 (Percutaneous transluminal coronary balloon angioplasty; single vessel) and 92995 (Percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty; single vessel).
 
The edits also bundle 36160 (Introduction of needle or intracatheter, aortic, translumbar) into 92980, 92982 and 92995. Codes 92982 and 92995 include 36120 (Introduction of needle or intracatheter; retrograde brachial artery). And 36140 (... extremity artery) is a component of 92995 alone.
 
All of these edits have a "1" status [...]