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Avoid G0275 and G0278 Selective Studies

Published on Sat Apr 23, 2005

Revert back to the 2004 rules

If you've been wondering how to interpret the 2005 HCPCS definitions for G0275 and G0278 without the term "nonselective," here's your answer - thanks to The Cardiology Coalition, a membership open to cardiology practices dedicated to cardiologist reimbursement advocacy and proficiency.

In 2005, HCPCS removed the "nonselective" verbiage from the descriptors of two codes:

  • G0275 - Renal angiography, nonselective, one or both kidneys, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of any catheter in the abdominal aorta at or near the origins (ostia) of the renal arteries, injection of dye, flush aortogram, production of permanent images, and radiologic supervision and interpretation (list separately in addition to primary procedure)

  • G0278 - Iliac and/or femoral artery angiography, nonselective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation (list separately in addition to primary procedures).

    The removal of the word "nonselective" suggested that these codes were not specific to nonselective studies of the renal and iliac arteries at the time of a heart catheterization.

    "You could infer that the 2005 definitions apply to both selective and nonselective studies. Depending on your interpretation, you would effect a substantial financial impact on billing," says Jim Collins, CPC, ACS-CA, CHHC, CEO of Cardiology Coalition in Matthews, N.C.

    "That made the usage really confusing, not to mention the impact to the physician's bottom line," agrees Deborah Ovall, CMA, CCS, CIC, lead coder and data quality analyst with Medical College Hospitals of Ohio at Toledo. "The appearance was that you would have to use these codes for all nonselective and selective renal and iliofemoral angiograms, and that meant not getting paid for a selective procedure, which was unprecedented."

    "These two codes have been a 'thorn in the side' for almost all cardiology practices, especially since CMS cannot seem to make up their minds as to how they want us to use them," says Donna McDonald, follow-up specialist in the central billing office of Ohio Heart and Vascular Center Inc. in Cincinnati.

    The Cardiology Coalition has been in discussions with CMS for the past few months to clarify the selective versus nonselective nature of codes G0275 and G0278. Share in this welcome news: 

  • CMS is reviewing the definitions of G0275 and G0278 with a better understanding of common clinical practice. "Before our discussions, the CMS representatives with whom we were working did not understand that cardiologists are especially well-suited to perform peripheral vascular procedures because of their experience and precision utilizing catheters in the coronary arteries," Collins says.
     
  • The Cardiology Coalition proposed to CMS that codes G0275 and G0278 remain "nonselective" in nature.
     
  • Until a final decision is made regarding the definition of these codes, CMS has said that you can report selective renal and iliac studies with the selective codes from CPT as opposed to the HCPCS codes G0275 and G0278. CMS informally indicated that this will be the final resolution of this concern, and a CMS publication is anticipated soon.

    "The clarification that the Coalition obtained resets everything back the way it was in 2004 and allows us once again to code, and get paid for, the more work-intensive selective procedures," Ovall says.

    "It is good to know that there are professionals out there trying to get some type of resolution from CMS," McDonald says.

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