Cardiology Coding Alert

Plus: Take this pulmonary angiography challenge.

You may find answers to your coding questions in an often overlooked place: the NCCI Policy Manual for Medicare Services. This manual for Medicare's National Correct Coding Initiative (NCCI or CCI) includes information on both general CCI concepts and explanations of code-specific edits.

Try your hand at two questions that are addressed by the manual, and then learn exactly where to look in the Jan. 1, 2012, version to support your coding choices.

1. Confirm Coding for X-Ray With Swan-Ganz

Question: The cardiologist inserts a Swan-Ganz catheter for hemodynamic monitoring purposes (not in conjunction with other catheterization services). He then reviews a chest X-ray to confirm proper positioning. You should report this as:

A. 93503 (Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes).

B. 93503, 71010 (Radiologic examination, chest; single view, frontal).

C. 93503, 71010-26 (Professional component).

D. 93503, 71010-26-59 (Distinct procedural service).

Answer: A. The CCI manual addresses this issue in Chapter 11, Section I.24, says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner of Precision Auditing and Coding.

Insertion of Swan-Ganz and other flow-directed catheters "is often followed by a chest radiologic examination to confirm proper positioning of the flow directed catheter. A chest radiologic examination CPT® code (e.g., 71010, 71020 [Radiologic examination, chest, 2 views, frontal and lateral]) should not be reported separately for this radiologic examination," the manual states.

Did you know? The manual offers even more information on proper use of 93503: "If a physician does not complete the insertion of one type of catheter and subsequently inserts another at the same patient encounter, only the completed procedure may be reported," according to the CCI manual. In Chapter 11, Section I.23, the manual states, "CPT® code 93503 (insertion and placement of flow directed catheter (e.g., Swan Ganz)) should not be reported with CPT® codes 36555-36556 (insertion of non-tunneled centrally inserted central venous catheter) or CPT® codes 36568-36569 (insertion of peripherally inserted central venous catheter) for the insertion of a single catheter."

2. Pulmonary Angiography Has MUE Clue

Question: During a cardiac catheterization, the cardiologist performs angiography of the pulmonary artery and multiple pulmonary branches. For the pulmonary angiography, you should report:

A. 1 unit per vessel imaged of +93568 (Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for pulmonary angiography [List separately in addition to code for primary procedure]). For example, you could report +93568 x3.

B. multiple line items of +93568 with modifier 59 (Distinct procedural service) on the second and subsequent codes.

C. multiple line items of +93568 with modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) on the second and subsequent codes.

D. 1 unit total of +93568.

Answer: D. CCI addresses this issue in Chapter 11, Section V.9, says Stumpf. You should report +93568 only once. CCI enforces this by giving +93568 a frequency edit, called a medically unlikely edit (MUE), of 1.

As the manual explains it, "The MUE value for CPT® code 93568 (injection procedure during cardiac catheterization; for pulmonary angiography) is one (1). The code descriptor indicates that the angiography includes all pulmonary vessels and their branches. The code should not be reported with separate units of service for different parts of the pulmonary vasculature."

Don't forget: Code +93568 is an add-on code, so you must report it in conjunction with a code for the primary service. For this code, you'll choose among cardiac catheterization and coronary angiography primary codes 93530-93533 and 93451-93461.

Resources: The NCCI Policy Manual for Medicare Services is available in the Downloads section at www.cms.gov/NationalCorrectCodInitEd/. At that same site, you'll find a link to Medically Unlikely Edits in the menu on the left side of the page.