Cardiology Coding Alert

If your heart skipped a beat when you saw that January's Correct Coding Initiative (CCI) edits bundled catheter ablations with electrophysiology (EP) studies, you weren't alone.

Good news: CMS has decided to delete the edits retroactively because their addition was a mistake, according to the Heart Rhythm Society (HRS) (www.hrsonline.org/Policy/CodingReimbursement/coding/1-10_ncci_edits_update.cfm).

Snag: The deletion won't happen until April 1. Here's what you need to know.

Get a Grip on the New EP Edits

CCI version 16.0, effective Jan. 1, added edits preventing you from receiving payment for recording, pacing, and EP studies performed on the same date of service as an intracardiac catheter ablation procedure. The edits have a modifier indicator of "0" -- meaning you cannot override the edits.

The edits are as follows (see chart on page 3 for code definitions):

93650: CCI version 16.0 bundles the following into atrioventricular (AV) ablation code 93650:

• Recording: 93602, 93603

• Pacing: 93610, 93612, 93618, 93623

• EP study: 93619, 93620-93622.

Fortunately, AV node ablations (93650) often are "elective, scheduled procedures that would not be accompanied by any of the codes impacted by these faulty edits," says Jim Collins, CCC, CPC, certified cardiology coder and president of CardiologyCoder.Com Inc. in Saratoga Springs, N.Y.

93651: You'll find the following bundled into supraventricular tachycardia (SVT) ablation code 93651:

• Pacing: 93610, 93612.

This faulty edit may cause the most trouble. "Some of the non-comprehensive EP studies performed by electrophysiologists will involve atrial (93610) or ventricular (93612) pacing. The [April] elimination of the edits bundling these codes into the SVT ablation code (93651) will help with these specific cases," Collins says.

93652: Ventricular tachycardia (VT) ablation code 93652 lands the column 1 spot for the following bundled column 2 codes:

• Bundle of His: 93600

• Recording: 93602, 93603

• Pacing: 93610, 93612, 93618.

Electrophysiologists tend to report VT ablation (93652) the least of all the ablation codes, Collins says. So you may not run up against this edit too often.

According to HRS, CMS has acknowledged that adding these edits was a mistake. In fact, CMS had decided against adding them to version 15.3 after receiving comments such as the following in a letter from HRS president Richard L. Page, MD, FHRS:

• The ablation procedure fees do not include the considerable work involved in EP studies, so edits would lead to severe underpayment.

• The edits contradict CPT guidelines which state, "Ablation procedures (93651-93652) may be performed: independently on a date subsequent to a diagnostic electrophysiologic study and mapping; or, at the time a diagnostic electrophysiologic study, tachycardia(s) induction and mapping is performed. When an electrophysiologic study, mapping, and ablation are performed on the same date, each procedure should be separately reported."

• The edits also go against the CPT rule that "Electrophysiology study (ies), mapping and ablation represents distinctly different procedures, requiring individual reporting whether performed on the same or subsequent dates."

Resource: You can read the letter here: www.hrsonline.org/Policy/CodingReimbursement/coding/upload/ncci_comments_june18-09.pdf.

Protect yourself: The CPT guidelines indicate that you may code diagnostic EP studies on the same date as ablation. If the cardiologist had diagnosed the problem on a previous date and uses the EP study simply for localization during ablation, reporting the study would be inappropriate.

CMS suggests that you delay submission of your claims that include the bundled code pairs until after the April 1 (version 16.1) edits introduce the retroactive deletion, HRS advises.

"For something like this, it is easy enough to stop the billing," says Jennifer Crowell, CPC, CCC, CEMC, lead hospital coordinator for Spokane Cardiology in Washington. For example, sending an e-mail to all of your practice's coders to hold affected claims may be sufficient.

In contrast, if office visits were affected by faulty edits, you might have to pull in the IT team or run daily queries to catch the claims, she says. The real trouble with the CCI error could be "how it affects our quarterly reimbursement," Crowell says.

"Having to hold EP claims could be painful" when you add it to the other recent Medicare fee cuts, she says.

Alternative: If you submit the claims now, you may resubmit claims for denied services after the retroactive deletion goes into effect. Collins recommends coding and billing claims accurately regardless of the CCI edits.

"Most, but not all, CCI edits bundle the less expensive procedure into the more expensive procedure. If you hold the claims for three months, you have $0 in the bank," Collins says. But if you submit the claims, and Medicare denies "one or two of the less expensive procedures, you will have the majority of the revenue earned in the bank," he says. You'll also have a list of denied sub-component codes that you must rebill after CCI deletes the edits, he adds.

Money talks: For example, Medicare's national rate for SVT ablation (93651) is roughly $886, while the fee  schedule values bundled pacing code 93610 at roughly $164. If your practice performs and reports both for the same date prior to April 1, you at least would receive the payment for 93651 now. You can then resubmit for 93610 payment when CCI deletes the edits.

Resource: You can download the latest CCI edits from www.cms.hhs.gov/NationalCorrectCodInitEd/.