Take These 2 Other NCCI 13.1 Cardio Edits to Heart
Published on Fri Apr 13, 2007
Pinpoint your modifier indicator for CCTA edits You've got more than angiography edits to implement as of April 1. You should also examine the way you report Category III codes 0144T-0150T as well as abdominal aortic aneurysm (AAA) code G0389. But watch out--you can't always separate these edits with a modifier. 1. Secure CCTA Payments If your cardiologist performs cardiovascular CT angiographies (CCTAs), you should take several edits into account.
National Correct Coding Initiative version 13.1 bundles the following procedures into the Category III codes for CCTA (0144T-0150T):
• Anesthesia (01916, 01922)
• EKG (93000, 93005, 93010) • Rhythm strip (93040, 93041, 93042).
Watch for: You can't override the anesthesia edit with a modifier because this edit has a modifier status "0."
Also, you'll find that NCCI bundles venous catheterization (36000) and venipuncture (36410) into the codes for CCTA with contrast (0145T-0150T).
Rationale: CCTA includes cardiac gating, so you should not be charging separately for an EKG or rhythm strip. In this situation, the modifier indicator is "1," meaning that you can use a modifier to override this edit.
For example, if a patent presents with symptoms that trigger a diagnostic EKG and those findings trigger a CCTA study on the same day, you can add modifier 59 (Distinct procedural service) to the EKG code, says Jim Collins, CPC, ACS-CA, CHCC, president of The Cardiology Coalition in Matthews, N.C. Don't forget to include supporting documentation to show that these were separate, distinct procedures. 2. Activate Aortic Aneurysm Edits NCCI 13.1 bundles the new HCPCS code for screening for abdominal aortic aneurysm (G0389, Ultrasound, B-scan and/or real time with image documentation; for abdominal aortic aneurysm [AAA] screening [one time for men 65 years of age or older]) into the following procedures:
• Abdominal duplex exam (93975, 93976) • Duplex of aorta (93978, 93979) • Retroperitoneal ultrasound (76770, 76775). Tip: The edit bundling G0389 and 76775 (limited retroperitoneal ultrasound) is mutually exclusive, but the edit combining G0389 and 76770 (complete retroperitoneal ultrasound) is nonmutually exclusive. Remember: Mutually exclusive edits pair procedures or services that the physician would not reasonably perform at the same session, at the same anatomic location, or on the same beneficiary
Rationale: AAA screening (G0389) is a limited retroperitoneal ultrasound exam reported with its own G code to show that you performed it for screening purposes.
Don't miss: You should now include intraoperative ultrasound (76998) in AAA screening (G0389).
NCCI also bundles the following procedures into placement of a wireless physiologic sensor during endovascular aortic aneurysm repair (0153T):
• Ultrasound (76942, 76998) • Fluoroscopy (76000, 76001, 77002). Tip: This edit reflects the fact that 0153T includes radiological supervision and interpretation.
