Cardiology Coding Alert

Make a note of the one cardiology-related deletion

If you're still uncertain what a mutually exclusive edit is and whether you're using the latest NCCI version in your cardiology practice, you could be setting yourself up for possible future reimbursement hassles.
 
Get a handle on the NCCI ins and outs by reading these six questions and the answers that our experts provided.

Question 1: What Are NCCI Edits?

National Correct Coding Initiative (NCCI) edits are pairs of CPT or HCPCS Level II codes that Medicare (and many private payers) will not reimburse separately except under certain circumstances. Medicare applies the edits to services billed by the same provider for the same beneficiary on the same service date, says Kelly Dennis, MBA, CPC, ACS-AP, owner of the consulting firm Perfect Office Solutions in Leesburg, Fla.
  
Example: The most recent edition of NCCI (version 12.2), effective July 1, bundles 75960 (Transcatheter introduction of intravascular stent[s] [except coronary, carotid, and vertebral vessel], percutaneous and/or open, radiological supervision and interpretation, each vessel) into 75894 (Transcatheter therapy, embolization, any method, radiological supervision and interpretation). This means that your cardiologist may not be able to collect if he bills both 75960 and 75894 for the same patient on the same day.

Question 2: What Does 'Mutually Exclusive' Mean?

NCCI contains two types of edits: mutually exclusive and comprehensive/component edits.
  
Mutually exclusive edits pair procedures or services that the physician would not reasonably perform at the same session, at the same anatomic location on the same beneficiary, Dennis says.
 
Example: Prior to July 1, you were not able to report critical care codes 99291-99292 when your cardiologist provided this service on the same that he reported 99239 (Hospital discharge day management; more than 30 minutes), thanks to a mutually exclusive edit.
 
If you were to report two mutually exclusive codes for the same patient during the same session, often the pairings are such that payers would pay for the procedure in the left-hand column (in this case 99239) and deny the payment for the service in the right-hand column (codes 99291 and 99292). Due to these problematic edits, payers would reimburse the less expensive service because they include all E/M services provided on the day of discharge in the discharge day management codes. 
 
Update: NCCI 12.2 now deletes this mutually exclusive edit, so as of July 1, you no longer have to worry about reporting 99291-99292 and 99239 on the same day.

Question 3: Do 'Column 1/Column 2' Edits Differ?

Comprehensive/component edits describe bundled procedures/services. That is, CMS considers the code listed in column 2 as the lesser service, which is included as a component of the more extensive column 1 service.
  
Example: NCCI 12.2 bundles 93040 (Rhythm ECG, one to three leads; with interpretation and report) into 93735 (Electronic analysis of single chamber pacemaker system [includes evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response]; with reprogramming).
 
In this case, 93735 is the column 1 code -- the more extensive procedure -- and 93040 is the column 2 code -- the lesser procedure. If a provider performs an analysis of a pacemaker on the same day as the patient undergoes an ECG, you should only report the pacemaker analysis.
 
If you were to report bundled (column 1/column 2) procedures/services for the same patient during the same session, Medicare would reimburse only the column 1 code, which is typically the higher valued of the two procedures (in this case, 93735). 
 
Note: If the cardiologist evaluates an abnormal sensation when the patient's heart pounds and discovers that the patient's pacemaker needs interrogation, you can separate this edit with a modifier. See Question 4 to learn how.

Question 4: Can I Ever Override NCCI Edits?

Yes, in certain circumstances you may override NCCI edits and achieve separate reimbursement for bundled codes.
  
Step 1: Check the correct coding modifier indicator. Each NCCI code-pair edit includes a correct coding modifier indicator of 0 or 1.
 
 A "0" indicator means that you may not unbundle the edit combination under any circumstances, according to NCCI guidelines.
 
For example, two new NCCI 12.2 edits have a modifier indicator of 0:

 • the edit that bundles 93741 (Electronic analysis of pacing cardioverter-defibrillator [includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response]; single chamber or wearable cardioverter-defibrillator system, without reprogramming) into 93742 (... single chamber or wearable cardioverter-defibrillator system, with reprogramming)
 • the edit that bundles 93743 (... dual chamber, without reprogramming) into 93744 (... dual chamber, with reprogramming).

In other words, Medicare and other payers that follow NCCI edits will always deny 93741 when you bill it with 93742. The same goes for when you bill 93743 with 93744.
 
An indicator of 1, however, means that you may use a modifier to override the edit if the procedures are distinct from one another (for instance, if they occur in separate anatomic locations or during different sessions).
  
Example: The new NCCI 12.2 edit that combines 75960 into 78594 has a 1 modifier indicator. To override this edit, your cardiologist must have documentation to show how both of these procedures were significantly different from each other if the cardiologist performs them on the same patient during the same day.
 
For instance, if the doctor is embolizing one artery and stenting another, he could secure reimbursement for both services by attaching modifier 59 (Distinct procedural service) to 75960. This is because the above- referenced NCCI edit has an indicator of 1, which means you can bypass it with an appropriate modifier.  
 
Step 2: Append the modifier to the correct code. You can append modifier 59 to the column 2 code to indicate to the payer that the billed procedures are distinct and separately identifiable, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.
 
Example: You can also separate the edit that bundles the ECG code 93040 into single-chamber pacemaker check 93735. So if your cardiologist performs a single- chamber pacemaker check and then the patient returns later with palpitations that warrant an ECG, you should append modifier 59 to 93040. The reason is that 93040 represents the column 2 or the lesser-procedure code. 

Question 5: How Often Are the NCCI Edits Updated?

CMS updates NCCI every quarter, and you should always consult the most recent version when coding.
  
The number of changes each quarter varies, but almost every update contains significant changes. "You'll always want to be sure to be using the latest edition of NCCI," Cobuzzi says. "If you're one or two versions behind, you could be coding incorrectly and not even know it."

Question 6: How Can I Find the NCCI Edits?

You can stay up-to-date on NCCI changes in two ways:
  
1. You can access NCCI updates through the CMS Web site www.cms.hhs.gov/physicians/cciedits/default.asp. The site contains a listing of the NCCI edits by specific CPT sections, and is available free for downloading.
  
2. You may purchase a quarterly or yearly subscription to the NCCI from the National Technical Information Service (NTIS) Web site: www.ntis.gov/products/families/cci.