Cardiology Coding Alert

CCI changes muddy the waters when you're reporting thoracentesis codesTEE, fluoro, and drug administration codes didn't escape the Correct Coding Initiative's notice, and you're responsible for making certain you implement these edits -- sooner rather than later. These edits, CCI version 14.1, go into effect April 1, and that's no joke.1. Sort Through These TEE EditsIf your physician performs TEEs using 93318 (Echocardiography, transesophageal [TEE] for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing [continuous] assessment of [dynamically changing] cardiac pumping function and to therapeutic measures on an immediate time basis), you'll want to pay attention to this next series of edits.Code 93318 is now a component of operative tissue ablation codes (33265-33266), closure of ventricular septal defects codes (33675-33677, 33681, 33684), pulmonary venous stenosis repair code 33726, complete repair of anomalous venous return code 33730, and repair of cor triatriatum or supravalvular mitral ring code 33732. You can apply a modifier to bypass any of these edits, but only if you have supporting documentation that shows that the multiple procedures involve a separate session or distinct service.2. Include These Thoracentesis EditsRemember: CPT 2008 coughed up a new thoracentesis code. No longer should you report 32002 (Thoracentesis with insertion of tube with or without water seal [e.g., for pneumothorax] [separate procedure]). Instead, you should use the 2008 code 32422 (Thoracentesis with insertion of tube, includes water seal [e.g., for pneumothorax], when performed [separate procedure]).Impact: The language change -- from "with or without water seal" to "includes water seal" -- makes for more accurate coding, says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.CCI 14.1 wants to hone that accurate coding. This procedure is now a component of cardiology codes 33250, 33254-33256, 33265-33266 and 33724-33726. These edits have a status indicator of "1," meaning that you could possibly apply modifier 59 (Distinct procedural service) to 32422 -- but only if you have supporting documentation.3. Focus on These Fluoroscopy ChangesYou've got new changes that affect fluoroscopy procedures.For instance, you should now consider 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) as part of the operative tissue ablation codes (33265-33266). This edit, like the rest of the imaging guidance edits, carries a status indicator of "1."Here are the other fluoro edits you should learn:4. Consider Drug Administrations Part of E/MCCI 14.1 hits drug administration codes (90760-90774) especially hard."Because you can bypass most of the edits with a modifier, these represent an administrative burden for physician coders," says Jim Collins, CPC-CARDIO, ACS-CA, CHCC, president of The Cardiology Coalition in Saratoga Springs, N.Y. In other words, if you "do [...]