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Medicare Compliance & Reimbursement

CARDIOVASCULAR SURGERY CODING:

A Modifier Won't Rescue You From Cardiovascular-Code Edits

Published on Wed Nov 28, 2007

New codes 33254-33256 could have strings attached.

Even before you break out your new cardiovascular surgery codes, you'll have to learn a whole new set of rules about what not to bill with them:

· New epicardial electrode insertion codes 33202-33203 (35-42 Component codes, 14 Comprehensive codes). Don't bill thoracentesis code 32002 or tube thoracostomy code 32020 with these codes, unless you have a modifier. You can't add transmyocardial revascularization codes 33140-33141, even with a modifier. Some other electrode insertion codes are also bundled with 33202-33203.

· New codes for ablation and reconstruction of atria 33254-33256 and 33265-33266 (31-33 Component codes). Tube thoracostomy code 32020 is bundled with these, and so are thoracoscopy codes 32601-32606, transmyocardial vascularization add-on code 33141, and some pacemaker insertion codes. Meanwhile, 33254-33256 also become components of 156 other cardiology codes, and you can't use a modifier to override those edits.

· New codes 33675-33677, for closure of multiple ventricular septal defects (32-34 Component codes). Many of the same codes are bundled with 33675-33677 as with 33202-33203, plus cardiotomy codes 33310-33315 and blood vessel repair code 35226.

· New venous anomaly repair codes 33724-33276 (27-28 Component codes). Again, many of the same codes are bundled with these as with 33675-33677, plus 33645 (Direct or patch closure, sinus venosus, with or without anomalous pulmonary venous drainage). You can use a modifier to override these edits, except for one edit bundling 33254-33326 into 33274-33276.

· New thromboendarectomy codes 35302-35305 (38 Component codes, 12 Comprehensive codes). You can't bill these codes with embolectomy/thrombectomy codes 34201-34203, femoral artery exposure code 34812, blood vessel repair code 35226 and 35286, thromboendarectomy codes 35371-35372, angioplasty codes 35456 and 35474, atherectomy code 35485, vein harvest code 35500, artery exploration codes 35721-35741 and 35860, unless you use a modifier.

· New bypass graft codes 35537-35540 (55-59 Component codes) and 35637-35638 (28-29 Component codes). You can't bill embolectomy/thrombectomy codes 34151-34201, open iliac artery exposure code 34820, bypass graft code 35646 or artery reoperation code 35700 with these codes, without a modifier. But even with a modifier, you can't ever bill arterial surgery code 34833 with the new graft codes, and you can use a modifier only to bill 34834 with 33537-35540, not with 35637-35638.

· New femoral anastomosis revision codes 35883-35884 (21 Component codes). Artery reoperation code 35700 is also bundled with these codes, and so are thrombectomy codes 35875-35876.

· New uterine fibroid embolization code 37210 (43 Component codes). Blood vessel repair codes 35226, 35256 and 35286 are components of this code, and so are transcatheter procedures codes 37202-37204, but a modifier will override those edits.

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