Medicare Compliance & Reimbursement
Find Out How Angioplasty Edits Affect HCPCS Codes G0392-3
Angioplasty codes didn't escape the National Correct Coding Initiative's (NCCI) notice, and you're responsible for making certain you implement these edits. In particular, one of the biggest sets of percutaneous transluminal angioplasty (PTA) edits affects angioplasty HCPCS codes G0392 and G0393.
Because these codes are new, you probably won't find the amount of edits applied to them surprising--but you do want to make sure you're up to speed on how to get the most out of your claims.
Codes in question: G0392 (Transluminal balloon angioplasty, percutaneous; for maintenance of hemodialysis access, arteriovenous fistula or graft; arterial) and G0393 (... venous).
What's changed: NCCI now bundles PTA of a dialysis fistula (G0392-G0393) into the corresponding regular PTA code (35475-35476), says Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, GA. You may use a modifier to override the edits when your physician performs PTA in a dialysis fistula and in a separate vessel on the same day, she adds.
Keep in mind: "According to the Society of Interventional Radiology (SIR) guidelines, you should include PTA of the outflow vein in the dialysis fistula PTA," Miller says.
The lowdown: NCCI 13.1 bundles the following procedures into arterial (G0392) and/or venous (G0393) PTA of a dialysis fistula, Miller says:
• Anesthesia (01924, 01930) (Note: This edit has a "0" modifier indicator, so you can't override the edit with a modifier.)
• Venous catheterization (36000, 36005)
• Thrombin injection for pseudoaneurysm (36002)
• Venipuncture (36410)
• Mechanical thrombectomy (37184) (Note: Use 36870 when your physician performs mechanical thrombectomy in a dialysis fistula, Miller says.)
• Transcatheter non-thrombolytic infusion (37202)
• Continuous epidural injection (62318, 62319)
• Brachial plexus injection (64415, 64416)
• Axillary nerve injection (64417)
• Other peripheral nerve injection (64450)
• Facet joint injection (64470, 64475)
• Ultrasound guidance (76942, 76998)
• Fluoroscopic guidance (77002)
• Injections and intravenous infusions (90760, 90765, 90772, 90774, 90775)
• Moderate sedation by the same physician (99143-99144) (Note: This edit has a "0" modifier indicator, meaning you can't override the edit with a modifier.)
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Find Out How Angioplasty Edits Affect HCPCS Codes G0392-3
Make sure you're getting the most out of your claims.
Angioplasty codes didn't escape the National [...]
