Pulmonology Coding Alert

NCCI bundles heparin into a number of stress tests Although your pulmonologist may use heparin sodium (J1644) to prevent blood clots during stress testing, don't expect Medicare to pay for the drug in 2004. The National Correct Coding Initiative (NCCI) edits, version 10.0, which took effect on Jan. 1, bundle J1644 with various stress test codes.
 
NCCI bundled J1644 (Injection, heparin sodium, per 1,000 units) with the following codes:

   94620 - Pulmonary stress testing; simple (e.g., prolonged exercise test for bronchospasm with pre- and post-spirometry)
   94680 - Oxygen uptake, expired gas analysis; rest and exercise, direct, simple
   94681 - ... including CO2 output, percentage oxygen extracted
   94690 - ... rest, indirect (separate procedure)
   94770 - Carbon dioxide, expired gas determination by infrared analyzer. These bundles will affect your practice only if the pulmonologist performs the stress test and administers heparin in the office. If the physician provides these services in a facility, the facility will bill for the heparin (J1644) and the procedure's technical component (94620-TC).
 
Your doctor will bill for the procedure's professional component by appending modifier -26 (Professional component) to the appropriate stress test code (94620-26), says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.
 
You may report a stress test code (94620-94770) in addition to J1644 if the medical documentation shows that the physician provided the heparin for reasons separate from the drug's use during the stress test.
 
Also, you would need to attach modifier -59 (Distinct procedural service) to J1644, which lets the insurer know that the drug's use is unrelated to the original stress test.