Radiology Coding Alert

Confused about moderate sedation? CCI Edits offers some answers

Along with a much-anticipated change of language that prevented billing multiple interventions, Correct Coding Initiative (CCI) has a few new edits you need to know. We've analyzed the changes that affect you most.

1. Play It Safe With Stents

CCI 14.3 adds one edit for stents, bundling 36245 (Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family) into 37215 (Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; with distal embolic protection).

But that's not the big news for stents, as last month's issue revealed. Version 13.3 introduced a rule that when a physician performed multiple interventions (angioplasty, atherectomy, stenting) in the same vessel, you should report only the successful one. Niles Rosen, MD, Correct Coding Initiative (CCI) medical director, announced in an Aug. 6 letter to the Society of Interventional Radiology (SIR) and the AMA, that CCI will temporarily reinstate old language in the next release (version 14.3, published on Oct. 1, 2008). It will state: "When percutaneous angioplasty of a vascular lesion is followed at the same session by a percutaneous or open atherectomy, generally due to insufficient improvement in vascular flow with angioplasty alone, only the most comprehensive atherectomy that was performed (generally the open procedure) is reported (see sequential procedure policy, Chapter I, Section M)."

Note: The change is retroactive to October 2007.

Problem: The CMS policy is vague, failing to explain what to do for an angioplasty and stent placement of the same lesion. But you still have standards to follow. Be sure the medical record establishes that angioplasty was the physician's primary intent. Remember: According to SIR, an angioplasty isn't a viable primary intervention for treating ostial renal lesions. So the radiologist should document that a suboptimal result led to the decision to treat the lesion with a stent. The reality is these restrictions keep you from coding multiple interventions many times.

2. CPT and CCI Agree on 99148, 99149

The latest CCI version bundles moderate sedation codes 99148-99149, (Moderate sedation services [other than those services described by codes 00100-01999], provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports ...) into many interventional procedures, including:

• 35470-35476, percutaneous transluminal balloon angioplasty

• 36560-36568, 36570-36571, central venous access device insertion

• 37184-37188, percutaneous transluminal mechanical thrombectomy

• 37210, uterine fibroid embolization.

This edit falls in line with CPT's indication that these codes include moderate sedation, so you should not report it separately.

Remember: When a code includes conscious sedation, CPT lists the code with a bull's-eye symbol and includes the code in Appendix G, says Kelly Dennis, MBA, CPC, ACS-AP, of Perfect Office Solutions in Leesburg, Fla.

3. Face the Follow-Up CT Facts

The latest CCI edits also clarify that you shouldn't report 76380 (Computed tomography, limited or localized follow-up study) with CT guidance codes 77011-77014. For example, if the radiologist provides CT guidance for placing radiation therapy fields (77014, Computed tomography guidance for placement of radiation therapy fields) and then performs a follow-up CT (76380), you should report only 77014.