Radiology Coding Alert

Good news: If you've been coding correctly, the latest Correct Coding Initiative (CCI) edits shouldn't change the way you code interventional radiology (IR) services. But they will help you fight the urge if you're tempted to report cardiac catheterization alongside an angiogram.

The rules: You should apply CCI version 13.3 to services performed on or after Oct. 1. Payers that follow Medicare's CCI conventions won't pay you for a service CCI designates as a component of another service in its non-mutually exclusive edits, which are also called column 1-column 2, or comprehensive-component, edits.

CCI 13.3 clearly indicates that you shouldn't have cardiac cath injection codes on the same claim as certain IR services:

• Internal mammary angiography: CCI now bundles internal mammary artery injection during heart catheterization (93539, Injection procedure during cardiac catheterization; for selective opacification of arterial conduits [e.g., internal mammary], whether native or used for bypass) into mammary arteriogram (75756, Angiography, internal mammary, radiological supervision and interpretation), says radiology coding expert Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc. in Powder Springs, Ga.

• Pulmonary angiography: Code 93541 (Injection procedure during cardiac catheterization; for pulmonary angiography) is now a component of pulmonary angiography codes 75741, 75743 and 75746, Miller says.

• Aortography: CCI makes aortic root injection during heart catheterization (93544, Injection procedure during cardiac catheterization; for aortography) a component of thoracic aortogram (75600-75605), abdominal aortogram (75625-75630) and aortic CTA (75635), Miller says.

Tip: Depending on the services your radiologists perform, you may rarely encounter something such as a run-off case (75635), says Rhonda G. Townley, CPC, with Association of University Radiologists, a 16-physician academic radiology practice in Knoxville, Tenn.

So use CCI edits to help keep yourself on the coding straight and narrow when you can't fall back on the rules that are second nature to you for more typical cases.

In addition to bundling heart cath codes into many 75xxx codes, CCI 13.3 also makes some 75xxx codes components of heart catheterization, Miller says.

Example: Thoracic aortogram (75600-75605), pulmonary angiogram (75741, 75743, 75746) and mammary arteriogram (75756) are now components of heart catheterization codes 93501, 93508 and 93510.

Bottom line: Cardiologists typically perform cardiac catheterization, so none of these edits should affect your daily coding if you report only interventional radiology services, Miller says.

You can save time by using the chart to the right to see which 75xxx codes CCI 13.3 bundles with heart catheterization codes effective Oct. 1.

Remember: A "0" modifier indicator means that you cannot use a modifier to break the edit. When an edited pair has a "1" modifier indicator status, you can override the edit using a modifier (such as 59, Distinct procedural service)--- as long as you have supporting documentation.

Modifier 59 tells the payer that the procedures were not components of one another -- they were both medically necessary and separate, says Heather Corcoran, coding manager at CGH Billing Services in Louisville, Ky.

Below is the CCI 13.3 breakdown.