Radiology Coding Alert

CCI makes code only 1 dialysis fistula PTA rule official.

With the hundreds of thousands of new edits Correct Coding Initiative (CCI) version 15.1 put into effect April 1, slapping modifier 59 on every claim is more tempting than ever.

Careful: Many practices apply modifier 59 (Distinct procedural service) indiscriminately to bundled pairs to override the edits. But misusing modifier 59 this way is a serious compliance issue, leading to a high likelihood of audit and risking fraud charges, according to Frank Cohen, MPA, senior analyst with MIT Solutions Inc. in Clearwater, Fla., in his March 25, 2009, webinar NCCI Version 15.1 Update.

Protect yourself and your practice by keeping an eye out for these edits andidentifying legitimate opportunities to override them.

The Usual Suspects Take Center Stage

CCI takes aim at a few select codes this round, with only 524 unique codes listed in column 2 of the new column 1/column 2 edit list, Cohen says.

In most cases, procedures such as injections performed during surgery would be included in the main surgical procedure anyway, so these edits shouldnt hurt too badly, says Heather Corcoran with CGH Billing in Louisville, Ky.

For example: CCI bundles many of the codes it focuses on into interventional procedures, such as G0392 (Transluminal balloon angioplasty, percutaneous; for maintenance of hemodialysis access, arteriovenous fistula or graft; arterial).

The column 2 codes with a modifier indicator of 1 (indicating you may override the edit with a modifier when appropriate) include:

" venipuncture: 36400-36406, 36420-36425

" push transfusion: 36440

" arterial puncture/catheterization: 36600, 36640

" naso- or oro-gastric tube placement: 43752

" anesthetic agent injection: 64505-64530

" surface neurostimulator application: 64550

" ECG: 93000-93010, 93040-93042

" transesophageal echocardiography: 93318

" pulmonary services: 94002, 94200, 94250, 94680-94690, 94770

" electroencephalography: 95812-95822, 95829, 95955

" sequential IV push: +96376.

Column 2 codes with a modifier indicator of 0 (indicating you may never override the edit, Cohen explains) include:

" epidural or subarachnoid injection: 62310-62311

" anesthetic agent injection: 64400-64413, 64418-64449, 64479, 64483.

Dont Miss the G0393 Needle in the CCI Haystack

G0393 caution: Watch for the individual edits amidst the masses. CCI bundles G0393 (& venous) into G0392. This edit has a modifier indicator of 1.

The vast majority of dialysis fistula PTAs are properly coded as venous -- G0393, says Jackie Miller,RHIA, CCS-P, CPC, vice president of product development for Coding Metrix Inc. in Powder Springs,Ga. You use the venous code when PTA is performed within the body of the graft, at the venous anastomosis, or in the outflow vein in the arm, she explains.

Tip: The general guidance has long been that, in the absence of payer-specific instructions, you should use the venous code when PTA of the arterial anastomosis is performed together with PTA of any of the above-listed sites, Miller notes.

Example: The general approach has been that PTA of the venous anastomosis plus PTA of the arterial anastomosis equals one unit of G0393, Miller says.

You traditionally use the arterial PTA code when angioplasty is performed only at the arterial anastomosis.This is an unusual situation, Miller says.

Best bet: Verify your payers preference for which code to report for PTA of both the venous and arterial anastomoses.

Watch for RS&I Included in Urinary Code

CCI bundles 75984 (Change of percutaneous tube or drainage catheter with contrast monitoring [e.g.,genitourinary system, abscess], radiological supervision and interpretation) into:

" 50385 -- Removal (via snare/capture) and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy,including radiological supervision and interpretation

" 50386 -- Removal (via snare/capture) of internally dwelling ureteral stent via transurethral approach,without use of cystoscopy, including radiological supervision and interpretation (mod indicator 1).

Logic: Both 50385 and 50386 state including radiological supervision and interpretation, so all RS&I is already included in these codes.

Heed Crucial Note Under Intracranial Codes

The following codes are bundled into 61630 (Balloon angioplasty, intracranial [e.g., atherosclerotic stenosis],percutaneous) and 61635 (Transcatheter placement of intravascular stent[s], intracranial [e.g., atherosclerotic stenosis], including balloon angioplasty, if performed),with a modifier indicator of 1:

" angiography: 75650, 75665, 75671, 75685

n

" transcatheter introduction of intravascular stent,RS&I: 75960

" fluoroscopy: 76000, 76001

" needle placement guidance: 76942, 77002,77012, 77021.

Keep in mind: A note in CPT under 61630 and 61635 states that these codes include all selective vascular catheterization of the target vascular family, all diagnostic imaging for arteriography of the target vascular family, and all related radiological supervision and interpretation.

Resource: You can download the edits at www.cms.hhs.gov/NationalCorrectCodInitEd/. And to brush up on when modifier 59 use is appropriate to override an edit, read the Modifier 59 Article at the same site.