Radiology Coding Alert

If you code for diagnostic, vascular or pain procedures, Correct Coding Initiative (CCI) version 13.2 has changes you don't want to miss.

Don't forget: These edit additions and deletions are effective July 1.

CCI 13.2 bundles 73530 (Radiologic examination, hip, during operative procedure) into a long list of pelvis and hip joint surgical codes. But these edits aren't the giant hit on physician reimbursement that they might seem at first glance.

The edits: The nonmutually exclusive 13.2 edits bundle 73530 into the following pelvis and hip joint codes from CPT's Musculoskeletal System chapter:

• incision codes 26990-27036

• excision codes 27040-27080

• introduction or removal codes 27086-27096

• repair, revision and/or reconstruction codes 27097-27187

• fracture and/or dislocation codes 27193-27266

• manipulation code 27275

• arthrodesis codes 27280-27286

• amputation codes 27290-27295.

These new edits have modifier status "0," which means you can't override them with a modifier, says Jackie Miller, RHIA, CPC, senior coding consultant with Coding Strategies Inc., based in Powder Springs, Ga.

Good news: CCI edits apply only to procedures performed by the same provider, so these new 73530 edits won't affect your ability to code a radiologist's interpretation of a hip x-ray taken during surgery performed by an orthopedist, Miller says.

Hospital note: Next quarter, if CMS adopts these edits without change for hospital use, the edits will prevent Medicare payment to the hospital for hip x-rays performed during outpatient hip surgery, Miller says.

Nonmutually exclusive edits are also known as column 1/column 2 edits and were formerly called comprehensive/component edits. If you report both the column 1 and

column 2 codes of a bundled pair, payers that adopt CCI edits will pay you only for the more extensive procedure (typically the column 1 code).

On the other hand, CCI edits also include mutually exclusive edits, which pair procedures or services a physician would not reasonably perform during the same session at the same anatomic location on the same beneficiary, says Kelly Dennis, MBA, CPC, ACS-AP, owner of the consulting firm Perfect Office Solutions in Leesburg, Fla.

If you were to report two mutually exclusive codes for the same patient during the same session, payers would pay for the lower reimbursed procedure.

You've got another long list of edits involving two endovascular aortic aneurysm repair codes:

• +0153T -- Transcatheter placement of wireless physiologic sensor in aneurysmal sac during endovascular repair, including radiological supervision and interpretation and instrument calibration

• 0154T -- Noninvasive physiologic study of implanted wireless pressure sensor in aneurysmal sac following endovascular repair, complete study including recording, analysis of pressure and waveform tracings, interpretation and report.

Codes 0153T and 0154T are column 2 codes to (and therefore are included in) the following column 1 codes:

• thoracic aortic aneurysm codes 33860-33877

• direct repair of aneurysm or excision (partial or total) and graft insertion for aneurysm, pseudoaneurysm, ruptured aneurysm, and associated occlusive disease codes 35001-35152.

Red flag: For all of these edits, you'll find a modifier indicator of "0." This means you cannot override the edit pair under any circumstances.

You should use 0153T to report transcatheter placement of a wireless sensor during endovascular aorta repair, Miller says. Result: You can report 0153T only with the endovascular repair codes.

Follow guidelines: If you look at the parenthetical note under 0153T, you'll see, "Use in conjunction with 34800, 34802, 34803, 34804, 34805, and 34900." These are the only codes with which you should report 0153T, and the CCI edits do not affect this.

You should use 0154T "to report a subsequent study of data from the wireless sensor," Miller says. These edits effectively include sensor placement and sensor data study in the listed open repair procedures.

CCI 13.2 also bundles catheterization code 36247 (Selective catheter placement, arterial system; initial third-order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family) into open atherectomy code 35485 (Transluminal peripheral atherectomy, open; tibioperoneal trunk and branches).

In other words, if the physician performs the selective arterial catheter placement (36247) as well as an open atherectomy (35485), you'll report only 35485.

Good news: This edit has a modifier indicator of "1," which means you may use a modifier to override the edit if the procedures are distinct from one another (for instance, if they occur in separate anatomic locations). You can append modifier 59 (Distinct procedural service) to the lesser code (in this case, 36247) to indicate to the payer that the billed procedures are distinct and separately identifiable. But don't forget to back up your claim with supporting documentation.

Reality: These edits won't affect your typical radiology claims because they involve open procedures, but they do affect cardiothoracic and vascular surgery procedures and claims.

If your radiologist performs pain procedures, don't miss these deleted nonmutually exclusive edits "that bundled spinal injections into a variety of percutaneous spine procedures including endoscopic epidurolysis, percutaneous vertebroplasty, kyphoplasty and percutaneous discectomy," Miller says.

Example: CCI no longer bundles a single epidural injection (62310, Injection, single [not via indwelling catheter] ...) into percutaneous discectomy (62287, Aspiration or decompression procedure, percutaneous ...), Miller says.

Scan this list to see the deleted edits:

Col. 1      Col. 2

0027T      62310, 62318

22520      62319, 64475

22521      62318, 64470

22523      62319, 64475

22524      62318, 64470

62287      62310, 62318, 64470.