Radiology Coding Alert

One slip could delay payment for this $2,000 service

National Correct Coding Initiative edits , version 12.2, effective July 1, streamline your transcatheter procedure coding. Here's what you need to know.
 
When your physician provides percutaneous transcatheter permanent occlusion or embolization and performs transcatheter intravascular stent placement at the same anatomic location during the same encounter, you should only report the occlusion or embolization. Adding the stent placement code to your claim will just lead to a denial.
 
The specifics: NCCI 12.2 added the following nonmutually exclusive, or column 1/column 2, edits.

The rules: Medicare applies the edits to services reported by the same provider for the same beneficiary on the same date of service, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.
 
Column 1/column 2 edits describe "bundled" procedures. That is, CMS considers the code listed in column 2 as the "lesser" service, which is included as a component of the more extensive column 1 procedure.
 
Example: Your physician performs an embolization procedure and uses a Neuroform stent to treat a wide-necked aneurysm in the patient's brain. The stent serves as a framework to hold embolization particles in place. You should report the embolization procedure (61624), not the stent placement, says radiology coding expert Jackie Miller, RHIA, CPC, senior coding consultant with Coding Strategies in Powder Springs, Ga.
 
If you were to report bundled (column 1/column 2) procedures for the same patient during the same session, Medicare would reimburse only for the more extensive of the two procedures.

Consult the Modifier Indicator Column

In certain circumstances you can override NCCI edits and achieve separate reimbursement for bundled codes. Follow these steps if you have distinct services:
 
Check the correct coding modifier indicator. Each NCCI code pair edit includes a correct coding modifier indicator of 0 or 1.
 
A "0" indicator means that you may not unbundle the edit combination under any circumstances, according to NCCI guidelines. An indicator of "1" means that you may use a modifier to override the edit if the procedures are distinct from one another.
 
Verify that the procedures are independent and distinct. You should attempt to override NCCI code pair edits only if the paired procedures are separate and unrelated, Cobuzzi says.
 
For instance, the provider may have provided the services/procedures at different sessions or at different anatomic locations.
 
Append modifier 59. You must append modifier 59 (Distinct procedural service) (or another appropriate modifier) to the column 2 code to indicate to the payer that the billed procedures are distinct and separately identifiable, says Beth Glenn, CPC, CMA, with Jefferson Physicians in Jefferson City, Tenn. "Without modifier 59, the payer will simply apply the NCCI edits and deny payment," she says.
 
Modifier 59's primary purpose is to indicate that providers performed the two procedures "at different anatomic sites or different patient encounters," according to Chapter 1 of the CMS National Correct Coding Policy Manual, Miller says.
 
Example: Your physician documents performing embolization (61624) of a middle cerebral artery aneurysm and stent placement (37205) in the left superficial femoral artery for a single patient on the same date. You should report 61624, 37205-59, Miller says.

Keep Up With the Latest Edits

CMS updates the NCCI every quarter, and you should always consult the most recent version when coding. Remember: Hospital edits run one quarter behind physician edits.
 
You can access NCCI updates through the CMS Web site at www.cms.hhs.gov/NationalCorrectCodInitEd/01_overview.asp. This site contains a listing of the NCCI edits by specific CPT sections and is available free for downloading to the public.