CCI 17.1: Get on Top of These Three Key Highlights for Cardiology This Quarter

Take a look at these major pointers to comply with the just-in cardiology-related edits, including cardiac catheterization, radiological supervision and interpretation, cardiac rehabilitation, and more.

Avoid denials by remembering 93454-93461 are diagnostic

Just-in edits will prevent you from reporting heart catheter/angiography codes 93454- 93461 (column 2) with the following cardiovascular therapeutic services and procedures (column 1):

92975, 92980, 92982, 92995

Take away: In column 1, the 929xx codes describe coronary therapies. You shouldn't use the 934xx diagnostic codes in column 2 to report catheter placement and coronary angiography performed as an integral part of the therapeutic column 1 services.

Opportunity: The edits have a modifier indicator of 1; as such you may override them with a proper modifier when the procedures are distinct. If you report both codes in the edit pair and do not add a modifier to the column 2 code, Medicare will reimburse you for only the column 1 code.

The AMA, via CPT Assistant (April 2005), indicates that you may report a true diagnostic catheterization apart from the therapeutic procedures described by 92980 and 92982:These two distinct procedures, therefore, should be reported separately when carried out at the same session or on the same day at a different session."

When the cardiologist does carry out a distinct 93454-93461 diagnostic service on the same date as a cardiovascular therapeutic service, you should append modifier 59 (Distinct procedural service) to the diagnostic code. You may also require to add modifier 51 (Multiple procedures).

Modifier 59 identifies the procedure as being a distinct procedural service while modifier 51 identifies multiple procedures were performed during the same session. Even though CPT identifies many codes as modifier 51 exempt, 93454-93461 are not currently exempt. But then, Medicare and other payers may tell you not to use modifier 51 since they'll apply the multiple procedure rule themselves.

Hints: You should also add modifier 26 (Professional component) to 93454-93461 when you need to indicate you're reporting only the professional component of the service. The Medicare physician fee schedule shows different PC and TC for these codes.

Follow S&I instructions to stay compliant

Like many other existing edits, a large number of the just-in cardiology-related edits help keep your coding in line with CPT guidelines for using radiology codes with procedure codes.

Example 1: Code 0236T includes radiological supervision and interpretation (S&I) in its definition. As such, you should not be surprised to know that the latest CCI bundles radiology codes 75600-75630 (Aortography … radiological supervision and interpretation) into 0236T.

Example 2: Now CCI bundles 75600-75774 and 75810-75891 into 37205. But then this should not restrict your coding since a CPT instruction with 37205 tells you that the proper code for S&I related to 37205 is 75960.

Good move: To stay away from denials, check code definitions, CPT guidelines, and CCI edits prior to reporting an S&I code with a procedure code – both to ensure you report the proper S&I code for the procedure and to be sure you comply with CCI edits.

Watch for blood draw, pulmonary services, EEG and others

In the latest CCI, it bundles many of the same column 2 codes into the following column 1 codes:

93660, 93724, 93797-93798

While the column two codes in the edits are not entirely identical for each of the column 1 codes above, there is a definite pattern. Here's a sampling of the column 2 codes:

364xx, 366xx, 37202, 43752, 94xxx, 958xx, 95955

Bottom line: Before you report a tilt table exam, an antitachycardia-pacemaker analysis, or outpatient cardiac rehab code, take a look at the CCI edits to verify that you haven't included one of the many bundled codes on your claim.