Cardiology Edit Pairs: Know what's in and What's Out

CCI 16.2 went in full effect on July 1 this year

. If you are a cardiology coder, you need to beware of coding transcatheter therapy and vascular imaging on the same date. However there is good news too.

What's been deleted: Correct coding initiatives deletes edits for MTWA and stress tests

Earlier, you faced an edit that has barred reporting cardiovascular stress test codes 93015-93017 with 93025. But from July 1, you are able to report these codes together, owing to an edit deletion in the new CCI edits.

What's in: Comply with new ECG and Imaging Edits

Of all the just-in correct coding initiatives, ensure you note these areas in particular: Now CCI bundles 75896 into many codes, including endovascular repair codes 34800-34805, as well as vascular procedure codes 75600-75791 and 75810-75891. These edits have a modifier indicator of 1, which means that you may override the edit with a modifier like 59 when appropriate. Now CCI also bundles 93000-93010 into cardiac CT codes 75571-75574. These edits also have a modifier indicator of 1.

Remember: As modifier 59 has the potential to bypass CCI edits, practices use this modifier quite often. However you should never use modifier 59 just to get paid for a procedure.

That apart, CPT instructions say that if a more specific modifier describes the situation, you should go for modifier 59. This modifier should be a modifier of last resort and only used when there's no other modifier to compliantly bypass the bundling edit, and the procedure was clearly distinct and different from that of the other procedure. For instance modifiers LT and RT may be more apt for your case.

For more on the CCI 16.2 edits, sign up for a one-stop Medical Coding Website.

Cardiology Edit Pairs: Know what's in and What's Out

By: James Smith

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