CCI Update: Get the Scoop on What’s In and What’s Out for Cardiology Edit Pairs   (July 2010)

Beware of coding transcatheter therapy and vascular imaging on the same date.
Correct Coding Initiative (CCI) Version 16.2 is in full effect, as of July 1. But not all news from CCI Version 16.2 is bad news.
CCI deletes dozens of edit pairs, said Frank Cohen, MPA, MBB, of The Frank Cohen Group, in a June 17 announcement about the CCI changes. Below, see which cardiologyrelated edits have been ousted and what’s been added.
What’s Out: CCI Deletes [...]

Echocardiography: Tackle Proper TEE Coding for Cleaner Claims   (July 2010)

Think you don’t need modifier 26 for 93314? Think again.
Transesophageal echocardiography (TEE) has long troubled coders who need to choose among the procedure’s available codes (93312-93318). If you’re fuzzy on which TEE code will bring in deserved reimbursement, take these tips from the experts.
Watch for Congenital and Global Clues
For a study that involves real-time image acquisition and documentation, you’ll use a code from 93312-93314 (Echocardiography, transesophageal, real-time with image documentation [2D] [with or without M-mode recording]…), [...]

E/M Coding: Capture Additional 99215 Opportunities By Mastering Time-Based Coding   (July 2010)

Employ this start/stop time tip to stand up to audit scrutiny.
The cardiologist provides an E/M service for an established patient that requires an expanded problem focused history and exam. The E/M encounter, however, takes nearly 45 minutes to complete. How would you report this E/M service?
Opportunity: If the visit meets the correct counseling/coordination of care parameters, you might be able to report the visit using time as the controlling factor rather than the standard three [...]

You Be the Coder: Pick Proper ICD Codes   (July 2010)

Question: How should I code the following services from a single operative note? Incision along deltopectoral groove Pacer pocket created Guidewires advanced in the left subclavian via pacer pocket (modified Seldinger) Ventricular pacer defibrillator lead advanced to the right ventricle and fixated (threshold parameters documented) Right atrial lead fixated in right atrium (threshold parameters documented) Leads attached to Teligen ICD Device placed in pocket and pocket closedIndiana Subscriber
Answer: One code describes all of these services: [...]

Reader Questions: Separate Hypertension Diagnoses   (July 2010)

Question: Should I report both essential hypertension and pulmonary hypertension together? Or should I code only the pulmonary hypertension because it’s more specific?
Tennessee Subscriber
Answer: Assuming the essential hypertension you reference is general high arterial blood pressure (not pulmonary), essential and pulmonary hypertension are separate diagnoses. So if the cardiologist documents both diagnoses as medically relevant to the visit, you should report both.
For essential hypertension, use 401.x (Essential hypertension).
Essential hypertension, also called primary or idiopathic, means [...]

Reader Questions: Check CPT and CCI About Conscious Sedation   (July 2010)

Question: Is it OK to report conscious sedation for a cardiac catheterization?
Florida Subscriber
Answer: CPT guidelines and Correct Coding Initiative (CCI) edits will keep you from reporting conscious sedation with most cardiac catheterization codes.
CPT: CPT uses a symbol – that looks like a circle with a dot in the center – to identify codes which CPT considers to include conscious sedation as part of the procedure. As a result, you should not report moderate sedation (99143-99145, Moderate sedation [...]

Reader Questions: Extra Long Visit? Consider +99354   (July 2010)

Question: The cardiologist spent 105 minutes evaluating a new patient in the office. Is 99205 the only code I can bill?
Massachusetts Subscriber
Answer: You also should look at the prolonged office visit codes +99354-+99355 (Prolonged physician service … requiring direct [face-to-face] patient contact … ).
Here’s why: Code 99205 (Office or other outpatient visit for the evaluation and management of a new patient … Physicians typically spend 60 minutes face-to-face with the patient and/or family) notes the [...]

Reader Questions: Bypass Matters for Injection Code   (July 2010)

Question: How should I report an injection procedure during a heart catheterization if the patient has had a bypass?
California Subscriber
Answer: Because the patient has had a bypass, you should consider the following codes:93539 – Injection procedure during cardiac catheterization; for selective opacification of arterial conduits (e.g., internal mammary), whether native or used for bypass93540 – … for selective opacification of aortocoronary venous bypass grafts, 1 or more coronary arteries.
For instance, if the patient had a radial [...]

Reader Questions: Check Rules for Injection + E/M   (July 2010)

Question: A payer denied our claim for an established patient office visit in addition to 96372. We appended modifier 25 and appealed but were denied again. What are we doing wrong?
Texas Subscriber
Answer: If you’re billing a payer that follows the Correct Coding Initiative (CCI), the edits bundle office visit codes 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient …) into therapeutic injection code 96372 (Therapeutic, prophylactic, or [...]

ICD-9 2011 Preview: Diagnosis Update: Get Ready for New Ectasia Codes Come Oct. 1   (June 2010)

Plus, check out V13.65 for corrected congenital heart malformations.
Each October you’re faced with new ICD-9 codes to add to your diagnosis arsenal. 2011 is no exception, with new ectasia, congenital malformation, and body mass index (BMI) codes you’ll need to learn. Take a look at the proposed changes that will affect your cardiology practice, so that you’re ready when fall rolls around.
End Your Ectasia Hunt at 447.7x
The proposed changes to ICD-9 2011 add four codes [...]