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Cardiology Coding Alert

Be Certain Your Cardiac Device Claim Reimbursement Doesn't Skip a Beat

Hint: See how NCCI 11.2's edits change the way you report these services

If you've been reporting wearable cardioverter-defibrillator (WED) setup with analysis of a dual-chamber pacemaker, it's time for a change - thanks to new National Correct Coding Initiative edits that took effect July 1.

Start Including ECGs With Defibrillator Setup Don't set yourself up for denials when reporting WED setup code CPT 93745 (Initial setup and programming by a physician of wearable cardioverter-defibrillator, includes initial programming of system, establishing baseline electronic ECG, transmission of data to data repository, patient instruction in wearing system and patient reporting of problems or events).

You won't be able to separately report 93745 with the following component codes:
  93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpre-
  tation and report
  CPT 93005 - ... tracing only, without interpretation and report
  CPT 93010 - ... interpretation and report only
  CPT 93040 - Rhythm ECG, one to three leads; with interpretation and report
  CPT 93042 - ... interpretation and report only. Notice how 93745's descriptor includes the phrase "establishing baseline electronic ECG." Fragmenting the ECG component part and coding that service separately is inappropriate, says Cynthia A. Swanson, RN, CPC, a cardiology coding specialist at Seim, Johnson, Sestak & Quist LLP in Omaha, Neb.

Example: A patient presents with sign/symptoms warranting an evaluation that includes an ECG. Based on the findings of the ECG, the cardiologist decides that the patient is at increased risk of sudden cardiac death and/or ventricular fibrillation. As a bridge to the patient receiving an implanted defibrillator, the cardiologist sets up a wearable defibrillator (93745). In this case, the ECG was truly diagnostic and not a part of the wearable defibrillator setup. Result: You would report both services and apply  modifier 59 (Distinct procedural service) to the ECG code.

Red flag: Make sure your cardiologist's documentation meets one of two criteria to justify reporting modifier 59: (1) The physician performs services he does not normally provide together on the same day, but the services are necessary under the circumstances and (2) the procedure codes fit into any of five situations: different sessions or encounters, different sites/organ systems, separate incisions/excisions, separate lesions, or separate injuries. Count 93745 as a Component of 93743/93744 You won't get anywhere, however, if you try to append a bundle-breaking modifier to 93745 and report it alongside 93743 (Electronic analysis of pacing cardioverter-defibrillator [includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response]; dual chamber, without reprogramming) or 93744 (...dual chamber, with reprogramming). Scratch out those two code combinations from your [...]