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Julie Posted Sat 22nd of February, 2020 14:18:40 PM
When using 3D ICE, along with billing for the primary procedure, can we also bill for CPT code 93662 (ICE) and CPT code 76376 (3D) to describe the 3D portion of the procedure? I don't see any other way to code for 3D ICE.
SuperCoder Answered Mon 24th of February, 2020 09:49:22 AM

Hi Julie,

When using CPT 93662 {Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (List separately in addition to code for primary procedure)}, it is suggested to use 93662 in conjunction with 92987, 93453, 93460-93462, 93532, 93580, 93581, 93620, 93621, 93622, 93653, 93654, 93656 as appropriate. CPT 76376 {3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation} is not mentioned in this list.

However, for ICE-3D, there is specific code is available, i.e. 93613 {Intracardiac electrophysiologic 3-dimensional mapping (List separately in addition to code for primary procedure)}. Since, this is an add-on code, then you have to bill this code with the primary code. Guidelines suggests using 93613 in conjunction with 93620, 93653 and/or 93656.

So, check the complete documentation and bill the 3D-ICE code with primary procedure code.

Hope this helps!

Julie Posted Mon 24th of February, 2020 09:55:39 AM
Thank you for your response but can you clarify the coding recommendation? Intracardiac echo (described by 93662) is different from intracardiac electrophysiologic 3-D mapping (described by 93613). I have not seen that recommendation before - ICE is considered "guidance" rather than 3D mapping, isn't it? Can you clarify how you come to that recommendation? Why could 93662 and 76376 be used to describe 3D ICE? Thanks!
SuperCoder Answered Tue 25th of February, 2020 04:21:59 AM

Hi Julie,

Hope you are keeping well.

Yes, you are absolutely correct, there is difference between the "Intracardiac electrophysiologic" and "Intracardiac echocardiography". Since, it is mentioned ICE in base the query, so recommended CPT 93613, as sometimes intracardiac electrophysiologic also interpreted as ICE with 3-Dimensional mapping.

Now it is clear, as per your report, ICE meant "Intracardiac echocardiography". Inconvenience is regretted.

CPT 93662 is correct to bill for Intracardiac echocardiography. But as per AMA CPT 93662 can be used in conjunction with 92987, 93453, 93460-93462, 93532, 93580, 93581, 93620, 93621, 93622, 93653, 93654, 93656 as appropriate. Whereas, CPT 76376 is not mentioned in the list. So, it is suggested to append the modifier 22 (Increased Procedural Services) with the procedure for 3D rendering rather billing both the codes together to avoid the possible denial.

In order to append modifier 22 to a surgical procedure, check that the physician documented the reason(s) why the work he performed was more than he typically performs, and the documentation should include any or all of the following:

  • Increased intensity
  • Additional time
  • Technical difficulty
  • Severe patient condition, which causes the surgery to be difficult, dangerous to the patient, and requires additional physical and mental effort from the physician

An unusual procedure is not when the physician took only a few extra minutes on the patient’s case or when the physician documents that the procedure was only slightly more difficult. There is an average range of difficulty for every procedure. A procedure could be slightly more difficult and still meet the definition of the procedure and not warrant appending modifier 22.

Hope this helps!

Julie Posted Tue 25th of February, 2020 11:33:41 AM
I'm very concerned by the responses I am receiving. 1) Modifier -22 may only be used with procedures that have a 0, 10, or 90-day global period. Code 93662 does not meet this requirement, as its global period is ZZZ - so I don't understand how you can recommend use of modifier -22 with CPT code 93662. 2) In regards to 93662 not being used with 76376 "because it is not mentioned in the list" - does not make sense either. The codes listed are intended to be primary procedures that may be billed in conjunction with 93662 - it has nothing to do with billing additional procedures. As long as 93662 is used with a primary procedure, additional codes may also be used. So my question is - how to bill for 3D Intracardiac echocardiogram (93662) when performed in conjunction with a primary procedure listed above. Is it appropriate to bill CPT 76376 in addition to 93662 when performed in conjunction with a listed primary procedure code. Would there be another expert who could review this question?
SuperCoder Answered Wed 26th of February, 2020 04:13:59 AM

Hello Julie,

Greetings from SuperCoder.

We have reviewed your query thoroughly.

Yes, you are absolutely right on modifier 22. For procedure code 93662, the global period is ZZZ, which means "The code is related to another service and is always included in the global period of the other service". But modifier was suggested to append with the primary procedure, not with the add-on procedure i.e. 93662.

Although, American Medical Association guidelines appropriately direct to bill the CPT 93662 with the code(s) 93460-93462, 93532, 93580, 93581, 93620, 93621, 93622, 93653, 93654, 93656. Since, CPT 93662 is in the list which is separately billable in addition to code for primary procedure, so you can bill it with the 3D rendering procedure i.e. 76376. However, no where in the CCI edits guidelines it is suggested to bill CPT 76376 and 93662 together. On that note, we suggest you to clarify it with the payer on billing of CPT 76376 and 93662.

We wish you for the best reimbursement.

Please let us know in case of any further assistance.

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