2016 CCI Manual Updates for Cardiology
On April 1, version 22.1 of the National Correct Coding Initiative (NCCI or CCI) went into effect. Cardiology coder need to be aware that there are several changes that affect cardiology, for e.g. endomyocardial biopsy and device services. As you must know, the CCI edits mainly consist of pairs of CPT® or HCPCS level II codes that can’t be paid separately except in certain circumstances. Primarily, CCI edits are applied to services billed by the same provider for the same patient on the same date of service. Incorrect reporting of codes that are part of a CCI edit pair can lead to claim denials and rejections.
The Correct Coding Initiative (CCI) manual has an updated version effective Jan. 1, 2016, and coders typically check quarterly CCI updates, also referred as NCCI (National Correct Coding Initiative). The new versions go into effect every January 1, April 1, July 1, and October 1. It’s important for the practices to subscribe to the NCCI quarterly updates to stay abreast of the quarterly changes.
Two Key changes for Cardiology:
- Update in the language on coding an abbreviated right heart catheterization (RHC) during endomyocardial biopsy
According to 2015 wording: “Endomyocardial biopsy requires intravascular placement of catheters into the right ventricle under fluoroscopic guidance. Physicians should not separately report a right heart catheterization or selective vascular catheterization CPT® code for placement of these catheters. A right heart catheterization CPT® code may be separately reportable if it is a medically reasonable, necessary, and distinct service performed at the same or different patient encounter.”
In 2016: There is an addition of this sentence at the end: “The right heart catheterization CPT® code may be reported only if a complete right heart catheterization procedure is performed. If an abbreviated right heart catheterization is medically reasonable and necessary, it may be reported with CPT® code 93799 (Unlisted cardiovascular service or procedure).”
Following heart transpant, endomyocardial biopsy is usually performed. However, experts advise that post heart transplant without further explanation is not adequate to support reporting both the RHC and biopsy at the same session, as it’s hardly medically necessary. Plus, terms like elective, periodic, routine, and surveillance for the RHC suggest that RHC is not reportable as a diagnostic service. Hence, your documentation needs to strongly support why the cardiologist thought the minimal RHC was medically necessary. It’s imperative to use 93799 cautiously and provide a description explaining what the cardiologist did.
Note: Use the CCI manual’s language change cautiously; don’t start using the manual as an excuse to start reporting RHCs that are not medically necessary diagnostic procedures.
- 2. New language about coding a limited diagnostic electrophysiology (EP) test to determine whether a patient needs an electrode or device procedure.
In 2015: there was no related language.
In 2016: “CPT® codes 93600 (Bundle of His recording), 93602 (Intra-atrial recording), 93603 (Right ventricular recording), 93610 (Intra-atrial pacing), and 93612 (Intraventricular pacing) should not be reported with a code describing insertion or replacement of an electrode or device (pacemaker, defibrillator) as they are essential to the procedure.
If a physician performs a medically reasonable and necessary limited diagnostic electrophysiology test preceding the insertion or replacement of the electrode or device to determine the necessity to proceed with insertion or replacement of an electrode or device, the appropriate CPT® codes describing the limited diagnostic electrophysiology testing may be reported with an NCCI-associated modifier. The limited diagnostic electrophysiology testing to determine the necessity to proceed with insertion or replacement of the electrode or device may be performed at the same or different patient encounter.”
Note: This new language should help support coding for testing performed before lead replacement. Plus, always append modifier 59 (Distinct procedural service) to the diagnostic test code.
Are you confused about EP/Ablations/PM/ICD-10 coding changes in Cardiology? Join expert speaker Terry Fletcher in this informative audio session “Cardiology: EP/Ablations/PM/ICD” to get answers to your most confusing queries. This session will provide guidelines and references for Medicare with various tip charts and real-life examples on coding requirements for cardiology.