Check Out CCI Edits for Cardiology Coding

By Susan Dooley

Version 22.1 of the National Correct Coding Initiative (NCCI or CCI) just went into effect April 1. But did
you catch that the NCCI Manual saw some updates way back in January? It contains some interesting
changes that cardiology coders will want to pay attention to. Well detail one of them here.
As you know, CCI edits consist of pairs of CPT or HCPCS level II codes that cant be paid separately
except in certain circumstances. 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.

Get Your CCI Manual Ready!

CMS released the updated NCCI Policy Manual effective January 1, and it released the first quarters CCI
updates effective the same day. CMS releases quarterly updates January 1, April 1, July 1, and October 1.
Updates to the manual appear in an italic red font.

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

Right Heart Catheterization With Biopsy Lands in CCI Manual Updates

An update offers advice on coding an abbreviated right heart catheterization (RHC) during endocardial
biopsy, but be careful about reporting this code.
Heres what the NCCI Manual had to say about this procedure in 2015: 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.
But in 2016, this sentence was added 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).
Why does the 2016 advice raise the caution flag? It would be unusual for a cardiologist to perform an
abbreviated right heart catheterization because the extensive information obtained from the
procedure is so important in deciding how to treat the patient.

Document It or It Didnt Happen!

As always, documentation is key. If you choose to report the minimal right heart catheterization with
93799, make sure the documentation clearly explains why this procedure was medically necessary.
Provide a description of what the cardiologist did during the procedure.
Though endomyocardial biopsy is often performed after heart transplant, documentation simply reading
post heart transplant without further explanation wont cut it for reporting both the right heart cath
and biopsy in the same session. If your documentation includes terms like elective, periodic, routine, or
surveillance, these are red flags that the cath isnt reportable as a diagnostic service. Also, performing
right atrial and ventricular pressures can be part of the standard protocol for the biopsy rather than
being a true diagnostic right heart cath.

Got Tips?
Keeping up with CCI edits can be tricky. Got any tips for success? Write to us!

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The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

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The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com