Thrombectomy, US, LHC: Did You Catch These Cardio CCI Manual Changes for 2018?

Mon, Apr 23, 2018 --


cardiology CCI manual updates

National Correct Coding Initiative (NCCI or CCI) is one of those hidden-depths areas of coding. If you cardiovascular coders know the major CCI edits that apply to you, you’ve got one layer down. But you need to know what’s in the policy manual (available here), too, if you truly want to code in compliance with CCI. Here is a helping hand: a look at what’s new for cardio in the 2018 CCI manual.

Think of 30000 and Thrombectomy First

Chapter V, section D, of the manual is titled Cardiovascular System and focuses on 30000-range codes. If you code these services, you should read the complete section. It will improve your knowledge and may help you understand edits that you’ve wondered about.

The manual helpfully marks changes in red so they’re easy to find. The first change is a new subsection 28 (which resulted in the renumbering of existing sections from the 2017 manual).

Here’s the wording: “Thrombectomy of thrombus in the vascular territory of a diseased artery is inherent in the work of an atherectomy procedure. CPT® code 37186 (Secondary percutaneous transluminal thrombectomy) shall not be reported for removal of such thrombus.”

Don’t miss: The addition goes on to provide this hint: “For example, if a physician performs a lower extremity endovascular revascularization atherectomy, removal of any thrombus from the vascular territory of the vessel treated with atherectomy is not separately reportable.”

Now Nix US Guidance With This 90000-Range Addition

Chapter XI, section I, is titled Cardiovascular Services and focuses on 90000-range codes.

The first major addition is to the end of subsection 15. The subsection explains that cardiac caths, percutaneous coronary interventions, and internal cardioversion include typical components like needle and catheter insertion, infusion, fluoroscopy, and ECG rhythm strips.

Here’s the new language: You’ll find this text added at the end: “Additionally, ultrasound guidance is not separately reportable with these procedures. Physicians shall not report CPT® codes 76942, 76998, 93318, or other ultrasound procedural codes if the ultrasound procedure is performed for guidance during one of these procedures.”

Know When Overriding These LHC Edits Is OK

There’s also a new subsection 33 in Chapter XI, section I, with this wording: “CPT® code 93590 describes percutaneous transcatheter closure of a mitral valve paravalvular leak. If a left heart catheterization by transapical puncture is additionally performed, add-on CPT® code 93462 may additionally be reported. However, if the left heart catheterization is performed by transseptal puncture, CPT® code 93462 shall not be additionally reported. Therefore, CPT® code 93590 is listed as a primary code for add-on CPT® code 93462. These two codes are also bundled in a procedure to procedure edit that allows use of an NCCI-associated modifier to bypass it if left heart catheterization by transapical puncture is performed.”

In other words: The CCI manual added an instruction that is in line with CPT® guidelines to use +93462 with 93590 for transapical puncture, but not transseptal puncture. The CCI manual instruction is especially helpful because it explains when you may override the edit.

What About You?

What’s something you’ve learned from the CCI manual?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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