For cardiac cath services, a number of issues exist that tend to be regular topics of discussion when it comes to common coding challenges. Topping the list is the proper use of codes +93571 and +93572.
+93571 | Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; initial vessel (List separately in addition to code for primary procedure)
+93572 | Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; each additional vessel (List separately in addition to code for primary procedure)
These codes describe intravascular Doppler flow reserve measurement – most commonly referred to as FFR. It involves the use of a guidewire with a Doppler transducer at its end to measure blood pressure and flow in coronary arteries. This procedure can be performed during cardiac catheterization or other therapeutic intervention (and can be coded in addition), or prior to an intervention to help determine whether an intervention may be necessary. The procedure includes the use of a stressing agent (i.e., adenosine), which is included in the codes.
Codes +93571 and +93572 are both add-on codes, meaning they must be reported with a primary procedure code for either a coronary angiogram or intervention. It is also important to note that code +93572 cannot be assigned without first reporting code +93571.
- How many times can code +93571 be reported?
Code +93571 is reported only once per patient encounter, regardless of the number of measurements taken. However, remember that there are five major coronary vessels in the heart:
- Left main coronary artery – LM
- Left anterior descending coronary artery – LD
- Left circumflex coronary artery – LC
- Right coronary artery – RC
- Ramus intermedius coronary artery – RI
It is possible to report FFR performed in each major coronary artery during the same patient encounter. In cases where FFR is performed in more than one major coronary artery, code +93571 would be reported once and code +93572 would be reported for each additional major coronary artery. Code +93572 may be reported up to four times in addition to code +93571.
- Can code +93572 be reported for an additional FFR performed in a branch of the same major coronary artery?
No, FFR codes are reported only once for each major coronary artery and/or branch. Meaning, code +93572 is only reported for FFR performed in additional major coronary arteries. If FFR is performed in a major coronary artery and then additionally performed in a branch of that same artery, the branch is inclusive and not separately reportable.
- If FFR is performed without induction of stress, how is that reported?
When performed without the use of stress, commonly referred to as iFR, codes +93571 and +93572 still apply, but would be reported with modifier 52 (reduced service) to indicate that the procedure performed was less than what is stated in the code.
Common Coding Challenges
With coding for FFR, there are a couple of common mistakes that result in denials and incorrect coding. The good news is that these mistakes are easily overcome with a few tweaks.
The first common issue is reporting codes +93571 and +93572 without coronary modifiers (LM, LD, LC, RC, RI). The coronary modifiers (as seen above) are reported to illustrate that a separate procedure was performed in a separate major coronary artery, and to override NCCI edits that prevent reporting multiple procedures. Reporting codes +93571 and +93572 withoutthe appropriate coronary modifiers will result in denials.
The second common issue is reporting codes +93571 and +93572 without an interpretation in the report. In order to report codes +93571 and +93572 the documentation must contain some type of interpretation of the FFR. Documentation stating simply that “FFR was performed” without an interpretation is not separately reportable. It is essential to make sure this requirement is met to avoid denials and mitigate compliance risk.
Guidance with Cardiac Cath and Peripheral Procedures
It’s all in the Peripheral & Cardiology Coder, your one-stop solution. Time tested and industry trusted, this resource is designed to specifically respond to real-world coding, documentation and billing issues for a full range of cardiac cath and peripheral services with workable solutions, translated into clear-cut instruction, actionable tips and case examples – an invaluable resource for cath labs.