The Column 1/Column 2 code edits are published by NCCI (National Correct Coding Initiative). The CPT codes appearing in Column 1 are the payable service. The codes in Column 2 are the non-payable codes (unless they qualify for an appropriate modifier). The column 1/column 2 correct coding edit table contains two types of code pair edits. In effect, the edit combines the Column 2 service into the Column 1 service when either:

 

 

When reported with the column 1 code, the column 2 code generally represents the code with the lower work RVU of the two codes. Some column 1/2 codes are mutually exclusive. In this instance the table will list a “0.” This means that if both procedures are reported, only the column 1 code will be paid. In other words, the column 2 code is dropped in favor of the higher-level column 1 code.

 

Other column 1/column 2 code pairs allow for the use of a modifier. In this instance the table will list a “1.” This means that the two procedures can be coded together and both procedures will be paid, but a modifier will need to be attached to the column 2 code. This would require that one of the X{EPSU} modifiers be used.  It should be noted that the same code can be a column 1 code when paired with one code and a column 2 code when paired with a different code.

 

In the case of fibrin sheath removal, this is a column 2 code but with a 1 designation meaning that it can be used with the column 1 code and both procedures will be paid. However, a modifier will need to be attached. The appropriate modifier in this case is XU.

 

The X{EPSU} modifiers were introduced in 2015 to replace the 59 modifier which had multiple uses but was confusing. This group of modifiers is used to indicate that a procedure or service was distinct or independent from other services with which it would normally be considered as bundled.

 

Modifier XU is used to designate a separate unusual or nonoverlapping service. In other words, a service not bundled with another service that has been coded. This is the case with the fibrin sheath removal code. It is a separate service not bundled with the primary service and since it has a “1” designation it can be separately billed. Since it is classified as a separate service, it should have the XU modifier attached.

 

Summary:

 

As these issues relate to the relationship between the catheter exchange code and the fibrin sheath removal code. The latter is a category 2 code with a 1 designation allowing it to be separately coded and billed. However, since it is a category 2 code related to the category 1 code of catheter exchange, it requires and XU modifier to designate that it is a separate distinct service.

 

The coding of fibrin sheath removal is further complicated by the fact that the descriptor for the code specifies a femoral vein access which is not done. This means that the procedure as it is done represents a reduced level of service and should be designated as such with a 52 modifier.

 

Another issue related to this problem is the relationship between stenosis in the central vein associated with the fibrin sheath. Angioplasty performed from an internal jugular access site is a higher-level code than fibrin sheath removal. However, an angiogram to document the stenosis is not possible the way the procedure is performed. When an angioplasty balloon is used to remove a fibrin sheath and a stenosis is identified by observing >50% waist (defect) in the inflated balloon, the balloon image should be saved for documentation of the stenosis. The case should then be coded as an angioplasty rather than fibrin sheath removal.