# Separate procedures at different hospitals



## Jim Pawloski (Jun 29, 2010)

Hello everybody!,

I have a question for everybody.  A patient has a heart cath at one hospital, and is transferred to a different hospital for a cardiac interventional procedure.  Doctor states that information in the interventional report, and what was found in the diagnostic procedure.  Do you code for a repeat diagnostic exam, and the intervention, or code just the interventional performed (PTCA or Stent).  

Thanks,
Jim Pawloski, CIRCC


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## dpeoples (Jun 30, 2010)

Jim Pawloski said:


> Hello everybody!,
> 
> I have a question for everybody.  A patient has a heart cath at one hospital, and is transferred to a different hospital for a cardiac interventional procedure.  Doctor states that information in the interventional report, and what was found in the diagnostic procedure.  Do you code for a repeat diagnostic exam, and the intervention, or code just the interventional performed (PTCA or Stent).
> 
> ...



Jim,
If the diagnostic heart cath at hospital #1 is insufficient for the intervention at hospital #2, you can bill for another as long as the physician documents the medical necessity (previous cath insufficient, patient condition has changed etc). Otherwise, IMO, you should not bill for a second diagnostic heart cath.

HTH


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## Jim Pawloski (Jun 30, 2010)

dpeoples said:


> Jim,
> If the diagnostic heart cath at hospital #1 is insufficient for the intervention at hospital #2, you can bill for another as long as the physician documents the medical necessity (previous cath insufficient, patient condition has changed etc). Otherwise, IMO, you should not bill for a second diagnostic heart cath.
> 
> HTH



Thanks Danny for your response.  I audit a cath lab, and they had questioned me about patients who either had a diagnostic cath on one day, and the intervention on the second day, why I had credited the second heart cath.  There was no mention of a change of status on the patient.  They billed for a diagnostic heart cath along with the intervention, so I credited the diagnostic part of the bill.  I wanted a second opinion on this issue.

Thanks again,
Jim Pawloski, CIRCC


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## carolhodge (Jun 30, 2010)

I've run into this situation before too.  I'm just curious, was the cath and the stent performed by the same physician or different physicians?  I worked for a group where the docs had priviledges at multiple hospitals.


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## twizzle (Jun 30, 2010)

Unless the patients' condition has changed significantly, in other words worsened or a new Dx is available necessitating a repeat cath, you would not bill the cath performed concurrently with the intervention, just bill the intervention at the second hospital.


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